Professor Sarah Dennis (University of Sydney)
Associate Professor Lauren Ball (Griffith University)
Australian Journal of Primary Health
Volume 27 Number 2 2021
RESEARCH FRONT: School-based Models of Primary Health Care
School-based nurses are ideally located to advocate for services and policies to address the health inequities experienced by vulnerable school populations. However, these nurses can confront barriers that limit their capacity to embed health advocacy into their practice and to meaningfully effect change. Guidance is required to redress this situation. School-based nurses who are competent and supported health advocates are required to achieve substantial and sustained health equity and social justice outcomes for vulnerable students and school populations.
Integrating health care into education settings represents a promising model to address complex health problems in disadvantaged communities by improving access to services. Our Mia Mia is an example of a school-based health hub that has achieved success by removing barriers to health care access and facilitating collaboration between health and education. This case study exemplifies both the successes and challenges associated with school-based healthcare delivery, as well as critical learnings for the replication of this model in other disadvantaged communities.
Rural children experience poorer health and educational outcomes than urban children. This study describes the role of health district-employed primary health care registered nurses working with school learning support teams in a rural community. The nurses linked schools, families and health and social care services to improve the support provided to students with health and developmental issues. Integrating primary health care nurses with existing student support services is a promising intersectoral approach to reduce inequities experienced by disadvantaged students.
Successful educational outcomes, particularly for young people in areas of poverty, are missing an important component: the direct involvement of health professionals. Learning must involve all aspects of the whole person to be successful. To fill the gap, a low socioeconomic status public high school has employed a seven-member health team integrated within its learning culture. This qualitative study examined the views of a large range of staff across the school about its efficacy, and the results are overwhelmingly positive.
People from refugee-like backgrounds living in Australia face substantial challenges accessing appropriate health services. We found that a 1-day education forum that trained education staff to refer students and their families to appropriate refugee-focused health services increased staff knowledge, confidence and rates of referral. This suggests that local low-intensity training of education staff can create alternative pathways for refugee-like people to improve their access to health services.
Adolescents face increasingly complex challenges in navigating health care in the digital age. Adolescence is also the time when many risk-taking behaviours emerge and attendance at primary health care is low. This study explored the awareness and use of a national digital health record by Australian adolescents and clinicians in school-based health services. We identified privacy and security concerns, gaps in understanding and direct benefits that can guide digital health literacy.
Integrated regional planning has been identified by governments in Australia as a key objective for the mental health system. This paper describes the processes, barriers and facilitators, and key outcomes of a joint regional planning exercise between different health networks using a purpose-built national integrated mental health planning tool.
Chronic hepatitis B can cause death and high levels of disability. Culturally and linguistically appropriate resources to support people living with hepatitis B are lacking. We developed a plain language resource to promote understanding and increase health literacy about hepatitis B. This case study demonstrates the practical application of the resource and the positive outcomes it had. Producing health information with consumer participation is a worthwhile process in increasing patients’ health literacy and improving care.
General practitioners provide frontline care for a growing number of patients with multimorbidity, which may involve a life-limiting, progressive condition. Most guidelines for life-limiting conditions acknowledge comorbidity; however, there may be missed opportunities to warn clinicians on the potential for inappropriate polypharmacy, drug–drug interactions, and guideline-imposed treatment burden. Guidelines might consider incorporating ‘guiding principles’ of multimorbidity care and reframing management in the context of reduced life expectancy.
Asylum seekers have poorer health compared to host populations, often attributed to restricted access to healthcare services and limited healthcare entitlements. Frontline healthcare workers in three large asylum seekers’ centres in Melbourne were interviewed to identify programs, initiatives or policies for reducing health inequities in asylum seekers. Providing full healthcare services, working rights, access to food banks, English lessons, free or discounted medicines and culturally competent professionals should bridge the gap of health inequities between asylum seekers and the host population.
The findings from this study showed that Australian primary healthcare providers have broadly accurate knowledge of the modifiable risk factors for dementia (when compared with the current evidence base on dementia risk reduction); but face several barriers to working with patients to reduce dementia risk. Increasing patients’ awareness of dementia risk reduction and system level changes are needed to help overcome some of these barriers.
Accurate data collection and reporting are vital to guide policy and health service planning. A mixed-methods evaluation of a chronic disease surveillance and data quality improvement strategy in general practices in a regional Australian Primary Health Network demonstrated the effectiveness of a structured approach to improve the quality of primary care data. Investing in this intervention has the potential to create sustained improvements in data quality, which can drive clinical practice improvement.
PY20247 Abstract | PY20247 Full Text | PY20247PDF (481 KB) Open Access Article
GPs prescribe a range of medications within the commonly used blood pressure medication class, angiotensin-converting enzyme inhibitors (ACE) inhibitors. Medications within this class are considered equivalent, but the cost of each ACE inhibitor varies. We found GPs were aware of equivalence within this drug class, but unaware of cost differences. GPs were open to fewer available prescribing options if there was a decreased cost to the health system. Restricted prescribing options in primary care may be an acceptable cost-containment strategy.
Telehealth is known to be a viable model for health care delivery and has been in use for well over a decade in rural and regional Australia. Despite rapid implementation of telehealth in response to the COVID-19 pandemic, telehealth was perceived favourably by primary healthcare clinicians, even first-time users of this technology. Telehealth as a model of primary healthcare consultation is not yet embedded, and training and education for staff may be required to promote ongoing use post pandemic.
PY20182 Abstract | PY20182 Full Text | PY20182PDF (137 KB) Open Access Article