A tool to evaluate patients' experience of nursing care in Australian general practice: Development of the Patient Enablement and Satisfaction Survey (PESS)

Australian health policy initiatives have increasingly supported the employment of nurses in general practice. An understanding of the impact of nursing care on patients in this setting is integral to assuring quality, safety and a patient-centred focus

Health promotion in schools: a multi-method evaluation of an Australian School Youth Health Nurse Program

BACKGROUND: Health promotion provides a key opportunity to empower young people to make informed choices regarding key health-related behaviours such as tobacco and alcohol use, sexual practices, dietary choices and physical activity. This paper describes the evaluation of a pilot School Youth Health Nurse (SYHN) Program, which aims to integrate a Registered Nurse into school communities to deliver health promotion through group education and individual sessions. METHODS: The evaluation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. The objectives were to explore: 1) whether the Program was accessible to the high school students; 2) the impacts of the Program on key stakeholders; 3) which factors affected adoption of the Program; 4) whether implementation was consistent with the Program intent; and 5) the long-term sustainability of the Program. Research included retrospective analysis of Program records, administration of a survey of student experiences and interviews with 38 stakeholders. RESULTS: This evaluation provided evidence that the SYHN Program is reaching students in need, is effective, has been adopted successfully in schools, is being implemented as intended and could be maintained with sustained funding. The nurses deliver an accessible and acceptable primary health care service, focused on health promotion, prevention and early intervention. After some initial uncertainty about the scope and nature of the role, the nurses are a respected source of health information in the schools, consulted on curriculum development and contributing to whole-of-school health activities. CONCLUSIONS: Findings demonstrate that the SYHN model is feasible and acceptable to the students and schools involved in the pilot. The Program provides health promotion and accessible primary health care in the school setting, consistent with the Health Promoting Schools framework.This project was supported by funding from the Australian Capital Territory Government Health Directorate, Health Promotion Branch

Stakeholder involvement in primary health care research: report and recommendations

Australia has not progressed in engaging consumers in research to the same level as other countries such as the UK. The National Health and Medical Research Council (NHMRC) and Consumers’ Health Forum (CHF) introduced a Statement on Consumer and Community Participation in Health and Medical Research in 2002 (2), but little in terms of follow up and implementation has occurred. Some universities (e.g., University of Western Australia (UWA)) and peak bodies (e.g., Cancer Council) have established processes for involving consumers in research but these efforts have not spread far beyond their own organisations.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Health and social care coordination for severe and persistent mental illness in Australia: a mixed methods evaluation of experiences with the Partners in Recovery Program

Background Care coordination has been identified as a person-centred response to the difficulty in meeting the needs of people with severe and persistent mental illness and complex needs. This study evaluated the processes and outcomes of the Partners in Recovery initiative in the Australian Capital Territory, a program established to improve coordination of health and social care for this population. Methods Client, carer and service provider experiences were investigated using a combination of quantitative and qualitative methods. Quantitative data were collected through questionnaires completed by clients (n = 25) and service providers (n = 14). Qualitative data comprised open-ended written feedback from the surveys, together with semi-structured interviews with selected clients (n = 6), carers (n = 2), and service providers (n = 4). In both study elements, questions focused on dimensions of experience such as communication, continuity and coordination, teamwork and sustainability. Descriptive statistics were calculated for quantitative data; qualitative data were analysed using content analysis. Results Clients were satisfied with the program across the majority of experience dimensions, and there was evidence of improved access to coordinated care. Support Facilitators (care coordinators) were central to client and carer reports of the impacts of the program, and to coordination between services through connections built at the individual level. Challenges included difficulties with information continuity, a lack of role clarity for service providers, and uncertainty about the legacy of the program given the absence of formal agreements connecting different services. Conclusions The Support Facilitator role was critical to the success of the program. Support Facilitators acted as a source of stability and relational continuity for clients, while also enabling connections with external services through the development of individual level partnerships and personal networks. Systems level coordination was limited by communication difficulties and a lack of formalised infrastructure to support cooperation between services, calling into question the lasting impact of the program for system change.Funding for this evaluation was provided by Capital Health Network, the Lead Agency for Partners in Recovery in the ACT. During the conduct of this study, MB was supported by ARC DECRA DE150100637 and OF was supported by ACT Health Services Agreement 2015.27504.340

Improving coordination through information continuity: a framework for translational research

BACKGROUND There is good evidence that coordination can have beneficial impacts on patient care and outcomes but the mechanisms by which coordination is to be achieved are poorly understood and rarely identified in relevant policies. One approach suggests that continuity of information is a key element but research is yet to provide guidance on how to optimise coordination through improving continuity in healthcare settings. DISCUSSION In this paper we report on the development of a conceptual framework of information continuity in care coordination. We drew on evidence from systematic reviews of coordination and empirical studies on information use in integrated care models to develop the framework. It identifies the architecture, processes and scope of practices that evidence suggests is required to support information continuity in a population based approach to care coordination. The framework offers value to policy makers and practitioners as a map that identifies the multi-level elements of an integrated system capable of driving better coordination. Testing of the framework in different settings could aid our understanding of information continuity as a mechanism for linking coordination strategies that operate at different levels of the health system and enable synthesis of findings for informing policy and practice.This study was supported by a grant from the Ian Potter Foundation to the Menzies Centre for Health Policy. The Australian Primary Health Care Research Institute is supported by a grant from the Australian Government Department of Health and Ageing

Whose story is it? Mental health consumer and carer views on carer participation in research

Abstract BACKGROUND: Mental health carers contribute a unique set of perspectives and lived experiences to research; however, national research ethics guidelines do not specifically address the issues that affect informal carers as participants. OBJECTIVE: This study sought to explore Australian mental health consumer and carer views on the ethical conduct of research involving mental health carers. DESIGN: A public forum (n = 14; consumer = 5, carer = 9) and a subsequent series of interviews (n = 10; consumer = 5, carer = 4, both = 1) were conducted to investigate consumer and carer views on mental health research ethics. Data collection and analysis drew strongly on methodological features of grounded theory. RESULTS: Conducting research involving carers and consumer-carer relationships raises potential concerns related to story ownership. Lived experience stories have shared and separate elements; thus, it is important to consider potential risks to the privacy of non-participants and of social harm to participants' relationships when conducting research in this space. These risks could be minimized and managed through communication between researchers and participants, and within relationships. CONCLUSIONS: When conducting research involving carers and consumer-carer relationships, researchers may need to facilitate the negotiation of information-sharing boundaries within relationships and the safe and confidential telling of shared stories.ACACIA is supported by ACT Health [contract numbers 2013.21920.590, 2015.27504.340]. At the time of the research, MB was supported by Australian Research Council Discovery Early Career Researcher Award [DE150100637]

Unlocking information for coordination of care in Australia: a qualitative study of information continuity in four primary health care models

BACKGROUND Coordination of care is considered a key component of patient-centered health care systems, but is rarely defined or operationalised in health care policy. Continuity, an aspect of coordination, is the patient's experience of care over time, and is often described in terms of three dimensions: information, relational and management continuity. With the current health policy focus on both the use of information technology and care coordination, this study aimed to 1) explore how information continuity supports coordination and 2) investigate conditions required to support information continuity. METHODS Four diverse Australian primary health care initiatives were purposively selected for inclusion in the study. Each has improved coordination as an aim or fundamental principle. Each organization was asked to identify practitioners, managers and decision makers who could provide insight into the use of information for care coordination to participate in the study. Using in-depth semi-structured interviews, we explored four questions covering the scope and use of information, the influence of governance, data ownership and confidentiality and the influence of financial incentives and quality improvement on information continuity and coordination. Data were thematically analyzed using NVivo 8. RESULTS The overall picture that emerged across all four cases was that whilst accessibility and continuity of information underpin effective care, they are not sufficient for coordination of care for complex conditions. Shared information reduced unnecessary repetition and provided health professionals with the opportunity to access records of care from other providers, but participants described their role in coordination in terms of the active involvement of a person in care rather than the passive availability of information. Complex issues regarding data ownership and confidentiality often hampered information sharing. Successful coordination in each case was associated with responsiveness to local rather than system level factors. CONCLUSIONS The availability of information is not sufficient to ensure continuity for the patient or coordination from the systems perspective. Policy directed at information continuity must give consideration to the broader 'fit' with management and relational continuity and provide a broad base that allows for local responsiveness in order for coordination of care to be achieved.This study was supported by a grant from the Ian Potter Foundation to the Menzies Centre for Health Policy. The Australian Primary Health Care Research Institute is supported by a grant from the Australian Government Department of Health and Ageing. The Menzies Centre for Health Policy is supported by a grant from the Sir Robert Menzies Memorial Foundation

Management or missed opportunity? Mental health care planning in Australian general practice

General practice care plans are designed to improve the management of chronic illness, facilitating multidisciplinary care and enabling GPs and consumers to work collaboratively. Evidence suggests that they work well for chronic physicalillnesses, butitis unclear ifthey operate asintended for people with mental disorders. The aims ofthis study were to: (1) compare rates of creation and review of GP care plans for mental disorders and type II diabetes; and (2) examine consumer experiences. Secondary analysis of 109 589 recorded encounters from a national cross-sectional study in Australian general practice (2006-16) demonstrated that encounters involving creation of a care plan for depression or anxiety were significantly higher than those for diabetes, bipolar disorder and schizophrenia. Rates of review were commensurate with creation of plans for diabetes, but not for mental disorders. Eighteen people with a GP care plan completed an online survey abouttheir experiences, reporting that care plans facilitated accessto allied health professionals, but did not improve the quality of care they received. Findings suggest that care plans are underutilised for people with low prevalence mental disorders, and while they offer financial benefits to consumers, they may not result in ongoing, collaborative care.At the time of the study, M. Banfield was the recipient of an Australian Research Council Discovery Early Career Researcher Award (DE150100637) funded by the Australian Government

Time's up. Descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey

Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5-16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.This work was funded by the National Health and Medical Research Council ID (402793, 2006)

A Peer-Led Electronic Mental Health Recovery App in a Community-Based Public Mental Health Service: Pilot Trial

BACKGROUND: There is an increasing need for peer workers (people with lived experience of mental health problems who support others) to work alongside consumers to improve recovery and outcomes. In addition, new forms of technology (tablet or mobile apps) can deliver services in an engaging and innovative way. However, there is a need to evaluate interventions in real-world settings. OBJECTIVE: This exploratory proof-of-concept study aimed to determine if a peer worker-led electronic mental health (e-mental health) recovery program is a feasible, acceptable, and effective adjunct to usual care for people with moderate-to-severe mental illness. METHODS: Overall, 6 consumers and 5 health service staff participated in the evaluation of a peer-led recovery app delivered at a community-based public mental health service. The peer worker and other health professional staff invited attendees at the drop-in medication clinics to participate in the trial during June to August 2017. Following the intervention period, participants were also invited by the peer worker to complete the evaluation in a separate room with the researcher. Consumers were explicitly informed that participation in the research evaluation was entirely voluntary. Consumer evaluation measures at postintervention included recovery and views on the acceptability of the program and its delivery. Interviews with staff focused on the acceptability and feasibility of the app itself and integrating a peer worker into the health care service. RESULTS: Consumer recruitment in the research component of the study (n=6) fell substantially short of the target number of participants (n=30). However, from those who participated, both staff and consumers were highly satisfied with the peer worker and somewhat satisfied with the app. Health care staff overall believed that the addition of the peer worker was highly beneficial to both the consumers and staff. CONCLUSIONS: The preliminary findings from this proof-of-concept pilot study suggest that a peer-led program may be a feasible and acceptable method of working on recovery in this population. However, the e-mental health program did not appear feasible in this setting. In addition, recruitment was challenging in this particular group, and it is important to note that these study findings may not be generalizable. Despite this, ensuring familiarity of technology in the target population before implementing e-mental health interventions is likely to be of benefit.Funding for the Apple iPads to conduct the program was provided by the Canberra Hospital Foundation and funding to employ the peer worker was provided by ACT Health. This funding applied to the e-mental health program delivery only. The Menzies School of Health Research also provided the Stay Strong app for the current research cost-free. The research study was conducted using in-kind resources at the Centre for Mental Health Research. This includes funding provided by ACT Health for ACACIA: The ACT Consumer and Carer Mental Health Research Unit. The funding support for ACACIA is managed by a separate area from the one involved in program delivery, and the research was conducted independently of program implementation. MB is supported by Medical Research Future Fund fellowship 1150698