Dementia and primary health care

Dementia care is becoming increasingly relevant in Australia as our population ages, presenting challenges for an already stretched health system. General practitioners are the first port of call in dementia identification and care, and are the coordinators of dementia identification and management. There is increasing involvement of practice nurses in these processes. Carers and many health professionals believe early diagnosis is critical, though GPs report diagnosing only for functional necessity such as to prescribe medication. Referrals for carers to information and support services are often delayed until carers reach ‘breaking point’, highlighting the need for anticipatory referral processes. Carers are often called the ‘hidden patients’ as they suffer from higher physical and mental illness resulting from caregiver burden

Divisions Performance Indicator Report 2008-2009: Divisions' ability to meet reporting thresholds

Divisions of General Practice report on a set of National Performance Indicators (NPIs) as part of their accountability to their funding source. This report examines patterns in the ability of Divisions to gather the data required to report on four NPIs for their 12 month reports for 2008-09. The four indicators were: Chronic Disease Management 1, 2, and 3, and Prevention 4. These are the only indicators that require Divisions to collect the data. Divisions were classified into two groups: 1) those that met all reporting thresholds; and 2) those that did not meet thresholds. We used data from the 2007-08 Annual Survey of Divisions to examine associations between Divisions’ characteristics and activities; and differences in reporting performance across Divisions

Chronic disease self-management

Chronic conditions cannot be ‘cured’. Therefore effective strategies are required to manage the illnesses and minimise their consequences for patients, their families and the health system. Self-management programs represent a way in which this care may be realised. Self-management programs focus on teaching patients to control their chronic illness more effectively. These programs can be generic (for those with multiple chronic diseases) or disease-specific, and are considered to be a component of the overall management of chronic disease. The Australian Government has focused on a dedicated push towards self-management practice. The Department of Health and Ageing currently administers the Sharing Health Care initiative as part of a package that is targeting older Australians with complex and chronic conditions

Evaluation of chronic disease management in primary health care

Rigorous evaluation of health care interventions can provide the evidence needed to improve patient outcomes and to inform decisions regarding future initiatives. A Healthier Future for all Australians emphasises “knowledge-led continuous improvement, innovation and research” and a “greater investment in public health, health policy and health services research including ongoing evaluation of health reforms”. This RESEARCH ROUNDup follows on from a previous issue: Chronic disease self-management. It covers evaluation research which is being undertaken within Australian primary health care in the field of chronic disease management (CDM)

The primary care role for people with cancer

The announcement in January 2009 of funding of $5.6 million for cancer research and a Primary Care Cooperative Cancer Clinical Trials Group to focus on prevention, detection and care of people with cancer comes after the call by a number of commentators for an expanded role for primary health care in the care of people with cancer. Some recent studies have shown that transfer of care from hospitals and specialists to general practitioners is safe and effective. However recent Australian research on service design to support cancer care in primary health care is limited, with most research focussing on the differences between care in urban and rural areas. The forthcoming evaluation of the Cancer Service Networks National Demonstration Program (CanNET) will fill a much needed gap in our research knowledge

Improving access to rural health care

Doctors and allied health professionals are in short supply in rural and remote areas of Australia. Added to this, scattered populations and small communities make meeting the health needs of the people living and working in these areas a challenge. Major Australian Government measures set by the newly established Office of Rural Health and visa arrangements for overseas trained medical doctors will help. At the local level, traditional approaches must make way for health services that are flexible and responsive to local circumstances to better meet the diverse needs of the population. Current rural research has a role at different stages of policy implementation: assessing the impact of infrastructure changes designed to improve pathways to care, and identifying and evaluating how local rural services are contributing to improved quality of care through increased inter-disciplinary cooperation

A new climate for Indigenous health

The Apology to the Stolen Generation set the tone for a new and vigorous approach to achieving health equity for Indigenous people. The symbolic impact of the Apology was reinforced and given practical direction by the Australia 2020 Summit and the Australian Government Department of Health and Ageing Budget Statements. The key primary health care messages arising from these are: improving health services for Indigenous people is essential to reducing health inequities between Australians; making health services accessible to Indigenous communities is a primary component of health service provision; and, Indigenous community engagement in health research, health services and health education is critical to meeting equity policy outcomes

Australia’s primary health care research workforce

Australian healthcare is on the brink of a significant reform process. While much is yet to be decided, two clear themes can be identified from the reform reports. The first is the importance of multidisciplinary team work in the primary health care (PHC) setting. The second is the importance of further developing and strengthening Australia’s PHC research sector, which is critical to inform its health policy and practice. These themes of a stronger multidisciplinary focus and a stronger PHC research sector reinforce each other, as clinical, health system and health services research increasingly needs to be undertaken by researchers from multiple disciplines and backgrounds

Continuity and safety in care transitions: communication at the hospital/community care interface

In the health care setting, risks to patient safety may arise when there is poor written or verbal communication between personnel during times of care transition. Care transition refers to the “set of actions designed to ensure the coordination and continuity of healthcare as patients transfer between different locations or different levels of care within the same location”. Transitions occur at staff shift changes within health care institutions, transfer between institutions, or, at the interface between acute and community care. This RESEARCH ROUNDup outlines communication mishaps that may occur in the latter instance, during discharge from hospital to community based care

Nursing in General Practice: still some way to go

A number of barriers and facilitators to an expanded role for practice nurses have been identified. These include legal and funding issues related to the lack of a system-level model, poor role definition for practice nurses, lack of space available in general practices and GP attitudes. Inter-professional issues, medico-legal concerns and a poorly defined scope of practice need to be addressed while a defined educational and career pathway for practice nursing to attract nurses to general practice is needed