Rural Clinical School - Research Publications
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ItemSexually transmissible infections, partner notification and intimate relationships: a qualitative study exploring the perspectives of general practitioners and people with a recent chlamydia infection(CSIRO PUBLISHING, 2020)UNLABELLED: Background Individuals diagnosed with a chlamydia infection are advised to notify their sexual partners from the previous 6 months so that they too can get tested and treated as appropriate. Partner notification is an essential component of chlamydia management, helping to prevent ongoing transmission and repeat infection in the index case. However, partner notification can be challenging, particularly in circumstances where a relationship has ended or transmission has occurred beyond the primary relationship. METHODS: In this study we use data from 43 semistructured interviews with general practitioners (GPs) and people with a recent diagnosis of chlamydia. The interviews examined experiences of chlamydia case management in the general practice context. Here, we focus specifically on the effect of a chlamydia infection on intimate relationships in the context of the consultation and beyond.? RESULTS: A chlamydia infection can have significant consequences for intimate relationships. Although GPs reported speaking to their patients about the importance of partner notification and participants with a recent chlamydia infection reported notifying their sexual partners, both would appreciate further support to engage in these conversations. CONCLUSIONS: Conversations with patients should go beyond simply informing them of the need to notify their sexual partners from the previous 6 months, and should provide information about why partner notification is important and discuss strategies for informing partners, particularly for those in ongoing relationships. Ensuring GPs have the training and support to engage in these conversations with confidence is vital.
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ItemPatient-delivered partner therapy for chlamydia in Australia: can it become part of routine care?(CSIRO Publishing, 2020-08-03)Background: Patient-delivered partner therapy (PDPT) is a method for an index patient to give treatment for genital chlamydia to their sexual partner(s) directly. In Australia, PDPT is considered suitable for heterosexual partners of men and women, but is not uniformly endorsed. We explored the policy environment for PDPT in Australia and considered how PDPT might become a routine option. Methods: Structured interviews were conducted with 10 key informants (KIs) representing six of eight Australian jurisdictions and documents relevant to PDPT were appraised. Interview transcripts and documents were analysed together, drawing on KIs’ understanding of their jurisdiction to explore our research topics, namely the current context for PDPT, challenges, and actions needed for PDPT to become routine. Results: PDPT was allowable in three jurisdictions (Victoria, New South Wales, Northern Territory) where State governments have formally supported PDPT. In three jurisdictions (Western Australia, Australian Capital Territory, Tasmania), KIs viewed PDPT as potentially allowable under relevant prescribing regulations; however, no guidance was available. Concern about antimicrobial stewardship precluded PDPT inclusion in the South Australian strategy. For Queensland, KIs viewed PDPT as not allowable under current prescribing regulations and, although a Medicine and Poisons Act was passed in 2019, it is unclear if PDPT will be possible under new regulations. Clarifying the doctor–partner treating relationship and clinical guidance within a care standard were viewed as crucial for PDPT uptake, irrespective of regulatory contexts. Conclusion: Endorsement and guidance are essential so doctors can confidently and routinely offer PDPT in respect to professional standards and regulatory requirements.
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ItemBeing in two minds: Staff's perspectives of paperwork in group homes for people with intellectual disabilities(WILEY-BLACKWELL, 2016-07-01)Aim: Paperwork is an important technology in group homes for people with intellectual disabilities. This study explored frontline staffs’ perceptions of paperwork in two Australian group homes. Method: Researchers used a constructivist grounded theory methodology. Data were collected from nine group home staff (1 supervisor and 8 support workers) using semi-structured interviews and observations. Open and focussed coding was used to identify participants’ perception of paperwork. Results: Participants described being in two minds about paperwork; considering it a useful yet problematic technology in group homes. They described paperwork as having particular characteristics and used these to evaluate the usefulness of different pieces. Conclusions: Frontline group home staff actively evaluate paperwork technologies in their workplace. Understanding staff perceptions of paperwork might better enable it to be better designed or help better equip staff with meaningful technologies to provide good resident support, rather than paperwork detracting staff from their core work of providing support to residents.
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ItemNo Preview AvailableStaff perspectives on paperwork in group homes for people with intellectual disability(Routledge, 2019-08-20)This book gathers together recent international research in intellectual disability (ID), examining the diverse modes of existence that characterise living with intellectual disabilities in the 21st century.
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ItemBeing a valuable contributor on the frontline: The self-perception of staff in group homes for people with intellectual disability(WILEY, 2018-05)BACKGROUND: Group home frontline staff have a critical role in implementing service policies, yet research typically examines implementation issues from an organisational perspective. The aim of this study was to explore the self-perception of frontline staff about their role in group homes for people with intellectual disability. METHOD: Constructivist grounded theory methodology guided the study. Data were collected with frontline staff through semistructured interviews and participant observations. Coding and sorting methods were used to analyse participants' self-perception. RESULTS: Frontline staff felt they were valuable contributors who knew the service setting and residents well. Despite this staff felt powerless in their roles, excluded from organisational dialogue, stressed and exhausted. CONCLUSIONS: Frontline staff have critical insight into service implementation although disability service organisations may limit their capacity to contribute to this. Further action could explore new ways to better nurture frontline staff engagement in organisational dialogue.
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ItemStaff perspectives on paperwork in group homes for people with intellectual disability(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2018)Background: Paperwork can transform organisational aims into action in group homes, but it can also be problematic for staff. The aim of this study was to explore frontline staff perspectives on paperwork in group homes for people with intellectual disability. Methods: Constructivist grounded theory methodology guided the study. Data were collected from 29 participants through semi-structured interviews, participant observations and journaling. Coding and sorting methods were used to analyse participants’ perspectives. Results: Staff have nuanced paperwork perspectives. They described and evaluated paperwork in terms of its value and fit with resident-focused practice. They identified gaps in paperwork and reimagined its design and use. Conclusions: Frontline staffs’ reflection suggests some paperwork hinders them from supporting residents well. This suggests organisations could consult better with staff to design paperwork that has a goodness of fit to their practice. Further research could explore how staff manage the limiting characteristics of paperwork.
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ItemExploring infant deformational or positional plagiocephaly prevention and management by Maternal Child Health Nurses and Paediatric Physiotherapists(AUSTRALIAN NURSING FEDERATION, 2016-12-01)Objectives To explore Maternal Child Health (MCH) nurses’ and Paediatric Physiotherapists’ (Physiotherapists) experience with infant deformational or positional plagiocephaly (plagiocephaly). Design Cross-sectional online survey. Setting Community health setting in Victoria, Australia. Subjects MCH nurses and Paediatric Physiotherapists in Victoria were invited to participate. Main outcome measures Survey results were collated and analysed descriptively. Results Surveys were completed by 183/961(19%) MCH nurses and a sample of 16 Physiotherapists, from a cross section of metropolitan (62%), regional (18%) and rural/remote (24%) Victoria. All MCH nurses and Physiotherapists reported seeing infants with plagiocephaly in the previous 12 months. Responses indicated MCH nurses saw between 11-50 infants with plagiocephaly (n=110). These were first diagnosed by MCH nurses at one to three months. Infants first presented to Physiotherapists on average at four to six months. All MCH nurses and Physiotherapists implemented prevention strategies and both groups thought it was effective subject to parents’ implementing the advice. Strategies for prevention and management of plagiocephaly included early prone play (tummy-time) and counter positioning. Physiotherapists also included gross motor exercises, stretches if torticollis was present and, if appropriate, referral for helmet therapy. Referrals of infants with plagiocephaly by MCH nurses were made to Physiotherapists, General Practitioners, Chiropractors and Osteopaths. Conclusions All MCH nurses and Physiotherapist respondents see infants with plagiocephaly, MCH nurses earlier than Physiotherapists. The effectiveness of plagiocephaly prevention advice can be called into question because of the high numbers of infants presenting and subsequent referrals to different health professionals. Recommendations from respondents included a review of past initiatives including extensive education for Maternal Child Health Nurses, Pamphlets in their Home visiting pack and video for demonstration at first time mothers group and the provision of clearer early prevention advice in the Government Key Ages and Stages (KAS) Framework for MCH nurses.
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ItemThe need for a culturally-tailored gatekeeper training intervention program in preventing suicide among Indigenous peoples: a systematic review(BIOMED CENTRAL LTD, 2016-10-21)BACKGROUND: Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. METHOD: Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: 'suicide', 'gatekeeper', 'training', 'suicide prevention training', 'suicide intervention training' and 'Indigenous'. Other internationally relevant descriptors for the keyword "Indigenous" (e.g. "Maori", "First Nations", "Native American", "Inuit", "Metis" and "Aboriginal") were also used. RESULTS: Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training. CONCLUSION: Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.
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ItemHealth professional networks as a vector for improving healthcare quality and safety: a systematic review(BMJ PUBLISHING GROUP, 2012-03)BACKGROUND: While there is a considerable corpus of theoretical and empirical literature on networks within and outside of the health sector, multiple research questions are yet to be answered. OBJECTIVE: To conduct a systematic review of studies of professionals' network structures, identifying factors associated with network effectiveness and sustainability, particularly in relation to quality of care and patient safety. METHODS: The authors searched MEDLINE, CINAHL, EMBASE, Web of Science and Business Source Premier from January 1995 to December 2009. RESULTS: A majority of the 26 unique studies identified used social network analysis to examine structural relationships in networks: structural relationships within and between networks, health professionals and their social context, health collaboratives and partnerships, and knowledge sharing networks. Key aspects of networks explored were administrative and clinical exchanges, network performance, integration, stability and influences on the quality of healthcare. More recent studies show that cohesive and collaborative health professional networks can facilitate the coordination of care and contribute to improving quality and safety of care. Structural network vulnerabilities include cliques, professional and gender homophily, and over-reliance on central agencies or individuals. CONCLUSIONS: Effective professional networks employ natural structural network features (eg, bridges, brokers, density, centrality, degrees of separation, social capital, trust) in producing collaboratively oriented healthcare. This requires efficient transmission of information and social and professional interaction within and across networks. For those using networks to improve care, recurring success factors are understanding your network's characteristics, attending to its functioning and investing time in facilitating its improvement. Despite this, there is no guarantee that time spent on networks will necessarily improve patient care.
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ItemThe rural pipeline to longer-term rural practice: General practitioners and specialists(PUBLIC LIBRARY SCIENCE, 2017-07-07)BACKGROUND: Rural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS). In particular, we wished to determine predictors of graduates' longer-term rural practice and whether the predictors differ between general practitioners (GPs) and specialists. METHODS: A cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002-2011. The outcome of interest was primary place of graduates' practice categorised as rural for at least 50% of time since graduation ('Longer-term Rural Practice', LTRP) among GPs and medical specialists. The main exposures were rural background (RB) or metropolitan background (MB), and attendance at a metropolitan clinical school (MCS) or the Rural Clinical School for one year (RCS-1) or two years (RCS-2). RESULTS: Independent predictors of LTRP (odds ratio [95% confidence interval]) were RB (2.10 [1.37-3.20]), RCS-1 (2.85 [1.77-4.58]), RCS-2 (5.38 [3.15-9.20]), GP (3.40 [2.13-5.43]), and bonded scholarship (2.11 [1.19-3.76]). Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21-0.57]). The effects of RB and RCS were additive-compared to MB and MCS (Reference group): RB and RCS-1 (6.58[3.32-13.04]), RB and RCS-2 (10.36[4.89-21.93]). Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner's background were apparent. CONCLUSIONS: Among both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan-based medical schools can enhance both specialist and GP rural medical workforce by enrolling rural background medical students and providing them with long-term rural undergraduate clinical training. Policy settings to achieve optimum rural workforce outcomes may differ between specialists and GPs.