Background and objective: General practice is the most common source of healthcare for people who use methamphetamine. The aim of this study was to explore primary care providers' understandings of ...access to and service utilisation by this group.
Methods: Semi-structured interviews were conducted with general practitioners, practice nurses and alcohol and other drug service providers from two large towns in rural Victoria
Results: Participants (n = 8) reported that availability (workforce shortages, time, complex clinician-client relationships), acceptability (stigma) and appropriateness of care (skill mix, referral networks, models of care) were associated with access to care for this population. Affordability of care was not perceived to be of concern.
Discussion: Availability of care is not enough to ensure utilisation and improved health outcomes among consumers who use methamphetamine. Provision of services to this group and to other substanceusing populations requires the right ‘skill mix’ across and within healthcare organisations.
ObjectivesThe rapid onset and progressive course of the COVID-19 pandemic challenged primary care practices to generate rapid solutions to unique circumstances, creating a natural experiment of ...effectiveness, resilience, financial stability and governance across primary care models. We aimed to characterise how practices in Melbourne, Australia modified clinical and organisational routines in response to the pandemic in 2020–2021 and identify factors that influenced these changes.DesignProspective, qualitative, participatory case study design using constant comparative data analysis, conducted between April 2020 and February 2021. Participant general practitioner (GP) investigators were involved in study design, recruitment of other participants, data collection and analysis. Data analysis included investigator diaries, structured practice observation, documents and interviews.SettingThe cases were six Melbourne practices of varying size and organisational model.ParticipantsGP investigators approached potential participants. Practice healthcare workers were interviewed by social scientists on three occasions, and provided feedback on presentations of preliminary findings.ResultsWe conducted 58 interviews with 26 practice healthcare workers including practice owners, practice managers, GPs, receptionists and nurses; and six interviews with GP investigators. Data saturation was achieved within each practice and across the sample. The pandemic generated changes to triage, clinical care, infection control and organisational routines, particularly around telehealth. While collaboration and trust increased within several practices, others fragmented, leaving staff isolated and demoralised. Financial and organisational stability, collaborative problem solving, creative leadership and communication (internally and within the broader healthcare sector) were major influences on practice ability to negotiate the pandemic.ConclusionsThis study demonstrates the complex influences on primary care practices, and reinforces the strengths of clinician participation in research design, conduct and analysis. Two implications are: telehealth, triage and infection management innovations are likely to continue; the existing payment system provides inadequate support to primary care in a global pandemic.
IntroductionThe COVID-19 pandemic has transformed healthcare systems worldwide. Primary care providers have been at the forefront of the pandemic response and have needed to rapidly adjust processes ...and routines around service delivery. The pandemic provides a unique opportunity to understand how general practices prepare for and respond to public health emergencies. We will follow a range of general practices to characterise the changes to, and factors influencing, modifications to clinical and organisational routines within Australian general practices amidst the COVID-19 pandemic.Methods and analysisThis is a prospective case study of multiple general practices using a participatory approach for design, data collection and analysis. The study is informed by the sociological concept of routines and will be set in six general practices in Melbourne, Australia during the 2020–2021 COVID-19 pandemic. General practitioners associated with the Monash University Department of General Practice will act as investigators who will shape the project and contribute to the data collection and analysis. The data will include investigator diaries, an observation template and interviews with practice staff and investigators. Data will first be analysed by two external researchers using a constant comparative approach and then later refined at regular investigator meetings. Cross-case analysis will explain the implementation, uptake and sustainability of routine changes that followed the commencement of the pandemic.Ethics and disseminationEthics approval was granted by Monash University (23950) Human Research Ethics Committees. Practice reports will be made available to all participating practices both during the data analysis process and at the end of the study. Further dissemination will occur via publications and presentations to practice staff and medical practitioners.
Organizational responses that support healthcare workers (HCWs) and mitigate health risks are necessary to offset the impact of the COVID-19 pandemic. We aimed to understand how HCWs and key ...personnel working in healthcare settings in Melbourne, Australia perceived their employing organizations' responses to the COVID-19 pandemic.
In this qualitative study, conducted May-July 2021 as part of the longitudinal Coronavirus in Victorian Healthcare and Aged Care Workers (COVIC-HA) study, we purposively sampled and interviewed HCWs and key personnel from healthcare organizations across hospital, ambulance, aged care and primary care (general practice) settings. We also examined HCWs' free-text responses to a question about organizational resources and/or supports from the COVIC-HA Study's baseline survey. We thematically analyzed data using an iterative process.
We analyzed data from interviews with 28 HCWs and 21 key personnel and free-text responses from 365 HCWs, yielding three major themes:
, and
. HCWs valued organizational efforts to engage openly and honesty with staff, and proactive responses such as strategies to enhance workplace safety (e.g., personal protective equipment spotters). Suggestions for improvement identified in the themes included streamlined information processes, greater involvement of HCWs in decision-making, increased investment in staff wellbeing initiatives and sustainable approaches to strengthen the healthcare workforce.
This study provides in-depth insights into the challenges and successes of organizational responses across four healthcare settings in the uncertain environment of a pandemic. Future efforts to mitigate the impact of acute stressors on HCWs should include a strong focus on bidirectional communication, effective and realistic strategies to strengthen and sustain the healthcare workforce, and greater investment in flexible and meaningful psychological support and wellbeing initiatives for HCWs.
Equitable access to primary health care (PHC) is an important component of integrated chronic disease management. Whilst context is known to influence access to PHC, it is poorly researched. The aim ...of this study was to determine the contextual influences associated with access arrangements in four Australian models of integrated PHC.
A multi-method comparative case study design. Purposive sampling identified four models of PHC across six sites in two Australian states. Complexity theory informed the choice of contextual factors that influenced access arrangements, which were analysed across five dimensions: availability and accommodation, affordability, acceptability, appropriateness and approachability. Semi-structured interviews, document/website analysis and non-participant observation were used to collect data from clinicians, administrative staff and other key stakeholders. Within and cross-case thematic analysis identified interactions between context and access across sites.
Overall, financial viability, objectives of the PHC model and relationships with the local hospital network (LHN) underpinned access arrangements. Local supply of general practitioners and financial viability were strong influences on availability of after-hours services. Influences on affordability were difficult to determine because all models had nil/low out-of-pocket costs for general practitioner services. The biggest influence on acceptability was the goal/objectives of the PHC model. Appropriateness and to a lesser degree affordability arrangements were influenced by the relationship with the LHN. The provision of regular outreach services was strongly influenced by perceived population need, referral networks and model objectives.
These findings provide valuable insights for policy makers charged with improving access arrangements in PHC services. A financially sustainable service underpins attempts to improve access that meets the needs of the service population. Smaller services may lack infrastructure and capacity, suggesting there may be a minimum size for enhancing access. Access arrangements may be facilitated by aligning the objectives between PHC, LHN and other stakeholder models. While some access arrangements are relatively easy to modify, improving resource intensive (e.g. acceptability) access arrangements for vulnerable and/or chronic disease populations will require federal and state policy levers with input from primary health networks and LHNs.
Context: There is a global movement to advance the use of data to inform and improve health service delivery. Despite extensive and long term computerisation of Australian general practice, ...aggregated data has rarely been used to improve the quality of primary care. This project arose from an increasing interest from a large Academic Health Science Centre (AHSC) in data-led health care improvement in primary care. The AHSC, Monash Partners, commissioned this work to inform future data initiatives. Objective: Identify contextual influences, key challenges and approaches required to embed data-led primary health care improvement in the Monash Partners' region. Study Design and Analysis: Our qualitative design used semi-structured interviews. We used purposive and snowball sampling to recruit 24 clinicians, researchers and policy makers between October and November 2021. Interviews were conducted via Zoom video-conferencing and recorded. Analysis was iterative, with thematic coding developed using deductive and inductive processes and refined during analysis, reflection and investigator discussions. Setting: The AHSC's catchment, South East and East Melbourne, Australia, between October and November 2021. Population Studied: Regional data custodians and data users. Results: We found an uncoordinated system that mirrored Australia's difficulties in using health data to benefit society. Nearly all participants were passionate about the potential for data-led health care improvement, yet cautious about the practicalities of change. General practitioner (GP) academics stressed how difficult it was for GPs to see a 'value add' from primary care data, and whether data initiatives met GP and community needs. Nevertheless, participants saw potential in creation of an accessible high quality data asset linking GP clinical data with state and federal health datasets. This resource would require a regional data strategy and formalised partnerships between regional primary care organisations, data custodians and academics. Conclusions: Our findings suggest that a region-wide strategy involving creative individual and organisational capacity building could achieve success in sustainable primary care data-led improvement. This should focus on the needs of diverse communities, and the priorities of primary care clinicians and their teams. The AHSC appears to be the only regional organisation with the mandate and capacity to promote such an approach.
Feminist and trans theory challenges "the" binary sex/gender system, but can create a new binary opposition of subversive transgender versus conservative transsexual. This paper aims to shift debate ...concerning bodies as authentic/real versus constructed/mutable, arguing that such debate establishes a false dichotomy that may be overcome by reappraising scientific understandings of sex/gender. Much recent biology and neurology stresses nonlinearity, contingency, self-organization, and open-endedness. Engaging with this research offers ways around apparently interminable theoretical impasses.
To explore experiences and perspectives of healthcare workers regarding LGBTIQA+ safety and responsiveness.
Thematic analysis of semi-structured, in-depth interviews, and pre-surveys to collect ...demographics and knowledge self-rating scales.
Of 38 multidisciplinary healthcare staff, 44.7 % identified as LGBTIQA+ and 55.3 % as heterosexual and cisgender allies. Participants discussed experiences, noting strengths and gaps in affirming practice and organisational support, and training and education opportunities.
Health services need to prioritise LGBTIQA+ safety and responsiveness for staff, patients, carers and families. LGBTIQA+ healthcare staff report that they have had experiences of trauma, minority stress, discrimination, homophobia and/or transphobia, and look for visible safe spaces at work and see safer clinical care.
•LGBTIQA+ patients and staff experience inequity and marginalisation in health services.•Problems arise accessing healthcare, seeking support, in prevention and discrimination.•Workers' views, experiences and recommendations for safe, responsive practice were sought.•Implications for practitioners are to train, build awareness, and be visible if LGBTIQA+ staff.•Organisational leadership drives culture and policy via executive sponsorship/responsibility.
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