Acceptability, feasibility and cost of point of care testing for sexually transmitted infections among South African adolescents where syndromic management is standard of care

BACKGROUND: Young people (YP) in southern Africa are at substantial risk of HIV and sexually transmitted infections (STIs). Despite the epidemiological and biological link between STIs and HIV transmission and acquisition, infections such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) remain widely undiagnosed. Syndromic STI management is the standard of care in low- and middle-income countries (LMICs) despite a high prevalence of asymptomatic infections. We conducted an observational study to explore the acceptability, feasibility, and cost of a STI test-and-treat service for YP in Cape Town. METHODS: YP attending a mobile clinic (MC) and a youth centre clinic (YC) were offered STI screening. Urine testing for CT and NG using a 90-min molecular point-of-care (POC) test on the GeneXpert platform was conducted and treatment provided. Data were collated on demographics, sexual behaviour, presence of symptoms, uptake of same-day treatment, prevalence of CT/NG, and service acceptability. RESULTS: Three hundred sixty six participants were enrolled (median age 20, 83% female).57% (209/366) of participants tested positive for either CT (126/366, 34%) or NG (57/366, 16%) or co-infection (26/366, 7%). Clinical symptoms were a poor predictor of GeneXpert diagnosed CT or NG, with a sensitivity of 46.8% and 54.0% for CT and NG respectively. Although half of participants initially chose to receive same day results and treatment, only a third waited for results on the day. The majority of participants (91%) rated the service highly via a post-visit acceptability questionnaire. CONCLUSION: Curable STIs are highly prevalent in this population. STI screening using POC testing was feasible and acceptability was high. The study provides further impetus for moving policy beyond syndromic management of STIs in South Africa

Preventing chronic disease in overweight and obese patients with low health literacy using eHealth and teamwork in primary healthcare (HeLP-GP): A cluster randomised controlled trial

OBJECTIVES: To evaluate a multifaceted intervention on diet, physical activity and health literacy of overweight and obese patients attending primary care. DESIGN: A pragmatic two-arm cluster randomised controlled trial. SETTING: Urban general practices in lower socioeconomic areas in Sydney and Adelaide. PARTICIPANTS: We aimed to recruit 800 patients in each arm. Baseline assessment was completed by 215 patients (120 intervention and 95 control). INTERVENTION: A practice nurse-led preventive health check, a mobile application and telephone coaching. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were measured at baseline, 6 and 12 months, and included patient health and eHealth literacy, weight, waist circumference and blood pressure. Secondary outcomes included changes in diet and physical activity, preventive advice and referral, blood lipids, quality of life and costs. Univariate and multivariate analyses of difference-in-differences (DiD) estimates for each outcome were conducted. RESULTS: At 6 months, the intervention group, compared with the control group, demonstrated a greater increase in Health Literacy Questionnaire domain 8 score (ability to find good health information; mean DiD 0.22; 95% CI 0.01 to 0.44). There were similar differences for domain 9 score (understanding health information well enough to know what to do) among patients below the median at baseline. Differences were reduced and non-statistically significant at 12 months. There was a small improvement in diet scores at 6 months (DiD 0.78 (0.10 to 1.47); p=0.026) but not at 12 months. There were no differences in eHealth literacy, physical activity scores, body mass index, weight, waist circumference or blood pressure. CONCLUSIONS: Targeted recruitment and engagement were challenging in this population. While the intervention was associated with some improvements in health literacy and diet, substantial differences in other outcomes were not observed. More intensive interventions and using codesign strategies to engage the practices earlier may produce a different result. Codesign may also be valuable when targeting lower socioeconomic populations. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN 12617001508369) (http://www.ANZCTR.org.au/ACTRN12617001508369.aspx). TRIAL PROTOCOL: The protocol for this trial has been published (open access; https://bmjopen.bmj.com/content/8/6/e023239)

Scoping review of Australian evaluations of healthcare delivery models: are we making the most of the evidence?

Objective: Healthcare delivery models describe the organisation of healthcare practitioners and other resources to provide health care for a defined patient population. The organisation of health care has a predominant effect on the receipt of timely and appropriate health care. Efforts to improve healthcare delivery should be evidence informed, and large numbers of evaluations of healthcare delivery models have been undertaken. This paper presents a scoping review of Australian evaluations of new healthcare delivery models to inform a discussion of the appropriate use of such evidence to improve the efficiency and sustainability of the Australian health system. Methods: A systematic scoping review was undertaken, following an a priori published protocol. PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for primary comparative studies of healthcare delivery models undertaken in Australia and published between 2009 and 2018. Primary prevention studies, such as health promotion activities, were excluded. Results: Of 14923 citations, 636 studies were included in the scoping review. Of these, 383 (60%) were randomised control trials. There were 18 clinical specialties in which over 10 evaluations were identified. Most models involved allied health practitioners or nurses. Conclusion: Evaluations of healthcare delivery models provide important evidence that can be used to improve the use of the most important and costly assets of health systems, namely the healthcare practitioners who deliver health care. A nationally coordinated system is required to support local health services to assess the local value of alternative healthcare delivery models. What is known about the topic?: The organisation and delivery of health care is continuously evolving in response to changes in the demand and supply of health care. New healthcare delivery models are often evaluated in specific locations, but it is not clear how such evidence informs the delivery of care in other locations. What does this paper add?: This paper reports the findings of a scoping review of Australian evaluations of healthcare delivery models, highlighting the large and increasing number of such evaluations that have been published in the past 10 years. What are the implications for practitioners?: Opportunities to improve health system efficiency are likely being lost due to the underuse of the available Australian evidence on new healthcare delivery models. Local health services need support to interpret such evidence in their local context, which could be provided through the development of a national framework for local evaluation.Jacqueline Roseleur, Andrew Partington, Jonathan Karno

Mapping a decade of interventions to address the supportive care needs of individuals living with or beyond cancer: a scoping review of reviews

Published online: 14 January 2022PURPOSE: Individuals diagnosed with cancer have a range of supportive care needs that are often unmet despite substantial evidence supporting interventions to address them. Addressing this knowledge-translation gap represents a significant opportunity to improve health outcomes. A scoping review of reviews was conducted to map the breadth of evidence for interventions, highlighting those with an existing evidence base, as well as those requiring further research. METHODS: Systematic or meta-analytic reviews that examined interventions targeting supportive care needs of adults and children with cancer published between 2009 and 2019 were identified via searches in Medline, PsycINFO, CINAHL, Scopus and Cochrane. RESULTS: Five hundred fifty-one systematic reviews, including 250 meta-analyses, of interventions addressing supportive care needs, were included. Most reviews focused on interventions to address the physical and psychosocial needs of individuals with few reviews identified to address practical needs. Interventions using mental health therapies and physical activity were most commonly used to address all supportive care needs, followed by the use of pharmaceutical and medical devices, complementary and alternative therapies, information and education resources, dietary information and specific spirituality and return-to-work interventions. CONCLUSION: This scoping review of reviews presents the first broad overview of the literature addressing the supportive care needs of people living with or beyond cancer. It provides a database that health service providers can search to identify appropriate interventions. Results highlight specific research gaps, particularly for practical needs, where reviews are needed. It highlights where a substantial evidence base exists that researchers and policy-makers can consider when implementing interventions.Laura Catherine Edney, Jacqueline Roseleur, Jodi Gray, Bogda Koczwara and Jonathan Karno

The impacts of unmet supportive care needs of cancer survivors in Australia: A qualitative systematic review

Introduction: Cancer incidence and survivorship are increasing worldwide. With more people living through and beyond cancer, there is a subsequent increase in their supportive care needs. This systematic review of qualitative studies aimed to describe the impacts of unmet supportive care needs on cancer survivors in Australia. Methods: Databases MEDLINE, EMBASE and Scopus were searched, and after screening and applying eligibility criteria, 27 qualitative studies were included. Findings were synthesised according to the Supportive Care Framework for Cancer Care, including informational, physical, practical, emotional, psychological, social and spiritual need domains. Results: The systematic review identified impacts of unmet informational, physical, practical, emotional and psychological needs. Frequently identified impacts of unmet informational needs were feelings of abandonment and isolation, distress, confusion and regret. Common impacts of unmet physical and practical needs were financial burden and return-to-work difficulties. Over half of all unmet supportive care needs caused emotional and psychological impacts. Conclusions: Findings identify the detrimental emotional and psychological impacts resulting from a range of unmet supportive care needs. The review highlights the interconnections between supportive care need domains thereby enhancing the understanding of the impacts of unmet SCNs. Findings may inform policy and practice change to improve supportive cancer care.Olivia Bellas, Emma Kemp, Laura Edney, Candice Oster, Jackie Roseleu

Pragmatic review of interventions to prevent inpatient hypoglycaemia

Aims: This pragmatic review aimed to map and summarize the literature on model of care interventions to prevent inpatient hypoglycaemia. Model of care interventions were broadly defined as interventions that either directly target the workforce or where implementation had a strong workforce effect. The review intended to provide information for decision-makers in local health care settings regarding potential interventions to prevent inpatient hypoglycaemia in their local context. Methods: PubMed, Embase, CINAHL Plus and Scopus were systematically searched from 2009 to 2019 using key search terms for hypoglycaemia and hospital and evaluation. Included articles had to report an inpatient hypoglycaemiarelated outcome. Interventions were categorized by intervention type and setting. Dysglycaemia outcomes were extracted (severe-hypoglycaemia, hypoglycaemia, hyperglycaemia and severe-hyperglycaemia). Results: Forty-nine articles were included in the review. Interventions were categorized as: services (n = 8), role expansion (n = 6), education (n = 9), audit and feedback (n = 1), alerts and reminders (n = 3), protocol implementation methods (n = 1), order sets (n = 6), insulin charts (n = 1) and electronic glycaemic management systems (n = 14). Twenty-one articles reported on ICU-specific interventions, and 28 on interventions in non-ICU-specific settings. Study designs were predominantly non-randomized (n = 40). Conclusions: The review found positive evidence for a diverse range of evaluated interventions to prevent inpatient hypoglycaemia. Local decision-makers can use this review to identify interventions relevant to their local context. We suggest they evaluate those interventions using a decision analytic framework that combines the published evidence on effectiveness with local prevalence data to estimate the expected cost-effectiveness of the intervention options when implemented in their local context.Jodi Gray, Jacqueline Roseleur, Laura Edney, Jonathan Karnon, the Southern Adelaide Local Health Network's (SALHN) Hypoglycaemia Clinical Working Grou

Patient characteristics of, and remedial interventions for, complaints and medico-legal claims against doctors: a rapid review of the literature

Abstract Background It is uncertain if patient’s characteristics are associated with complaints and claims against doctors. Additionally, evidence for the effectiveness of remedial interventions on rates of complaints and claims against doctors has not been synthesised. Methods We conducted a rapid review of recent literature to answer: Question 1 “What are the common characteristics and circumstances of patients who are most likely to complain or bring a claim about the care they have received from a doctor?” and Question 2 “What initiatives or interventions have been shown to be effective at reducing complaints and claims about the care patients have received from a doctor?”. We used a systematic search (most recently in July 2023) of PubMed, Scopus, Web of Science and grey literature. Studies were screened against inclusion criteria and critically appraised in duplicate using standard tools. Results were summarised using narrative synthesis. Results From 8079 search results, we reviewed the full text of 250 studies. We included 25 studies: seven for Question 1 (6 comparative studies with controls and one systematic review) and 18 studies for Question 2 (14 uncontrolled pre-post studies, 2 comparative studies with controls and 2 systematic reviews). Most studies were set in hospitals across a mix of medical specialties. Other than for patients with mental health conditions (two studies), no other patient characteristics demonstrated either a strong or consistent effect on the rate of complaints or claims against their treating doctors. Risk management programs (6 studies), and communication and resolution programs (5 studies) were the most studied of 6 intervention types. Evidence for reducing complaints and medico-legal claims, costs or premiums and more timely management was apparent for both types of programs. Only 1 to 3 studies were included for peer programs, medical remediation, shared decision-making, simulation training and continuing professional development, with few generalisable results. Conclusion Few patient characteristics can be reliably related to the likelihood of medico-legal complaints or claims. There is some evidence that interventions can reduce the number and costs of claims, the number of complaints, and the timeliness of claims. However, across both questions, the strength of the evidence is very weak and is based on only a few studies or study designs that are highly prone to bias

Additional file 1 of Patient characteristics of, and remedial interventions for, complaints and medico-legal claims against doctors: a rapid review of the literature

Additional file 1: Table S1. Pubmed search - 8 September 2022. Table S2. Scopus search - 8 September 2022. Table S3. Web of Science - 8 September 2022. Table S4. Summary of study design for included studies for Question 1 and 2 using NHMRC levels of evidence [20]. Table S5. Summary of quality appraisal for eight comparative studies with concurrent controls, six for Question 1 (Q1) and two for Question 2 (Q2). Table S6. Summary of quality appraisal for three systematic reviews (one for Question 1 (Q1) and two for Question 2 (Q2)). Table S7. Summary of quality appraisal for 14 uncontrolled pre-post studies for Question 2 (Q2)