Despite their low cost, the use of email invitations to distribute surveys to medical practitioners have been associated with lower response rates. This research compares the difference in response ...rates from using email approach plus online completion rather than a mailed invitation letter plus a choice of online or paper completion. A parallel randomised controlled trial was conducted during the 11.sup.th annual wave of the nationally representative Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. The control group was invited using a mailed paper letter (including a paper survey plus instructions to complete online) and three mailed paper reminders. The intervention group was approached in the same way apart from the second reminder when they were approached by email only. The primary outcome is the response rate and the statistical analysis was blinded. 18,247 doctors were randomly allocated to the control (9,125) or intervention group (9,127), with 9,108 and 9,107 included in the analysis. Using intention to treat analysis, the response rate in the intervention group was 35.92% compared to 37.59% in the control group, a difference of -1.66 percentage points (95% CI: -3.06 to -0.26). The difference was larger for General Practitioners (-2.76 percentage points, 95% CI: -4.65 to -0.87) compared to other specialists (-0.47 percentage points, 95% CI: -2.53 to 1.60). For those who supplied an email address, the average treatment effect on the treated was higher at -2.63 percentage points (95% CI: -4.50 to -0.75) for all physicians, -3.17 percentage points (95% CI: -5.83 to -0.53) for General Practitioners, and -2.1 percentage points (95% CI: -4.75 to 0.56) for other specialists. For qualified physicians, using email to invite participants to complete a survey leads to lower response rates compared to a mailed letter. Lower response rates need to be traded off with the lower costs of using email rather than mailed letters.
Resettled refugees are an important and growing population in Australia with special health needs. Many are at an increased risk for health problems due to their past and current migration ...experiences, but how migration shapes refugee health is not well understood. Such information is important to help settlement nations' design services that best meet the needs of refugees. Drawing on a qualitative phenomenological perspective, semi-structured interviews were conducted with 19 adult refugees living in Australia to examine the relationship between their health and migration experiences. Data were analysed using Interpretative Phenomenological Analysis. Findings from this study indicate that the health of participants is influenced by pre-migration violence and loss, and stressors associated with living in transit and settlement countries. Social support, religiosity and future aspirations were commonly reported enablers of health and well-being. Gender appears to play a significant role in the health outcomes of our refugee population.
ObjectiveWe sought to understand the factors that influence a general practitioner’s (GP’s) experience of screening for primary aldosteronism (PA) in hypertensive patients.DesignA qualitative study, ...framed by phenomenology, using semistructured interviews that were audiorecorded, transcribed verbatim, entered into NVivo V.12.0 for coding and analysed for emerging themes.SettingMelbourne, Australia.ParticipantsEligible GPs had received education on PA as part of a previous study. We recruited a purposive sample of 16 GPs (6 females, 10 males) who varied in practice location, clinical experience and the number of patients screened for PA.ResultsAlthough GPs had been educated about PA, they found it challenging to explain the condition to patients and were uncertain about how to screen patients who were already taking antihypertensive medications. Most viewed the screening process to be practical, inexpensive and, by and large, acceptable to their patients. However, they found it inconvenient to alter antihypertensive medications before screening to allow for easier interpretation of the aldosterone-renin ratio. They were also less enthused about screening patients whom they thought fitted a clinical picture of essential hypertension. Knowledge of the screening process, cost and convenience of performing the aldosterone–renin ratio, conceptualisation of risk related to PA, and a desire to improve clinical care were influencing factors that modified the GPs’ screening experience.ConclusionOur findings suggest that knowledge gaps, practical limitations of the aldosterone–renin ratio, and errors in diagnostic reasoning were challenges of routine PA screening. Most of these practical barriers could be addressed by relatively simple educational and practice modifications to increase PA screening rates and optimise detection for the most common cause of secondary hypertension in primary care.
Refugee women are potentially at increased risk for chronic pain due to circumstances both in the pre-migration and post-settlement setting. However, this relationship between refugee-related ...challenges introduced along their migration trajectories and chronic pain remains unclear. This study will therefore examine the association between pre- and post-migration factors and chronic pain in refugee women five years into resettlement in Australia.
The first five waves of data from the 'Building a New Life in Australia' longitudinal study of humanitarian refugees living in Australia was analysed using logistic regression models to investigate the association between predictor variables and chronic pain. The study outcome was chronic pain and predictors were migration process and resettlement factors in both the pre-and post-settlement setting.
Chronic pain was reported in 45% (n = 139) of women, and among these a further 66% (n = 120) also reported having a long-term disability or health condition that had lasted 12 months. Pre- migration factors such as increasing age (OR 1.08; 95% CI 1.05, 1.11) and women who migrated under the Women at Risk Visa category (OR 2.40; 95% CI 1.26, 4.56) had greater odds of experiencing chronic pain. Interestingly, post migration factors such as women with better general health (OR 0.04; 95% CI 0.01, 0.11) or those who settled within metropolitan cities (OR 0.29; 95% CI 0.13, 0.68) had lower odds of experiencing chronic pain, and those who experience discrimination (OR 11.23; 95% CI 1.76, 71.51) had greater odds of experiencing chronic pain.
Our results show that there is a high prevalence of chronic pain in refugee women across the initial years of resettlement in Australia. This may be in part due to pre-migration factors such as age and migration pathway, but more significantly the post migration context that these women settle into such as rurality of settlement, poorer general health and perceived discriminatory experiences. These findings suggest that there may be many unmet health needs which are compounded by the challenges of resettlement in a new society, highlighting the need for increased clinical awareness to help inform refugee health care and settlement service providers managing chronic pain.
...LC-MS/MS-based clinical protein analysis has predominantly focused on improved analytical measurement for well-established biomarkers (5). Postextraction stability should be determined for both ...pools after storage in the autosampler (^24 h, reinjecting aliquots if feasible), freezing (^72 h, if rou- tine), and extract freeze-thaw for 1 and 2 cycles. Because many preclinical studies rely on biobanked materials, it should be noted that at least 3 freshly acquired samples should be evaluated for stability of 1 freeze-thaw cycle (assay fresh, freeze for ^12 h, thaw for ^2 h, reassay, and compare).
Alzheimer's disease (AD) is one of the looming health crises of the near future. Increasing lifespans and better medical treatment for other conditions mean that the prevalence of this disease is ...expected to triple by 2050. The impact of AD includes both the large toll on individuals and their families as well as a large financial cost to society. So far, we have no way to prevent, slow, or cure the disease. Current medications can only alleviate some of the symptoms temporarily. Many animal models of AD have been created, with the first transgenic mouse model in 1995. Mouse models have been beset by challenges, and no mouse model fully captures the symptomatology of AD without multiple genetic mutations and/or transgenes, some of which have never been implicated in human AD. Over 25 years later, many mouse models have been given an AD-like disease and then 'cured' in the lab, only for the treatments to fail in clinical trials. This review argues that small animal models are insufficient for modelling complex disorders such as AD. In order to find effective treatments for AD, we need to create large animal models with brains and lifespan that are closer to humans, and underlying genetics that already predispose them to AD-like phenotypes.
Aim
To explore recent research on care coordination interventions for people living with multimorbidity, from the perspective of the person receiving care.
Background
Care coordination interventions ...for people living with multimorbidity show some effectiveness in improving management of their health and reducing potentially preventable hospitalisations. The experience of people enrolled in care coordination interventions requires further exploration.
Design
State‐of‐the‐art review.
Methods
A review was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist where five databases (The Cochrane Library, PsycINFO, Scopus, CINAHL and MEDLINE) were searched for qualitative sources published from January 2008–March 2019. Two additional databases focused on multimorbidity and integrated care were included in the search. Titles, s and full texts were screened using inclusion criteria. Reference lists of the included articles were hand‐searched. Summary tables were developed for data extraction, and the data were mapped to the research question.
Results
Eighteen primary research articles were included. Three themes of participant experience were identified: (a) relationships built on trust, (b), a sense of safety and security and (c) feeling cared for and respected.
Conclusion
The contribution of qualitative approaches to evaluating the experiences of care for people living with multimorbidity is growing. Participants’ describe a focus on relationships formed with healthcare professionals during care coordination. Further research incorporating lived experiences of participants could illuminate these concepts further.
Relevance to clinical practice
People living with multimorbidity who require assistance via care coordination value trusting relationships with healthcare professionals, who respect their needs and provide a sense of security. Understanding participant experiences is important to shape care coordination interventions that incorporate person‐centred approaches.
Aims and objectives
To explore the healthcare professionals (HCP) experience of providing care coordination to people living with multimorbidity.
Background
There is increasing interest in improving ...care of people living with multimorbidity who need care coordination to help manage their health. Little is known about the experiences of HCP working with people living with multimorbidity.
Design
Phenomenological approach to understanding the experiences of HCP.
Methods
We interviewed 18 HCP, including 11 registered nurses, working in care coordination in Melbourne, Australia. We used interpretative phenomenological analysis to identify themes from descriptions of providing care, identifying and responding to a person’s needs, and the barriers and facilitators to providing person‐centred care.
Results
We identified four themes as follows: (a) Challenge of focusing on the person; (b) “Hear their story,” listening to and giving time to clients to tell their story; (c) Strategies for engagement in the programme; and, (d) “See the bigger picture,” looking beyond the disease to the needs of a person. Our results are reported using COREQ.
Conclusions
The HCP experienced challenges to a traditional approach to care when focusing on the person. They described providing care that was person‐centred, and acknowledged that optimal, guideline‐oriented care might not be achieved. They took the necessary time to hear the story and see the context of the person’s life, to help the person manage their health.
Relevance to clinical practice
For registered nurses in care coordination programmes, focusing on the client may challenge traditional approaches to care. Providing care involves developing a relationship with the client to optimise health outcomes. Experienced registered nurses appear to use skills in reflective practice and accept the parameters of care to improve the client’s health and well‐being.
ObjectivePatient navigators are a promising mechanism to link patients with primary care. While navigators have been used in population health promotion and prevention programmes, their impact on ...access to primary care is not clear. The aim of this scoping review was to examine the use of patient navigators to facilitate access to primary care and how they were defined and described, their components and the extent to which they were patient centred.Setting and participantsWe used the Arksey and O’Malley scoping review method. Searches were conducted in MEDLINE, Embase, ProQuest Medical, other key databases and grey literature for studies reported in English from January 2000 to April 2016. We defined a patient navigator as a person or process creating a connection or link between a person needing primary care and a primary care provider. Our target population was people without a regular source of, affiliation or connection with primary care. Studies were included if they reported on participants who were connected to primary care by patient navigation and attended or made an appointment with a primary care provider. Data analysis involved descriptive numerical summaries and content analysis.ResultsTwenty studies were included in the final scoping review. Most studies referred to ‘patient navigator’ or ‘navigation’ as the mechanism of connection to primary care. As such, we grouped the components according to Freeman’s nine-principle framework of patient navigation. Seventeen studies included elements of patient-centred care: informed and involved patient, receptive and responsive health professionals and a coordinated, supportive healthcare environment.ConclusionsPatient navigators may assist to connect people requiring primary care to appropriate providers and extend the concept of patient-centred care across different healthcare settings. Navigation requires further study to determine impact and cost-effectiveness and explore the experience of patients and their families.
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