Are patients willing participants in the new wave of community-based medical education in regional and rural Australia?

Community-based medical education is escalating to meet the increased demand for quality clinical education in expanded settings and patient participation is vital to the sustainability of this endeavour. This study aimed to investigate patients’ views on being used as an educational resource in medical student teaching, and whether they are being under- or over-used

Patients\u27 attitudes towards chaperone use for intimate physical examinations in general practice

BACKGROUND: The objective of this article is to investigate patients\u27 attitudes to the use of chaperones for intimate physical examinations (IPEs) in a sample of Australian general practices. METHODS: A cross-sectional survey of adult patients from 13 randomly selected general practices in regional New South Wales was conducted between September and November 2012. Generalised linear mixed models were used for analysis. RESULTS: Of 780 surveys distributed, 687 (88%) were returned; the age range was 18-91 years and 356 (52%) were from female patients. Most women had never had a chaperone present for a Papanicolaou (Pap) smear (82.6%). Between 23% and 33% of respondents preferred a chaperone with their usual general practitioner (GP) across IPEs and gender of the respondents. The odds of preference for a chaperone were significantly less with a GP whom the respondents did not know well, compared with their usual GP, for a Pap smear (female) or genital examination (male). DISCUSSION: Individualised discussion regarding chaperone use for IPEs is warranted, especially with patients seeing their usual GP

Using breath carbon monoxide to validate self-reported tobacco smoking in remote Australian Indigenous communities

Background: This paper examines the specificity and sensitivity of a breath carbon monoxide (BCO) test and\ud optimum BCO cutoff level for validating self-reported tobacco smoking in Indigenous Australians in Arnhem Land,\ud Northern Territory (NT).\ud \ud Methods: In a sample of 400 people (≥16 years) interviewed about tobacco use in three communities, both selfreported\ud smoking and BCO data were recorded for 309 study participants. Of these, 249 reported smoking tobacco\ud within the preceding 24 hours, and 60 reported they had never smoked or had not smoked tobacco for ≥6\ud months. The sample was opportunistically recruited using quotas to reflect age and gender balances in the\ud communities where the combined Indigenous populations comprised 1,104 males and 1,215 females (≥16 years).\ud Local Indigenous research workers assisted researchers in interviewing participants and facilitating BCO tests using\ud a portable hand-held analyzer.\ud \ud Results: A BCO cutoff of ≥7 parts per million (ppm) provided good agreement between self-report and BCO\ud (96.0% sensitivity, 93.3% specificity). An alternative cutoff of ≥5 ppm increased sensitivity from 96.0% to 99.6% with no change in specificity (93.3%). With data for two self-reported nonsmokers who also reported that they smoked\ud cannabis removed from the analysis, specificity increased to 96.6%.\ud \ud Conclusion: In these disadvantaged Indigenous populations, where data describing smoking are few, testing for\ud BCO provides a practical, noninvasive, and immediate method to validate self-reported smoking. In further studies\ud of tobacco smoking in these populations, cannabis use should be considered where self-reported nonsmokers\ud show high BCO

A review of tobacco interventions for Indigenous Australians

Abstract Objective:To conduct a review of interventions to reduce the harm resulting from tobacco use among Indigenous Australians and to discuss the likely effect of a range of tobacco interventions if conducted in this population. Methods:A systematic review of medical literature and an audit of information from 32 government departments, non‐government organisations and Indigenous health organisations, which was completed in March 2001. Results:A number of small tobacco programs had been conducted. Only four tobacco interventions had been evaluated in Indigenous communities: a trial of training health professionals in conducting a brief intervention for smoking cessation; a trial of a CD‐ROM on tobacco for use with Indigenous schoolchildren; a qualitative evaluation of the effect of a mainstream advertising campaign on Indigenous people; and a pilot study of smoke‐free workplaces, evaluated by qualitative methods. None of these studies assessed smoking cessation as an outcome. Two of these studies were unable to conclusively show any effect of the interventions; training health professionals in delivering a brief intervention resulted in some changes to practice and the evaluation of the mainstream advertising campaign showed that following the campaign, knowledge about tobacco had increased. Conclusions:There was a major lack of research on and evaluation of tobacco interventions for Indigenous Australians. Implications:More research and evaluation is required to ensure that tobacco interventions are appropriate and effective for Indigenous people. It is time to cease chronicling the ill health of Indigenous Australians and time to ensure the availability of well‐evaluated, effective tobacco programs

Tobacco and Aboriginal people in NSW

Tobacco use is a major cause of morbidity and mortality for Aboriginal people in NSW. Few interventions to reduce the harm resulting from tobacco use have been developed specifically for this population. However, brief interventions for smoking cessation, pharmacotherapies such as nicotine replacement therapy, bupropion and varenicline, quit groups and interventions aimed at reducing smoking by pregnant women and hospital inpatients are likely to be effective. Broader population interventions such as anti-tobacco advertising, price rises for tobacco products and prevention of sales to minors are also likely to be effective in reducing the harm resulting from tobacco use

Lifting the burden: A coordinated approach to action on Aboriginal tobacco resistance and control in NSW

Smoking prevalence continues to be significantly higher among Aboriginal people than non-Aboriginal people, resulting in a range of serious health consequences and inequities. The Aboriginal Health & Medical Research Council of New South Wales (AH&MRC) and the New South Wales (NSW) Ministry of Health (the Ministry) have worked in partnership to develop The ATRAC Framework: A Strategic Framework for Aboriginal Tobacco Resistance and Control in NSW, in collaboration with Aboriginal communities and a range of stakeholders. The goal of the ATRAC Framework is to reduce smoking prevalence and the harmful impacts of tobacco use among Aboriginal people and communities in NSW. The framework includes reviews of relevant evidence and recommended actions, organised under six areas: leadership, partnerships and coordination; community action, awareness and engagement; workforce development; supportive environments; quitting support; and evidence, evaluation and research. The framework stresses that, to be successful, Aboriginal tobacco resistance and control programs and activities need to be evidence based, coordinated, integrated and involve Aboriginal people and Aboriginal community controlled health organisations in all aspects, from development through to implementation and evaluation. Consultations and evidence reviews highlight the importance of workforce support and development, including the ongoing need for more workers specialising in Aboriginal tobacco resistance and control, as well as ongoing training for all staff involved in delivering care to Aboriginal people. Other key strategies identified in the framework include improving access to nicotine replacement therapy and other medications to support quitting; supporting, strengthening and building on existing innovative community-based programs; and further developing the evidence base. The AH&MRC and the Ministry will continue to work in partnership to drive the use of the ATRAC Framework by all people involved in Aboriginal tobacco resistance and control in NSW for resource allocation, planning, implementation and evaluation of existing and future activities