Publications by authors named "Richard L Reed"

31 Publications

Reducing preventable harm to residents in aged care: A systems approach.

Australas J Ageing 2020 Oct 2. Epub 2020 Oct 2.

Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.

Residents in Australian aged care facilities can suffer serious preventable harm from incidents ('adverse events' (AEs)). An inadequate response to AEs by aged care facilities can compound distress to residents and their families/carers. Facilities have an obligation to respond to and investigate AEs involving residents, learn from them, and take action to reduce the chance of them reoccurring . Residential aged care facilities have a duty to create a culture where staff, residents and families/carers feel comfortable reporting AEs or complaints; there is adequate time and resources to manage AEs and complaints; and feedback is provided to staff, residents and their families/carers on the results of investigations into AEs/complaints. The Aged Care Quality and Safety Commission's role should encompass additional governance functions such as sharing results and lessons learnt from AEs, complaints and investigations across Australia, assuring the quality of investigations conducted by facilities, and undertaking national system-wide investigations.
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http://dx.doi.org/10.1111/ajag.12861DOI Listing
October 2020

Engagement of General Practice in an Australian Organised Bowel Cancer Screening Program: A Cross-Sectional Survey of Knowledge and Practice.

Asian Pac J Cancer Prev 2020 Jul 1;21(7):2099-2107. Epub 2020 Jul 1.

School of Psychology, University of Adelaide, Adelaide, Australia.

Background: Understanding factors causing variation in family physicians/general practitioners (GPs) screening knowledge, understanding and support of organised population-based colorectal cancer (CRC) programs can direct interventions that maximise the influence of a CRC screening recommendation from a GP. This study aims to assess contextual factors that influence knowledge and quality improvement (QI) practice directed to CRC screening in Australian general practice.

Methods: A convenience sample of anonymous general practice staff from all Australian states and territories completed a web-based survey. Multivariate analyses assessed the association between CRC screening knowledge and QI-CRC practice scores and patient, organisational and environmental-level contextual factors.  Results: Of 1,013 survey starts, 918 respondents (90.6%) completed the survey. Respondents less likely to recommend FOBT screening had lower knowledge and QI practice scores directed to CRC screening. Controlling for individual and practice characteristics, respondents' rating of the Australian National Bowel Cancer Screening Program (NBCSP) support for preventive care, attending external education, and sufficient practice resources to implement QI practice (generally) were the strongest factors associated with QI practice directed towards CRC screening. Knowledge scores were less amenable to the influence of contextual factors explored.

Conclusion: More active engagement of family medicine/general practice to improve screening promotion could be achieved through better QI resourcing without changing the fundamental design of population-based CRC screening programs.
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http://dx.doi.org/10.31557/APJCP.2020.21.7.2099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573400PMC
July 2020

From participation to diagnostic assessment: a systematic scoping review of the role of the primary healthcare sector in the National Bowel Cancer Screening Program.

Aust J Prim Health 2020 Jun;26(3):191-206

School of Psychology, University of Adelaide, Level 7, Hughes Building, North Terrace Campus, Adelaide, SA 5000, Australia.

Primary health care (PHC) plays a vital support role in organised colorectal cancer (CRC) screening programs by encouraging patient participation and ensuring timely referral for diagnostic assessment follow up. A systematic scoping review of the current evidence was conducted to inform strategies that better engage the PHC sector in organised CRC screening programs. Articles published from 2005 to November 2019 were searched across five databases. Evidence was synthesised and interventions that specifically require PHC involvement were mapped to stages of the CRC screening pathway. Fifty-seven unique studies were identified in which patient, provider and system-level interventions align with defined stages of the CRC screening pathway: namely, identifying/reminding patients who have not responded to CRC screening (non-adherence) (n=46) and follow up of a positive screen referral (n=11). Self-management support initiatives (patient level) and improvement initiatives (system level) demonstrate consistent benefits along the CRC screening pathway. Interventions evaluated as part of a quality-improvement process tended to report effectiveness; however, the variation in reporting makes it difficult to determine which elements contributed to the overall study outcomes. To maximise the benefits of population-based screening programs, better integration into existing primary care services can be achieved through targeting preventive and quality care interventions along the entire screening pathway.
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http://dx.doi.org/10.1071/PY19181DOI Listing
June 2020

Patient perspectives on colorectal cancer screening and the role of general practice.

BMC Fam Pract 2019 07 29;20(1):109. Epub 2019 Jul 29.

College of Medicine and Public Health, Flinders University of South Australia, GPO Box 2100, Adelaide, South Australia, 5001, Australia.

Background: Colorectal cancer (CRC) is the second most frequent cause of cancer death in Australia. Early detection can reduce incidence and mortality. General practice-based initiatives have been proposed to improve CRC screening rates but to date have had modest impact. As there is limited research into the patient experience of CRC screening decision making, this study explored patient perspectives on CRC screening and the potential role for general practice.

Methods: Ten participants, aged between 50 and 74, from a general practice in South Australia were recruited by practice staff. Semi-structured interviews were conducted. Concurrent data collection and analysis were performed, guided by interpretative phenomenological analysis.

Results: Two key themes were evident: attitudes toward screening and potential roles for general practice. Participants structured the experience of screening in terms of being proactive, ambivalent or avoidant. Roles for general practice centred on tasks as educators, trusted advisors, monitors and screeners. Mixed views on whether general practice involvement was necessary prompted consideration of additional sources of health information and motivation around screening.

Conclusions: Exploration of the patient experience provides insight into how participants make sense of screening and perceived roles for general practice (or other agents) in screening. There is satisfaction with current Government-driven processes but perceived value in general practice playing a complementary part in increasing screening rates. A multifaceted strategy, accounting for attitudes, is required to improve screening and population health outcomes.
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http://dx.doi.org/10.1186/s12875-019-0997-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661764PMC
July 2019

: the appropriateness of care delivered to Australians living in residential aged care facilities: a study protocol.

BMJ Open 2019 06 25;9(6):e030988. Epub 2019 Jun 25.

Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.

Introduction: The aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice ('appropriate care') in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims of are to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia.

Methods And Analysis: We will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage sampling method. Experienced nurses, trained in the methods ('surveyors'), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents' QoL using validated questionnaires.

Ethics And Dissemination: The study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.
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http://dx.doi.org/10.1136/bmjopen-2019-030988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597647PMC
June 2019

Validation of a risk prediction model for Barrett's esophagus in an Australian population.

Clin Exp Gastroenterol 2018 28;11:135-142. Epub 2018 Mar 28.

School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia.

Background: Esophageal adenocarcinoma is a disease that has a high mortality rate, the only known precursor being Barrett's esophagus (BE). While screening for BE is not cost-effective at the population level, targeted screening might be beneficial. We have developed a risk prediction model to identify people with BE, and here we present the external validation of this model.

Materials And Methods: A cohort study was undertaken to validate a risk prediction model for BE. Individuals with endoscopy and histopathology proven BE completed a questionnaire containing variables previously identified as risk factors for this condition. Their responses were combined with data from a population sample for analysis. Risk scores were derived for each participant. Overall performance of the risk prediction model in terms of calibration and discrimination was assessed.

Results: Scores from 95 individuals with BE and 636 individuals from the general population were analyzed. The Brier score was 0.118, suggesting reasonable overall performance. The area under the receiver operating characteristic was 0.83 (95% CI 0.78-0.87). The Hosmer-Lemeshow statistic was =0.14. Minimizing false positives and false negatives, the model achieved a sensitivity of 74% and a specificity of 73%.

Conclusion: This study has validated a risk prediction model for BE that has a higher sensitivity than previous models.
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http://dx.doi.org/10.2147/CEG.S158627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878665PMC
March 2018

A self-management support program for older Australians with multiple chronic conditions: a randomised controlled trial.

Med J Aust 2018 02;208(2):69-74

Health System Improvement Unit, Centre for Population Health Research, Deakin University, Geelong, VIC.

Objective: To determine whether a clinician-led chronic disease self-management support (CDSMS) program improves the overall self-rated health level of older Australians with multiple chronic health conditions.

Design: Randomised controlled trial: participants were allocated to a clinician-led CDSMS group (including client-centred goal setting and the development of individualised care plans) or to a control group in which they received positive attention only.

Setting And Participants: Patients aged 60 years or more with at least two chronic conditions, recruited between September 2009 and June 2010 from five general practices in Adelaide.

Main Outcome Measures: The primary outcome was self-rated health. Secondary outcome measures related to health status (fatigue, pain, health distress, energy, depression, illness intrusiveness), health behaviour (exercise, medication adherence), and health service utilisation.

Results: 254 participants were randomised to the CDSMS and control groups, of whom 231 (117 control and 114 CDSMS participants) completed the 6-month programs and provided complete outcomes data (91%). An intention-to-treat analysis found that CDSMS participants were more likely than control participants to report improved self-rated health at 6 months (odds ratio, 2.50; 95% confidence interval, 1.13-5.50; P = 0.023). Between-group differences for secondary outcomes were not statistically significant.

Conclusion: CDSMS may benefit some older people with multiple chronic conditions to a greater extent than positive attention and health education.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12609000726257.
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http://dx.doi.org/10.5694/mja17.00127DOI Listing
February 2018

Pathways to research impact in primary healthcare: What do Australian primary healthcare researchers believe works best to facilitate the use of their research findings?

Health Res Policy Syst 2017 Mar 2;15(1):17. Epub 2017 Mar 2.

Discipline of General Practice, Flinders University, Bedford Park, Adelaide, Australia.

Background: Primary healthcare researchers are under increasing pressure to demonstrate measurable and lasting improvement in clinical practice and healthcare policy as a result of their work. It is therefore important to understand the effectiveness of the research dissemination strategies used. The aim of this paper is to describe the pathways for research impact that have been achieved across several government-funded primary healthcare projects, and the effectiveness of these methods as perceived by their Chief Investigators.

Methods: The project used an online survey to collect information about government-funded primary healthcare research projects. Chief Investigators were asked how they disseminated their findings and how this achieved impact in policy and practice. They were also asked to express their beliefs regarding the most effective means of achieving research impact and describe how this occurred.

Results: Chief Investigators of 17 projects indicated that a number of dissemination strategies were used but that professional networks were the most effective means of promoting uptake of their research findings. Utilisation of research findings for clinical practice was most likely to occur in organisations or among individual practitioners who were most closely associated with the research team, or when research findings were included in educational programmes involving clinical practice. Uptake of both policy- and practice-related research was deemed most successful if intermediary organisations such as formal professional networks were engaged in the research. Successful primary healthcare researchers had developed critical relationships with intermediary organisations within primary healthcare before the initiation of the research and had also involved them in the design. The scale of research impact was influenced by the current policy environment, the type and significance of the results, and the endorsement (or lack thereof) of professional bodies.

Conclusions: Chief Investigators believed that networks were the most effective means of research dissemination. Researchers who were embedded in professional, clinical or policy-focussed intermediary organisations, or had developed partnerships with clinical services, which had a vested interest in the research findings, were more able to describe a direct impact of their research. This suggests that development of these relationships and engagement of these stakeholders by primary healthcare researchers is a vital step for optimal research utilisation in the primary healthcare setting.
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http://dx.doi.org/10.1186/s12961-017-0179-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5335825PMC
March 2017

What general practitioners need to know about veterans' health.

Authors:
Richard L Reed

Aust Fam Physician 2016 Mar;45(3):85

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March 2016

The Australian Defence Force Post‑discharge GP Health Assessment.

Aust Fam Physician 2016 Mar;45(3):94-7

MD, FRACGP, Head, Discipline of General Practice, Flinders University, Bedford Park, Adelaide, SA.

Background: All former serving members of the Australian Defence Force (ADF) can receive a comprehensive health assessment from their general practitioners (GPs).

Objective: The aim of this article is to describe the ADF Post-discharge GP Health Assessment and introduce a tool that assists GPs in performing the assessment.

Discussion: The ADF Post-discharge GP Health Assessment is intended to promote the early detection and intervention of potential mental or physical health concerns in the veteran population and facilitate the establishment of ongoing care with a GP.
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March 2016

Medicare Local-Local Health Network partnerships in South Australia: lessons for Primary Health Networks.

Med J Aust 2015 Sep;203(5):219.e1-6

Flinders University, Adelaide, SA.

Objectives: To examine the partnerships in population health planning between Medicare Locals (MLs) and Local Health Networks (LHNs) in South Australia, and the factors that facilitated or constrained collaborations, to offer lessons for LHNs and Primary Health Networks.

Design, Participants And Setting: We conducted a qualitative study using individual interviews with key informants (executive or program leader staff) from the five South Australian MLs and the five South Australian LHNs. A total of 34 interviews were conducted between March and July 2014.

Results: Significant work was undertaken by MLs in the process of population health planning and needs assessment. Participants from both MLs and LHNs described examples of collaborative work, including data sharing and synthesis, program implementation and community consultation. The focus of LHNs on acute and intermediate care, the lack of system-level strategies to support collaboration, and constant policy and structural changes leading to uncertainty in the primary health care landscape were perceived as key barriers to collaboration.

Conclusions: The experience of MLs and their achievements in building relationships and trust with stakeholders in their regions, including LHNs, provide valuable lessons for the new Primary Health Networks in Australia.
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http://dx.doi.org/10.5694/mja14.01702DOI Listing
September 2015

Why do older people with multi-morbidity experience unplanned hospital admissions from the community: a root cause analysis.

BMC Health Serv Res 2015 Nov 27;15:525. Epub 2015 Nov 27.

Discipline of General Practice, Flinders University, GPO Box 2100, Adelaide, 5001, South Australia.

Background: Increasing demand for hospital services by older people is a major concern for Australian health care providers. To date there has been little in-depth research that encompasses contextual and systems factors contributing to hospital admissions. The objective of this study was to determine the reasons why older patients experienced unplanned hospital admissions to a major public hospital.

Methods: A retrospective qualitative study using a Root Cause Analysis (RCA) methodology was conducted in a major public hospital in Adelaide, South Australia and surrounding community. Community dwelling older people admitted to the hospital who were well enough to give informed consent and be interviewed were invited to take part in the study. With patients consent, family members, general practitioners (GPs) and specialists were also interviewed and patient hospital records reviewed. Using a purposive sampling technique to obtain maximum variability, thirty-six older people (aged 70 years and older) participated in the study. GPs (n = 17), family members (n = 14), and other healthcare providers (n = 12) involved in their care were also interviewed. Cases were then analysed according to a standardized protocol to determine the root cause of admission. Root causes were then assigned to broader categories using thematic analysis.

Results: The root causes of unplanned admissions were identified and categorised into six causal groups: a consequence of minimal care, progression of disease, home care accessibility, high complexity, clinical error, and delayed care-seeking by the patient.

Conclusions: RCA can be effectively applied to determine the causes of unplanned hospital admissions although the process is time consuming. Four categories of admission (minimal care, clinical error, home care access, delayed care-seeking) were deemed potentially preventable. This methodology and classification approach may assist in designing interventions to prevent future hospitalisations in this high-risk population.
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http://dx.doi.org/10.1186/s12913-015-1170-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662024PMC
November 2015

Testing a model of facilitated reflection on network feedback: a mixed method study on integration of rural mental healthcare services for older people.

BMJ Open 2015 Nov 11;5(11):e008593. Epub 2015 Nov 11.

School of Medicine, Flinders University, Adelaide, South Australia, Australia.

Objective: To test a management model of facilitated reflection on network feedback as a means to engage services in problem solving the delivery of integrated primary mental healthcare to older people.

Design: Participatory mixed methods case study evaluating the impact of a network management model using organisational network feedback (through social network analysis, key informant interviews and policy review).

Intervention: A model of facilitated network reflection using network theory and methods.

Setting: A rural community in South Australia.

Participants: 32 staff from 24 services and 12 senior service managers from mental health, primary care and social care services.

Results: Health and social care organisations identified that they operated in clustered self-managed networks within sectors, with no overarching purposive older people's mental healthcare network. The model of facilitated reflection revealed service goal and role conflicts. These discussions helped local services to identify as a network, and begin the problem-solving communication and referral links. A Governance Group assisted this process. Barriers to integrated servicing through a network included service funding tied to performance of direct care tasks and the lack of a clear lead network administration organisation.

Conclusions: A model of facilitated reflection helped organisations to identify as a network, but revealed sensitivity about organisational roles and goals, which demonstrated that conflict should be expected. Networked servicing needed a neutral network administration organisation with cross-sectoral credibility, a mandate and the resources to monitor the network, to deal with conflict, negotiate commitment among the service managers, and provide opportunities for different sectors to meet and problem solve. This requires consistency and sustained intersectoral policies that include strategies and funding to facilitate and maintain health and social care networks in rural communities.
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http://dx.doi.org/10.1136/bmjopen-2015-008593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654302PMC
November 2015

Models of general practitioner services in residential aged care facilities.

Authors:
Richard L Reed

Aust Fam Physician 2015 Apr;44(4):176-9

MD, FRACGP, Head, Discipline of General Practice, Flinders University, Bedford Park, Adelaide, SA.

Background: Provision of timely and high-quality general practitioner (GP) services to patients in residential aged care facilities (RACFs) is essential for this group of patients as they have high medical needs.

Objective: The aim of this article is to describe different models for general practice care for patients in RACFs.

Discussion: Models for general practice services include the Continuity Model, where GPs follow long-term patients; the RACF Panel model, where GPs provide care to several patients in nearby RACFs; the GPs with Special Interest in Residential Aged Care (GPwSI RAC) model, where GPs provide regularly scheduled services to larger groups of patients; the Longitudinal General Practice Team (LGPT) model, where GPs provide team-based care; and RACF-based models of care, where GPs partner with RACFs. Hospital-based models of care have also been developed to provide in-reach services to patients in RACFs during episodes of acute illness. There is limited evidence for which of these models is most effective. Developing and testing different models of general practice care should be a priority.
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April 2015

Recruitment for a clinical trial of chronic disease self-management for older adults with multimorbidity: a successful approach within general practice.

BMC Fam Pract 2013 Aug 28;14:125. Epub 2013 Aug 28.

Discipline of General Practice, Flinders Prevention Promotion and Primary Health Care Cluster, Flinders University, Health Sciences Building, Level 3, Registry Road, Bedford Park, South Australia, Australia.

Background: A robust research base is required in General Practice. The research output for General Practice is much less than those of other clinical disciplines. A major impediment to more research in this sector is difficulty with recruitment. Much of the research in this area focuses on barriers to effective recruitment and many projects have great difficulty with this process. This paper seeks to describe a systematic approach to recruitment for a randomized controlled trial that allowed the study team to recruit a substantial number of subjects from General Practice over a brief time period.

Methods: A systematic approach to recruitment in this setting based on prior literature and the experience of the investigator team was incorporated into the design and implementation of the study. Five strategies were used to facilitate this process. These included designing the study to minimize the impact of the research on the day-to-day operations of the clinics, engagement of general practitioners in the research, making the research attractive to subjects, minimizing attrition and ensuring recruitment was a major focus of the management of the study. Outcomes of the recruitment process were measured as the proportion of practices that agreed to participate, the proportion of potentially eligible subjects who consented to take part in the trial and the attrition rate of subjects. Qualitative interviews with a subset of successfully recruited participants were done to determine why they chose to participate in the study; data were analyzed using thematic analysis.

Results: Five out of the six general practices contacted agreed to take part in the study. Thirty-eight per cent of the 1663 subjects who received a letter of invitation contacted the university study personnel regarding their interest in the project. Recruitment of the required number of eligible participants (n = 256) was accomplished in seven months. Thematic analysis of interviews with 30 participants regarding key factors in their study participation identified a personalised letter of endorsement from their general practitioner, expectation of personal benefit and altruism as important factors in their decision to participate.

Conclusion: Recruitment can be successfully achieved in General Practice through design of the research project to facilitate recruitment, minimize the impact on general practice operations and ensure special care in enrolling and maintaining subjects in the project.
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http://dx.doi.org/10.1186/1471-2296-14-125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3844383PMC
August 2013

e-Mental health in South Australia: impact of age, gender and region of residence.

Aust J Prim Health 2013 ;19(4):331-5

Discipline of General Practice, Flinders University, Health Sciences Building, Level 3, Registry Road, Bedford Park, SA 5042, Australia.

Respondents to the 2008 South Australian Health Omnibus survey (n=2996) indicated whether, in the previous 12 months, they had searched for information on the Internet relating to emotional issues such as depression, anxiety or relationship problems. Logistic regression was used to examine the penetration of e-mental health in rural and metropolitan areas (region of residence), and determine if other demographic variables (age group, gender) also impacted on the likelihood of an individual reporting that they had used the Internet to obtain such information. Overall, 9% of respondents reported that they had used the Internet for this purpose. The multivariate model was significant, F(11, 2985)=4.82, P<0.0001, with middle-aged rural females most likely to report doing so (18.1%), whereas older rural males were least likely to report doing so (2.2.%). These findings have important implications for the design of e-mental health promotional programs that provide information and interventions to improve mental health.
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http://dx.doi.org/10.1071/PY13027DOI Listing
March 2014

Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life: a randomized trial.

JAMA 2013 Mar;309(10):997-1004

Adelaide Institute for Sleep Health, Repatriation General Hospital, Department of Medicine, Flinders University, Adelaide, South Australia.

Importance: Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea. With appropriate training and simplified management tools, primary care physicians are ideally positioned to take on a greater role in diagnosis and treatment.

Objective: To compare the clinical efficacy and within-trial costs of a simplified model of diagnosis and care in primary care relative to that in specialist sleep centers.

Design, Setting, And Patients: A randomized, controlled, noninferiority study involving 155 patients with obstructive sleep apnea that was treated at primary care practices (n=81) in metropolitan Adelaide, 3 rural regions of South Australia or at a university hospital sleep medicine center in Adelaide, Australia (n = 74), between September 2008 and June 2010.

Interventions: Primary care management of obstructive sleep apnea vs usual care in a specialist sleep center; both plans included continuous positive airway pressure, mandibular advancement splints, or conservative measures only.

Main Outcome And Measures: The primary outcome was 6-month change in Epworth Sleepiness Scale (ESS) score, which ranges from 0 (no daytime sleepiness) to 24 points (high level of daytime sleepiness). The noninferiority margin was -2.0. Secondary outcomes included disease-specific and general quality of life measures, obstructive sleep apnea symptoms, adherence to using continuous positive airway pressure, patient satisfaction, and health care costs.

Results: There were significant improvements in ESS scores from baseline to 6 months in both groups. In the primary care group, the mean baseline score of 12.8 decreased to 7.0 at 6 months (P < .001), and in the specialist group, the score decreased from a mean of 12.5 to 7.0 (P < .001). Primary care management was noninferior to specialist management with a mean change in ESS score of 5.8 vs 5.4 (adjusted difference, -0.13; lower bound of 1-sided 95% CI, -1.5; P = .43). There were no differences in secondary outcome measures between groups. Seventeen patients (21%) withdrew from the study in the primary care group vs 6 patients (8%) in the specialist group.

Conclusions And Relevance: Among patients with obstructive sleep apnea, treatment under a primary care model compared with a specialist model did not result in worse sleepiness scores, suggesting that the 2 treatment modes may be comparable. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12608000514303.
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http://dx.doi.org/10.1001/jama.2013.1823DOI Listing
March 2013

Hospital admissions from residential aged care facilities to a major public hospital in South Australia (1999-2005).

Australas J Ageing 2011 Dec 11;30(4):202-7. Epub 2010 Nov 11.

Discipline of General Practice, Flinders University, Adelaide, South Australia, Australia.

Aim:   To describe admissions patterns of residential aged care facility (RACF) residents admitted to a major public hospital.

Design, Setting:   Retrospective longitudinal study linking hospital admissions and the Department of Health and Ageing RACF provider data from July 1999 to June 2005.

Participants:   All permanent residents of aged care facilities in South Australia admitted to a single public hospital.

Main Outcome Measures:   Description of primary diagnoses and trends.

Results:   There were 3310 admissions from 147 RACFs across South Australia. The most frequent primary diagnoses were fractured femur/pelvis, pneumonia and ischaemic heart disease. Two diagnoses increased significantly with an 11% annual increase for infections and a 5% increase for femur fractures.

Conclusion:   Admissions from RACFs to a major South Australian public hospital are increasing primarily because of admissions for femur fractures and infections in high care. These conditions could be targeted for interventions to reduce hospital admissions.
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http://dx.doi.org/10.1111/j.1741-6612.2010.00479.xDOI Listing
December 2011

What research impacts do Australian primary health care researchers expect and achieve?

Health Res Policy Syst 2011 Nov 30;9:40. Epub 2011 Nov 30.

Discipline of General Practice, Flinders University, Bedford Park, Adelaide, Australia.

Background: Funding for research is under pressure to be accountable in terms of benefits and translation of research findings into practice and policy. Primary health care research has considerable potential to improve health care in a wide range of settings, but little is known about the extent to which these impacts actually occur. This study examines the impact of individual primary health care research projects on policy and practice from the perspective of Chief Investigators (CIs).

Methods: The project used an online survey adapted from the Buxton and Hanney Payback Framework to collect information about the impacts that CIs expected and achieved from primary health care research projects funded by Australian national competitive grants.

Results And Discussion: Chief Investigators (CIs) provided information about seventeen completed projects. While no CI expected their project to have an impact in every domain of the framework used in the survey, 76% achieved at least half the impacts they expected. Sixteen projects had published and/or presented their work, 10 projects included 11 doctorate awards in their research capacity domain. All CIs expected their research to lead to further research opportunities with 11 achieving this. Ten CIs achieved their expectation of providing information for policy making but only four reported their research had influenced policy making. However 11 CIs achieved their expectation of providing information for organizational decision making and eight reported their research had influenced organizational decision making.

Conclusion: CIs reported that nationally funded primary health care research projects made an impact on knowledge production, staff development and further research, areas within the realm of influence of the research team and within the scope of awareness of the CIs. Some also made an impact on policy and organizational decision-making, and on localized clinical practice and service delivery. CIs reported few broader economic benefits from their research. Routine use of an instrument of this type would facilitate primary health care research funders' determination of the payback for funding of research in this sector.
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http://dx.doi.org/10.1186/1478-4505-9-40DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256100PMC
November 2011

Protocol for a randomised controlled trial of chronic disease self-management support for older Australians with multiple chronic diseases.

Contemp Clin Trials 2011 Nov 16;32(6):946-52. Epub 2011 Aug 16.

Discipline of General Practice, Flinders University. Health Sciences Building, Level 3, Registry Road, Bedford Park, South Australia, 5042, Australia.

The prevalence of older Australians with multiple chronic diseases is increasing and now accounts for a large proportion of total health care utilisation. Chronic disease self-management support (CDSMS) has become a core service component of many community based health programs because it is considered a useful tool in improving population health outcomes and reducing the financial burden of chronic disease care. However, the evidence base to justify these support programs is limited, particularly for older people with multiple chronic diseases. We describe an ongoing trial examining the effectiveness of a particular CDSMS approach called the Flinders Program. The Flinders Program is a clinician-led generic self-management intervention that provides a set of tools and a structured process that enables health workers and patients to collaboratively assess self-management behaviours, identify problems, set goals, and develop individual care plans covering key self-care, medical, psychosocial and carer issues. A sample of 252 older Australians that have two or more chronic conditions will be randomly assigned to receive either CDSMS or an attention control intervention (health information only) for 6 months. Outcomes will be assessed using self-reported health measures taken at baseline and post-intervention. This project will be the first comprehensive evaluation of CDSMS in this population. Findings are expected to guide consumers, clinicians and policymakers in the use of CDSMS, as well as facilitate prioritisation of public monies towards evidence-based services.
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http://dx.doi.org/10.1016/j.cct.2011.08.001DOI Listing
November 2011

A simplified model of screening questionnaire and home monitoring for obstructive sleep apnoea in primary care.

Thorax 2011 Mar 20;66(3):213-9. Epub 2011 Jan 20.

Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, South Australia 5041, Australia.

Background: To address the growing burden of disease and long waiting lists for sleep services, a simplified two-stage model was developed and validated for identifying obstructive sleep apnoea (OSA) in primary care using a screening questionnaire followed by home sleep monitoring.

Methods: 157 patients aged 25-70 years attending their primary care physician for any reason at six primary care clinics in rural and metropolitan regions of South Australia participated. The first 79 patients formed the development group and the next 78 patients the validation group. A screening questionnaire was developed from factors identified from sleep surveys, demographic and anthropometric data to be predictive of moderate to severe OSA. Receiver operating characteristic (ROC) curve analysis was used to validate the two-channel ApneaLink device against full polysomnography. The diagnostic accuracy of the overall two-stage model was then evaluated.

Results: Snoring, waist circumference, witnessed apnoeas and age were predictive of OSA and incorporated into a screening questionnaire (ROC area under curve (AUC) 0.84, 95% CI 0.75 to 0.94, p<0.001). ApneaLink oximetry with a 3% dip rate was highly predictive of OSA (AUC 0.96, 95% CI 0.91 to 1.0, p<0.001). The two-stage diagnostic model showed a sensitivity of 0.97 (95% CI 0.81 to 1.00) and specificity of 0.87 (95% CI 0.74 to 0.95) in the development group, and a sensitivity of 0.88 (95% CI 0.60 to 0.98) and specificity of 0.82 (95% CI 0.70 to 0.90) in the validation group.

Conclusion: A two-stage model of screening questionnaire followed by home oximetry can accurately identify patients with OSA in primary care and has the potential to expedite care for patients with this common sleep disorder.
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http://dx.doi.org/10.1136/thx.2010.152801DOI Listing
March 2011

Equity of access in the spatial distribution of GPs within an Australian metropolitan city.

Aust J Prim Health 2010 ;16(4):284-90

Flinders University, Department of General Practice, GPO Box 2100, Adelaide, SA 5001, Australia.

Equitable access to primary health care is a key objective for health policy makers. In Australia, poor access to primary care providers has been well documented for many rural areas, yet the distribution of general practitioners (GPs) in metropolitan regions remains relatively unknown. Traditional methods of determining geographic access to GPs are limited as they rely on simple population to provider ratios within artificial administrative borders and, among other things, fail to take into account patients that utilise close-by facilities outside of these borders. This study utilised specialised geographic information systems to examine the equity of access to GPs in an Australia capital city (Adelaide). Results showed that by Australian standards, residents of metropolitan Adelaide have low GP ratios. However, an inequitable spatial distribution of GPs within metropolitan Adelaide was found, with ~16% of residents considered to be living in areas of GP workforce shortage. Residents in the outer suburbs and those with lower social economic status appeared to be the most disadvantaged. It is recommended that future studies employ specialised GIS techniques as they provide a more accurate measurement of variations in spatial accessibility to primary care within metropolitan cities.
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http://dx.doi.org/10.1071/PY10021DOI Listing
March 2011

Access to general practitioners in South Australia: a population survey.

Med J Aust 2008 Jul;189(2):95-9

Department of General Practice, Flinders University, Adelaide, SA, Australia.

Objective: To determine the timeliness of access to general practitioner appointments in South Australia.

Design And Setting: Face-to-face interviews with a random and representative sample of South Australians living in metropolitan Adelaide and country towns with a population of 1000 or more in 2007.

Participants: 2507 people aged 15 years and over who had seen a GP in the previous 12 months.

Main Outcome Measures: Waiting times for obtaining an appointment with a GP, patients' perceptions about appointment waiting times, and waiting times at the GP's surgery.

Results: Most respondents reported that for their last visit with a GP, they were able to be seen on the same day (39%) or within 1 or 2 working days (33%); 20% waited more than 2 working days for their appointment. Nine per cent of respondents (159/1764) reported waiting more than 2 working days because an earlier appointment was not available. Respondents reporting lower levels of household income were more likely to report longer waits for GP appointments. Most respondents (78%) felt that they were able to make a GP appointment as soon as they thought necessary. At the surgery, 46% of respondents were seen within 15 minutes, but 13% waited 45 minutes or longer.

Conclusions: In general, access to GPs is timely, and most South Australians reported that for their last GP visit they were able to make an appointment as soon as they thought was necessary.
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http://dx.doi.org/10.5694/j.1326-5377.2008.tb01929.xDOI Listing
July 2008

Expressions of interest - writing for success.

Aust Fam Physician 2006 Apr;35(4):255-6

Primary Health Care Research and Information Service, Department of General Practice, Flinders University, South Australia.

Primary health care research is a growing discipline and as such needs more funds to support the increase in this research. With the competition for research funds increasing, primary health care researchers need to be astute in how they apply for funds. This article provides key points to keep in mind when writing an expression of interest to increase your chance of success.
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April 2006

A controlled before-after trial of structured diabetes care in primary health centres in a newly developed country.

Int J Qual Health Care 2005 Aug 14;17(4):281-6. Epub 2005 Apr 14.

United Arab Emirates University, Family Medicine, Al Ain, Abu Dhabi, United Arab Emirates.

Objective: To evaluate the long-term impact of a structured approach to improving the quality of diabetes care in general practice in the United Arab Emirates.

Design: Controlled before-after trial within a health district with three primary health centres (PHCs) in the intervention group and the six remaining serving as controls. Outcomes and adherence to guidelines were measured over the year before the intervention began and for a second 1-year period at the end of the intervention period. Data were collected by chart abstraction.

Setting: The study was performed in PHCs in the United Arab Emirates, a newly developed country on the Arabian peninsula.

Study Participants: Subjects continuously followed in nine PHCs for diabetes care for the period of the study (N = 738) were included in the study.

Intervention: Structured diabetes care, including the development of general practice diabetes clinics, a patient education program, a health care professional education program, and improved recording of clinical information, was provided for the 33-month time period.

Results: There was a statistically significant improvement in three of the process of care variables (ordering HbA1c, cholesterol, and documenting foot examinations) whereas the four remaining variables did not improve. There was limited impact on outcome variables.

Conclusions: The intervention described in this study demonstrated an improvement in some process of care measures suggesting an impact of this type of delivery model in this environment.
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http://dx.doi.org/10.1093/intqhc/mzi043DOI Listing
August 2005

Effect of religious practices of Ramadan on sleep and perceived sleepiness of medical students.

Teach Learn Med 2004 ;16(2):145-9

Department of Family Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.

Background: Observant Muslims substantially alter their normal routines, including daytime fasting and day-night activity patterns during the month of Ramadan.

Purpose: It is unknown whether observing the religious practices of Ramadan impacts negatively on daytime somnolence, a factor known to impair learning.

Methods: A cross-sectional survey measuring self-reported sleep time and the Epworth Sleepiness Scale of observant Muslim medical students before, during, and after Ramadan.

Results: There was no significant variation in sleep score pre-Ramadan (10.04 +/- 3.47), during Ramadan (10.46 +/- 3.57)m and post Ramadan(9.73 +/- 3.33), F(2,355) = 1.278, p = .280. Night sleep hours were significantly longer both before (6.22 +/- 1.45) and after (6.22 +/- 1.59) than during Ramadan (5.22 +/- 1.85), F(2,366) = 15.289, p < .001. Daytime sleep hours pre-Ramadan (1.05 +/- 1.36) and post Ramadan (0.70 +/- 1.21) were significantly shorter than during Ramadan (1.48 +/- 1.46; pre: z = 2.654, p = .08; z = -4.940, p < .001).

Conclusion: Students successfully adapt and avoid a rise in daytime somnolence by increasing daytime sleep hours during Ramadan.
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http://dx.doi.org/10.1207/s15328015tlm1602_5DOI Listing
September 2004

Assessment of obesity, lifestyle, and reproductive health needs of female citizens of Al Ain, United Arab Emirates.

J Health Popul Nutr 2004 Mar;22(1):75-83

School of Clinical Medicine and Research, University of the West Indies, Cave Hill, Barbados.

This study was conducted to determine the reproductive and lifestyle characteristics in a representative sample (n = 535) of women in Al Ain, United Arab Emirates, to guide the development of health programmes for this population with rising affluence. A cross-sectional survey was carried out using the stratified two-stage sampling technique. Although most women were young, were pre-menopausal, did not smoke, reported good health status, and 84% (95% confidence interval [CI] 81-87%) reported being sufficiently active to meet expert recommendations, the prevalence of obesity (defined by body mass index > or = 30) was very high (35%; 95% CI 31-39%) and many (28%; 95% CI 24-32%) reported having a chronic disease. The prevalence of obesity was associated positively with age and negatively with education (p < 0.001 for both). Postmenopausal women had significantly more chronic diseases, reported poor health more often, were less physically active (p < 0.001 for all), and had a higher percentage of body fat (p = 0.002) compared to premenopausal women. Health services should emphasize the prevention and treatment of obesity and improving the general health status of postmenopausal women.
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March 2004

Patient satisfaction with primary health care services in the United Arab Emirates.

Int J Qual Health Care 2003 Jun;15(3):241-9

Department of Family Medicine, Faculty of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.

Objective: This study evaluated the suitability of a patient satisfaction questionnaire to survey health care consumers of traditional Arabic background.

Design: A cross-sectional survey using an Arabic language questionnaire that drew upon concepts of patient satisfaction measurement in Western research literature. All participants were interviewed once by experienced interviewers to ascertain their levels of satisfaction with their health care service.

Setting: Patient satisfaction was compared between the only resource-intensive clinic (RIC) in the United Arab Emirates and one resource-thrifty clinic (RTC) located in an adjacent suburb and serving essentially the same population.

Study Participants: A random sample of patients attending the RIC and RTC over a 5-day period.

Main Outcome Measures: Six domains of patient satisfaction were measured.

Results: Compared with the RTC (n = 125), the RIC (n = 156) scored significantly higher in continuity (P = 0.001), comprehensiveness (P < 0.001), health education (P = 0.05), effectiveness (P = 0.001), and overall satisfaction (P < 0.001), while accessibility (P = 0.130) and humaneness (P = 0.102) were not significantly different. Humaneness scored the highest and continuity the lowest at both clinics. Older people's satisfaction was higher for comprehensiveness but otherwise the same as those who were younger. More highly educated people's satisfaction was lower for effectiveness, but otherwise the same as those who were less educated. Men and women had equal levels of satisfaction.

Conclusions: The significantly higher patient satisfaction in the RIC compared with the RTC was a strong a priori expectation, suggesting that this satisfaction questionnaire is a useful quality assurance tool in this setting.
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http://dx.doi.org/10.1093/intqhc/mzg036DOI Listing
June 2003

Low serum albumin levels, confusion, and fecal incontinence: are these risk factors for pressure ulcers in mobility-impaired hospitalized adults?

Gerontology 2003 Jul-Aug;49(4):255-9

Department of Family Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.

Background: Studies of risk factors for clinically significant pressure ulcers in the hospital have been limited by the small number of study subjects that develop pressure ulcers, resulting in contradictory findings regarding some risk factors.

Objective: To determine if three risk factors (low serum albumin level, fecal incontinence, and confusion) were significant risk factors when tested in a large data set.

Methods: The study design was a longitudinal cohort study using data collected as a component of a multi-site controlled clinical trial. The data were collected at 47 Veterans Affairs Hospitals. 2,771 subjects that required high levels of nursing care were identified to have mobility impairment. Their medical records were abstracted using a standard form to identify a large number of potential risk factors. The subsequent development of stage 2 or greater pressure ulcers was recorded for a maximum of 14 days after admission.

Results: 406 patients (14.7%) subsequently developed at least one stage 2 or greater pressure ulcer over a 2-week period. In a multivariate model, the presence of low albumin levels (odds ratio OR = 1.40) and confusion (OR = 1.45) were both found to be statistically significant risk factors, while fecal incontinence was not. Having a Do Not Resuscitate (DNR) order was also a significant risk factor (OR = 1.55). Two other known risk factors also entered the model: being malnourished (OR = 1.69) and requiring a urinary catheter (OR = 1.55).

Conclusions: This study confirmed confusion and low albumin as pressure ulcer risk factors, but not fecal incontinence. A DNR order was found to be a new pressure ulcer risk factor not previously described in the literature.
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http://dx.doi.org/10.1159/000070407DOI Listing
September 2003

Performance in reading radiographs: does level of education predict skill?

J Contin Educ Health Prof 2003 ;23(1):48-53

Department of Family Medicine, United Arab Emirates University, POB 17666, Al Ain, United Arab Emirates.

Introduction: Previous studies demonstrated lack of progress in electrocardiographic analysis skills with increasing levels of medical education. This study examined radiograph analysis skills, a similar cognitive task, across a range of educational experience: senior medical students (n = 23), family practice residents (n = 16), general practitioners (n = 41), and their family practice educators (n = 7).

Methods: Written records of diagnosis or description of abnormalities were used to detect skill in interpreting radiographs. The instrument was 12 sets of radiographs: 2 normal and 6 abnormal chest radiographs and 2 normal and 2 greenstick radial fractures.

Results: The mean score for correctly diagnosing all 12 sets of radiographs was 5.59 +/- 1.68, and the mean score for correctly diagnosing the 4 normal radiographs as normal and the abnormal radiographs as abnormal was 8.76 +/- 1.55. There was no statistically significant difference between the four groups of participants.

Discussion: Skill level in interpreting radiographs did not appear to improve with additional experiential training and may require a more formal educational approach to address this issue.
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http://dx.doi.org/10.1002/chp.1340230108DOI Listing
June 2003