Abstracts of the Australasian Association for Academic Primary Care (AAAPC) Annual Research Conference

1. Striving for health equity through research and education. Building a network of Pasifika health professionals in Australia. A community approach using Talanoa

Alofivae-Doorbinnia Olataga^A, Lal Anchal^B, Patu Paniani^C, Meo-Sewabu Letiea^D, Semu Robbie^E, Patu Minerva^F and Doorbinnia Kamal^A

^APowell Street Family Practice.

^BWestern Sydney Health District Hospitals.

^CThe Practice Blacktown.

^DWestern Sydney University.

^ESpasifik Recruitment.

^FPatu Medics.

Background: Pacific peoples/Pasifika constitute a small proportion (1.2%) of Australia, and they are at a higher risk of significant illnesses than the general population. These health discrepancies became more apparent during the global pandemic due to their isolation from community networks. However, no platform existed to connect Pasifika communities with Pasifika health care professionals (HCPs) in Australia.

Aims/objectives: To identify Pasifika HCPs currently practising in Australia.

Methods: We conducted a countrywide search in Australia exploring existing database to find HCPs who are Pacific. A basic demographics search was conducted in 2020–2022 through Talanoa discussions on Zoom with fellow HCPs. A database then was created collating information primarily from the Australian Health Professional Regulation Agency.

Findings: The search revealed that there are 107 Pasifika HCPs working in Australia across various specialties. Thirty HCPs were then contacted via telephone of which 10 attended the Talanoa session. The majority of Pasifika HCPs had practiced for more than 15 years. Fijian male nationals were the highest numbers of HCPs practicing either in Queensland, NSW or Victoria. The highest percentage (40%) of Pasifika HCPs were general practitioners.

Implications: This search strengthened connections between Pasifika HCPs working in Australia and has formalised a network for further collaboration. Gaps in specialty have also emerged, revealing that there are no Pasifika Endocrinologists in Australia despite the prevalence of diabetes amongst Pasifika groups. This is the beginning of a network of practitioners that can support the health and wellbeing of Pacific peoples across Australia, inform workforce capacity and capability. To strive for health equity and promote education and research projects by collaborating with other health professions in Australia and beyond.

2. Supporting community pharmacists’ in delivering contraceptive counselling: the ALLIANCE co-design workshop with consumers and community pharmacists

Assifi Anisa^A, Chakraborty Samantha^A, Yasmeen Hussainy Safeera^A,B, Bateson Deborah^C, Johnston Stefanie^D, Tomnay Jane^E, Kasza Jessica^A, Church Jody^F, Grzeskowiak Luke^G,H, Nissen Lisa^I, Cameron Sharon^J and Mazza Danielle^K

^AMonash University.

^BPeter MacCallum Cancer Centre.

^CUniversity of Sydney.

^DPharmaceutical Society of Australia.

^EUniversity of Melbourne.

^FUniversity of Technology Sydney.

^GFlinders University.

^HSouth Australian Health and Medical Research Institute.

^IUniversity of Queensland.

^JUniversity of Edinburgh.

^KMonash University.

Background: Access to person-centred contraceptive counselling and methods has the potential to reduce unintended pregnancy. Community pharmacists are an untapped resource for increasing access to contraception information. To support community pharmacists in delivering contraceptive counselling a person-centred approach should build upon the lived knowledge and experiences of those accessing and implementing such services. An inclusive approach to developing a pharmacy-led contraceptive counselling and referral intervention was undertaken as part of the MRFF-funded ALLIANCE trial.

Aim/Objectives: To improve the experience of consumers and pharmacists receiving and providing contraceptive counselling in the community pharmacy setting.

Methods: A virtual co-design workshop was held using the ‘Experienced-Based Co-Design Framework’. Consumers, community pharmacists, sexual health organisations, pharmacy peak bodies and policy and practice makers were invited to participate. All activities were recorded and rewatched to ensure all information was collected. Reflexive analysis was conducted during the co-design process with participants and post-workshop.

Findings: Twenty-three participants took part in the co-design workshop. Participants discussed items to consider when: (1) designing the intervention; (2) preparing pharmacists to deliver the intervention; and (3) enabling pharmacists and pharmacy staff to deliver the intervention as planned. Several themes were raised consistently across these categories: understanding the consumer’s perspective from the start is key to a person-centred approach; ensure and emphasise confidentiality and privacy; develop rapport with the consumer; take a culturally sensitive and considerate approach; improving pharmacy workflow, ensuring patients are helped; take steps to reduce anxiety and stress around receiving emergency contraceptive pill and medical abortion medications; and adequate training for pharmacists to ensure confidence.

Implications: Community pharmacists, consumers and other key stakeholders co-designed a pharmacy-led intervention for delivering contraceptive counselling. Involvement of these groups ensures that consumers’ and community pharmacists’ needs and requirements for the delivery and receiving person-centred contraceptive counselling within community pharmacy are met.

3. Cardiovascular disease risk communication and prevention: a meta-analysis

Bakhit Mina^A, Fien Samantha^B, Abukmail Eman^A, Jones Mark^A, Clark Justin^A, Scott Anna^A, Glasziou Paul^A and Cardona Magnolia^A

^ABond University.

^BCentral Queensland University.

Background: Knowledge of quantifiable cardiovascular disease (CVD) risk may improve health outcomes and trigger behavioural change in patients or clinicians.

Aims/objectives: This review investigated the impact of CVD risk communication on patient-perceived CVD risk, changes in CVD risk factors, and clinician’s prescribing behaviour.

Methods: PubMed, Embase and PsycINFO databases were searched from inception to 6 June 2023, supplemented by citation analysis. Randomised trials that compared any CVD risk communication strategy versus usual care were included. Paired reviewers independently screened the identified records and extracted the data; a third author resolved disagreements. The primary outcome was the accuracy of risk perception. Secondary outcomes were clinician-reported changes in CVD risk, psychological responses, intention to modify lifestyle, and self-reported changes in risk factors and clinician prescribing of preventive medicines.

Findings: Sixty-two trials were included. Accuracy of risk perception was higher among intervention participants (odds ratio = 2.31, 95% confidence interval = 1.63 to 3.27). A statistically significant improvement in overall CVD risk scores was found at 6–12 months (mean difference = −0.27, 95% confidence interval = −0.45 to −0.09). For primary prevention, risk communication significantly increased self-reported dietary modification (odds ratio = 1.50, 95% confidence interval = 1.21 to 1.86) with no increase in intention or actual changes in smoking cessation or physical activity. A significant impact on patients’ intention to start preventive medication was found for primary and secondary prevention, with changes at follow-up for the primary prevention group.

Implications: In this systematic review and meta-analysis, communicating CVD risk information, regardless of the method, reduced the overall risk factors and enhanced patients’ self-perceived risk. Communication of CVD risk to patients should be considered in routine consultations.

4. Building our workforce capacity in primary care – here is the framework

Barraclough Frances^A, Smith-Merry Jennifer^A, Pit Sabrina^A and Stein Viktoria^B

^AUniversity of Sydney.

^BVM Partners Integrating Health and Care.

Background: There have been increasing calls in government policy recommending expanding scopes of practice for health professionals in primary care. Existing competencies and models of training to build capacity for this type of care known as integrated care are not comprehensive, and none has been developed through a formal global expert consensus technique.

Aims/objectives: Although the recommendations to date have focused on interprofessional learning, this study provides a concise framework and competencies to train our health workforce, higher education and vocational jurisdictions, curriculum developers, accreditation and registering bodies to understand, implement and practice the full potential of primary care.

Methods: This study identified key competencies and barriers to implementing this type of training as part of an international scoping review. We then used a modified Delphi consensus-building method with 21 experts from around the world with experience in delivering and designing this type of training to ascertain which competencies are important to include in an international framework.

Findings: A list of eight domains and 40 competencies was generated. The competencies focus on integrated care incorporating early intervention and prevention, working across sectors within the acute and community setting, ensuring a person-centred approach to care, interprofessional teamwork, collaborative practice, care coordination, digital skills and technology, professional attributes and leadership.

Implications: Higher education and other education providers, workplaces and accreditation bodies may use the results of our study to drive reform and to guide discussion about curriculum content and the systems needed to implement integrated care. The competencies can be used to shape job descriptions, orientation programs, performance reviews and as a resource for educators to shape curricula and training programs. The framework can be used to guide policy decisions and the review and implementation of accreditation standards, ensuring patients and carers are part of this process.

5. A cross-sectional study of in-consultation supervisory assistance-seeking: comparing GP registrars and non-vocationally registered doctors pursuing general practice Fellowship

Bentley Michael^A, Magin Parker^A, Patsan Irena^A, Tapley Amanda^A, Ali Rula^B, Wood Annabelle^A, van Driel Mieke^C, Davey Andrew^A, Moran Vanessa^A, Holliday Elizabeth^D, Dizon Jason^E, Mundy Ben^A and Fielding Alison^A

^ARoyal Australian College of General Practitioners.

^BUniversity of New South Wales.

^CUniversity of Queensland.

^DUniversity of Newcastle.

^EHunter Medical Research Institute.

Background: The most common pathway to Fellowship of the Royal Australian College of General Practitioners (RACGP) is the Australian General Practice Training Program (AGPT). There are alternative, self-directed pathways, such as the Practice Experience Program (PEP), for non-vocationally registered doctors, often from overseas countries and with several years of experience working in general practice. AGPT registrars work in accredited training facilities under the guidance of dedicated supervisors from whom they seek assistance while developing clinical competencies. Unlike the AGPT, PEP doctors are not required to have a direct GP supervisor. While the PEP doctor can access informal ‘supervision’ – advice from an experienced GP in the practice, the lack of ‘formal’ supervision raises the question as to whether PEP doctors seek less in-consultation assistance than AGPT registrars who have dedicated supervisors.

Aims/objectives: This study sought to establish how often PEP doctors access supervisory in-consultation assistance and compare assistance-seeking of PEP doctors with that of AGPT registrars.

Methods: Cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT methodology was adapted to collect comparable PEP participant data. Univariable and multivariable logistic regression analyses were undertaken.

Findings: Participants (1013 AGPT registrars, 14 PEP doctors) contributed details of 125,228 problems/diagnoses, of which 6.0% (n = 7567) (95% confidence interval [CI]: 5.9%–6.2%) involved seeking in-consultation supervisory assistance. PEP participants sought assistance in 9.3% (95% CI: 8.1%–10.7%) of problems, compared with AGPT registrars: Term 1 (9.4% [95% CI: 9.1%–9.7%]); Term 2 (5.1% [95% CI: 4.9%–5.4%]); Term 3 (2.9% [95% CI: 2.8%–3.1%]). Differences in PEP participant and AGPT registrar in-consultation supervisory assistance-seeking were not multivariable statistically significant.

Implications: The findings from this study can inform the development of other non-AGPT pathways to RACGP Fellowship such as the Fellowship Support Program. Providing funded, tailored supervisory support and documenting in-practice clinical experience may better prepare non-vocationally registered doctors pursuing GP Fellowship.

6. Frequency of consultations in Australian general practice and factors associated: a national study

Bernardo Carla^A, Gonzalez-Chica David^A and Stocks Nigel^A

^AUniversity of Adelaide.

Background: In Australia, general practice is the first point of contact of patients with the health system. Still, there is a lack of information on factors increasing the frequency of GP consultations, which is essential for informing primary care planning.

Aims/objectives: To identify the frequency of GP consultations in Australia and explore its associated factors.

Methods: Using a national general practice database (MedicineInsight), we included data from all regular patients (3+ consultations in the past two years) aged 18+ years who consulted in 2021. We explored the frequency of GP consultations between January and December 2021 and its association with patient’s characteristics (sex, age group, socioeconomic level and health conditions). Multilevel zero-truncated negative binominal models were performed.

Findings: Of 1,302,932 regular patients, 58% were women, one-third aged 65+ years, 34.4% had hypertension, 30.7% depression/anxiety and 19.7% chronic pain. The total number of consultations in 2021 was 10,811,729. The overall number of consultations was similar for men and women (median[IQR] of 6[3; 10] and 6[3; 11], respectively). Consultations were higher among older people (median[IQR] of 4[2; 7] for 18–34 year-olds and 11[7; 18] for aged 75+ years). Adjusted analyses showed that sex (female, RR: 1.16, 95% CI: 1.15; 1.17), increased age (75+ years, RR: 2.54, 95% CI: 2.48; 2.61), low socioeconomic status (RR: 1.15, 95% CI: 1.08; 1.22), chronic conditions (e.g. hypertension, RR: 1.38, 95% CI: 1.36; 1.40, chronic pain RR: 1.82, 95% CI: 1.79; 1.85), recurrent conditions (e.g. depression/anxiety, RR: 1.67, 95% CI: 1.65; 1.69), and acute respiratory infections (RR: 1.59, 95% CI: 1.56; 1.62) were associated with a higher number of consultations. When comparing people with chronic conditions, women consulted more than men, especially at younger ages, but this difference was not found among those without chronic conditions.

Implications: We provided current estimates of GP consultations and patient’s characteristics, including clinical history. Identifying groups consulting more or less can support primary care planning and costing, and intervention strategies. Young men diagnosed with chronic conditions might be neglecting opportunities for improved management.

7. How does difficulty perceiving and communicating emotions impact doctor-patient communication and management of stigmatised chronic illness among people living with Chronic Obstructive Pulmonary Disease (COPD)

Bibikar Keya^A, Madawala Sanduni^A, Hutton Claire^A, Holland Anne^A and Barton Christopher^A

^AMonash University.

Background: Studies suggest that stigma can elicit a set of emotional responses that may hinder open discussions and shared-decision making with health care providers, contributing to perceptions of vulnerability. These responses likely impact patient engagement in healthcare and communication with healthcare providers.

Aims/objectives: To determine if doctor-patient communication is impacted by the anticipation of stigma in primary care settings and whether this can be explained by the presence of alexithymia, a cognitive-affective trait that has been associated with difficulty identifying feelings, finding the words to describe them and distinguishing emotions from body sensations.

Methods: An online survey will be distributed to people with doctor-diagnosed Chronic Obstructive Pulmonary Disease (COPD), aged over 40 years and living independently in the community. Participants will be invited from online support groups, social media posts and from a list of participants completing a previous related study. The survey will open in May 2024 for approximately 8 weeks and we anticipate recruiting approximately 150 people.

Findings: The research protocol has been submitted to Monash University Human Research Ethics Committee (MUHREC). It is hypothesised that people with COPD who report higher levels of anticipated stigma will score more highly on a validated alexithymia scale. This group are hypothesised to experience poorer levels of doctor-patient communication, reduced trust and satisfaction with their health care providers and poorer self-management capability. We will also determine associations with health outcomes including quality of life, anxiety and depression symptoms.

Implications: Understanding the relationship between emotions and stigma among COPD patients and investigating the impact on doctor-patient communication will raise awareness and provide avenues for intervention to address stigma in primary care management of stigmatised chronic illnesses. Effective communication between doctor and patients can contribute positively to patient involvement in treatment decisions, medication adherence, greater health equity and better quality of life.

8. Outcomes POST COVID (OUTPOST) pilot study: lessons learned

Biezen Ruby^A, Smith Miranda^A, Cysique Lucette^B, Lloyd Andrew^B and Sanci Lena^A

^AUniversity of Melbourne.

^BUniversity of New South Wales.

Background: There is an urgent need to understand the personal, societal and health service impacts of Long COVID and develop appropriate responses in the Australian context. To set up a broader study to identify the impact of Long COVID in Australia, we conducted a pilot study recruiting people with mild respiratory illness in the community, where most COVID infections now occur.

Aims/objectives: To explore the feasibility and acceptability of study design, including recruitment methods and materials, PCR testing protocols and study questionnaires.

Methods: Three general practices participated in the pilot study in December 2023 to March 2024. Recruitment strategies included sending SMSs and mailouts to eligible patients (≥12 years) from participating general practices; study poster, study flyers and fridge magnets displayed at the practices and nearby pharmacies. Eligible and consented participants were sent a study kit to self-swab for respiratory viruses, as well as a link to the baseline and 6-week study questionnaires. Workshops/interviews were conducted with participants to explore the feasibility and acceptability of recruitment strategies, PCR testing process and study questionnaires. Data were analysed thematically.

Findings: 58 participants registered for the pilot study. Of those, 21 were ineligible, 13 did not complete the consenting process, with 24 enrolled in the study. Participants (n = 9) in the workshops/interviews found the study well designed, and recruitment via general practices feasible and acceptable. Some expressed that SMS can be seen as ‘scams’, and largely ignored. Study flyers and fridge magnets were useful, with pharmacies seen as important places to promote the study. PCR testing was acceptable; however, participants found the questionnaires to be repetitive and too long.

Implications: The results from the pilot study will inform a larger study to understand the burden of Long COVID and health service responses, and to develop ongoing prospective Long COVID surveillance in primary care.

9. People’s expectations about the natural history of common acute infections: an Australia-wide survey

Peprah Boaitey Kwame^A, Bakhit Mina^A and Hoffmann Tammy C.^A

^ABond University.

Background: People’s expectations about infection duration and their health-seeking behaviour have implications for antibiotic prescribing. There are limited data regarding how long people expect common infections to last.

Aims/objectives: To explore people’s expectations about the duration of common acute infections and determine the factors influencing their decision to seek care for such infections.

Methods: A cross-sectional, online survey of adult Australians, sampled via an online survey company (Dynata). Data were analysed descriptively. We calculated the proportion of participants predicting a mean duration of infections below, within or above evidence-based estimates and coded responses to open ended-questions into categories.

Findings: Data were collected from 589 respondents, of which 62% stated they would not routinely seek care for acute infections. Participants’ mean estimates of duration of a common cold and sore throat were comparable to evidence-based estimates with over 70% of participants estimating a duration within estimates. However, the mean duration of cough, sinus pain, conjunctivitis, and urinary tract infections, were under-estimated my more than 60% of participants compared to evidence-based estimates, while the duration of impetigo and middle ear infections was overestimated. The most reported reasons to seek care were the severity and nature of symptoms, desire to get better quickly and the fear of disease progression to complications. Across all conditions, most participants reported they would have no concerns waiting for acute infections to resolve naturally beyond using over-the-counter medicines.

Implications: There is a mismatch between participants’ expectations of recovery timeframes for some common acute infections, which may contribute to demand for antibiotics. Clinicians should routinely incorporate natural history information into discussions with patients seeking care for common acute infections. This may help set realistic expectations about illness duration, guiding patients toward self-management, reduce consultations, and limit unnecessary antibiotics use.

10. Implementation research – frameworks and outcomes

Bonney Andrew^A, Mullan Judy^A, Russell Grant^B, Zwar Nick^C, Mazza Danielle^B, Metusela Christine^A and Cortie Colin^A

^AUniversity of Wollongong.

^BMonash University.

^CBond University.

Aim and intended outcome: There is a huge wastage of research effort arising from the failure to translate research findings into improved health care. This failure arises from many sources, including research results not being fit for purpose, siloing between research and clinical communities and barriers to change in clinical behaviour. It has been estimated that it takes 17 years to turn 14% of original [clinical] research to the benefit of patients (Green 2014). Implementation research (IR) provides a pathway for improving the fitness of research evidence and its uptake into practice. As defined by the National Institutes of Health, IR is ‘the scientific study of the use of strategies to adopt and integrate evidence-based health interventions into clinical and community settings in order to improve patient outcomes and benefit population health’. IR is particularly important when improving health care provision equity. This hands-on workshop aims to provide participants with a foundation in key IR frameworks for application in primary care. The workshop will equip participants with the tools to select and apply IR frameworks to implementation problems and select appropriate outcomes to measure implementation success. The workshop will be presented by researchers from a long-standing collaboration between the University of Wollongong, Monash University, University of Tasmania and Bond University. This group currently holds MRFF funding for a 5-year program of implementation research in primary care.

Format: This is an interactive workshop which will be tailored to the needs of the participants. Participants will be encouraged to bring relevant projects or research ideas in development. Following a learning needs assessment, a tailored interactive didactic session will provide foundational practical and theoretical content material. This section of the workshop will last 20 minutes. This will be followed by facilitated small group work to select a framework and design the evaluation of an IR project. Each small group will receive hands on guidance by a researcher experienced in IR. This section will last 20 minutes. In the final 20 minutes, each group will then present their project, with an opportunity for feedback and reinforcement of key concepts.

Content: The didactic content will include: (i) learning needs assessment with the participants; (ii) IR frameworks, concepts, definitions, and typology; (iii) introduction to theoretical (deterministic) and evaluation frameworks, with a focus on the Theoretical Domains Framework (TDF) and RE-AIM planning and evaluation framework; (iv) study designs applicable to IR, with a focus on mixed-methods designs; (v) key outcome measures. The small group work will include developing and presenting an IR project, with a focus on the outcome measures.

Intended audience: The session is aimed at researchers with some familiarity with IR and is aimed at being especially helpful for those who are developing a project and would like to test their ideas. There will be a maximum of 20 participants (four groups of five). Recommended pre-workshop reading will be supplied by email request to gsm-research@uow.edu.au. The reading will comprise three relevant peer reviewed journal articles providing background information, taking approximately 30 minutes to read.

11. Evaluation of Asylum Seeker Clinical Advocacy Team

Brooks Miriam^A, Abbott Penny^A, Alrubayi Baneen^A and Slewa-Younan Shameran^A

^AWestern Sydney University.

Background: The Asylum Seeker Advocacy Clinical Team (ASACT) at NSW Refugee Health Service (RHS) has over 12 years’ experience in providing primary health care for people seeking asylum. These clients have encountered significant adversity and trauma, often with complex health difficulties and face many barriers accessing health care in Australia.

Aims/objectives: This evaluation assesses what is working well from the perspective of clients, staff and community partner organisations, and where improvements can be made.

Methods: The evaluation framework was drawn from international guidelines on people-centred health services, culturally responsive healthcare, and trauma informed approaches. Qualitative methods were utilised to explore how these principles are implemented in the ASACT context. 15 ASACT clients were interviewed, as well as 16 staff participants from RHS and community partner organisations also assisting asylum seekers.

Findings: People-centred care is implemented in ASACT context by providing affordable and accessible clinics. Staff practices include addressing all client concerns, enhancing health literacy, advocacy to overcome barriers, and collaboration with organisations supporting asylum seekers. Culturally responsive care is facilitated through language services, staff cultural humility practices and partnerships with multicultural groups. Trauma informed care is achieved through staff skills in creating safe compassionate relationships, offering flexible care based on client needs, whilst RHS staff supervision facilitates trauma-informed practice. Through these trauma informed, culturally responsive and people-centred practices, ASACT enhances health equity for people seeking asylum. Gaps in access to psychiatry and dental services were identified. Beyond evaluation purposes, our research highlights principles of quality refugee health care that can be implemented in other settings.

Implications: The evaluation informs service improvement to strengthen ASACT programs and to seek enhanced funding for their work. It also articulates successful clinical practice strategies, contributing to the international evidence base for culturally responsive, trauma informed and people-centred health care.

12. The value of extended primary care teams for supporting high-needs patients with type 2 diabetes

Chepulis Lynne^A,B, Mustafa Sara^A, Gordon Karis^A, Keenan Rawiri^A, Crosswell Rebekah^A, Cannon Claire^C and Paul Ryan^D

^AUniversity of Waikato.

^BUniversity of Tasmania.

^CTe Korowai O Hauraki.

^DHealth New Zealand Te Whatu Ora Waikato.

Background: Type 2 diabetes (T2D) management is complex, complicated by both patient- and clinic-level barriers. In particular, Indigenous Māori and rural patients often have higher HbA1c and significant challenges with healthcare access.

Aims/objectives: This study explores the efficacy of a mobile, extended primary-care team (nurse, dietitian, occupational therapist, GP, kaiāwhina [cultural support worker]) for supporting patients with high-risk T2D.

Methods: This was a mixed-methods evaluation of high-needs patients with T2D (HbA1c ≥ 65 mmol/mol) enrolled into the ‘Piki Te Ora’ service with Te Korowai O Haruaki, a Māori Primary Healthcare provider with clinics across the Hauraki/Coromandel region of New Zealand. Via an opt-in process, we reviewed changes in clinical outcomes in 68 of the 112 users (mean age 58.4 ± 13.0 years; Māori 61.5%, European 38.5%) who accessed this service during 2021–2023. Qualitative interviews were undertaken with 10 participants in Nov/Dec 2023.

Findings: Medication prescribing was optimised for all patients. Mean HbA1c decreased from 79.3 ± 23.1 mmol/mol at baseline to 69.3 ± 20.0 mmol/mol after 3 months, with reductions maintained at 6 months in the majority of patients (P < 0.05). Mean total cholesterol decreased from 5.4 ± 1.6 mmol/L at baseline to 5.1 ± 1.1 mmol/L at 6 months, though there were no change in mean LDL-cholesterol or BP (P > 0.05). In qualitative interviews, participants identified the value of accessibility, dietitian support/care, individualised care, and empowerment. Patients expressed a preference for the Piki Te Ora service over the standard/mainstream model of healthcare, citing improvements with healthcare access, reduced financial and travel barriers and improved therapeutic relationships.

Implications: The use of extended primary care team appears to be a successful model for supporting improved glycaemia in high-risk patients with T2D. Further work is required to assess the long-term effectiveness of this model in other long-term conditions.

13. Real world impact of SGLT2i and GLP1RA on clinical biomarkers and prescribing for type 2 diabetes

Chepulis Lynne^A,B, Paul Ryan^C, Rodrigues Mark^A, Keenan Rawiri^A, Scott-Jones Jo^D, Moffit Allan^E, Kenealy Tim^F, Murphy Rinki^F, Te Karu Leanne^F and Clark Penny^G

^AUniversity of Waikato.

^BUniversity of Tasmania.

^CHealth New Zealand Te Whatu Ora Waikato.

^DMidlands Health Network.

^EProcare Health Limited.

^FUniversity of Auckland.

^GNorthcare Medical Centre.

Background: Type 2 diabetes (T2D) management includes pharmacotherapy, and since 2021 in New Zealand this has included empagliflozin (a SGLT2i) and dulaglutide (a GLP1RA), available under ‘special authority’ with prioritisation for Māori, Pacific and those with high-risk/established cardiovascular/renal disease (CVRD).

Aims/objectives: To determine efficacy of these drugs in a New Zealand population.

Methods: We evaluated a T2D primary care dataset (n = 56,053; 304 general practice clinics) from the Auckland and Waikato regions (Feb 2021–April 2023). We reviewed recurrent users of empagliflozin/dulaglutide [E/D] (≥2 prescriptions) and calculated change in HbA1c and T2D prescriptions based on most recent results/data at baseline (0–6 months prior to first script) and at 6 and 12 (±3) months following initiation.

Findings: Overall, 12,756 patients received ≥2 prescriptions, including 4264 European, 3319 Māori and 3228 Pacific peoples. The mean HbA1c decreased from 74.7 mmol/mol at baseline to 66.2 mmol/mol (6 months) and 65.1 mmol/mol (12 months). At 12 months improvements in HbA1c were comparable in Māori, European and Pacific (−9.9, −9.9 and −9.7 mmol/mol) but were lower in Asian (−8.3 mmol/mol) (P < 0.05). Mean HbA1c improvements were greater in those with higher vs lower baseline HbA1c values (−28.4 vs −15.9 and −7.2 mmol/mol in those with baseline of ≥95, 80–94 and 65–79 mmol/mol, respectively; P < 0.05) and in those without CVRD compared to those with CVRD (−10.7 vs −8.9; P < 0.05). At 12 months compared to baseline, E/D use associated with reduced prescribing of vildagliptin (−10.3%), sulphonylureas (−28.3%) and pioglitozone (−8.4%) with minimal changes in metformin and insulin prescribing.

Implications: The introduction and use of E/D has led to sustained improvements in glycaemia and reduced prescribing of other diabetes medications. Further work is required to assess the impact of this on cardiovascular and equitable health outcomes.

14. Ethnic minorities – the forgotten groups: the value of including ethnicity in primary care data

Chepulis Lynne^A,B, Mustafa Sara^A, Rodrigues Mark^A, Paul Ryan^C, Keenan Rawiri^A and de Graaf Barbara^B

^AUniversity of Waikato.

^BUniversity of Tasmania.

^CHealth New Zealand Te Whatu Ora Waikato.

Background: Australian primary care does not routinely collect ethnicity data other than Aboriginal and Torres Strait Islander yet at least 20% of Australia’s population identify as Asian, Middle Eastern/Latin American/African (MELAA) or Pacific/Oceania. Health disparities are common for many of these ethnic minority groups, and understanding how they benchmark to other groups for clinical outcomes and prescribing is essential for future targeted care.

Aims/objectives: Using a primary care diabetes dataset from New Zealand (where ethnicity is comprehensively recorded) we review how outcomes/measures differ by ethnicity.

Methods: Clinical characteristics and medication use were reviewed in a primary care dataset of adult patients with diabetes from 302 practices (2021–2023) using Level 1 [primary grouping] and Level 3 ethnicity [sub-grouping].

Findings: Our population comprised European (n = 23,280), Māori (n = 11,675), Pacific (n = 10,414), Asian (n = 9143), MELAA (n = 920). Mean HbA1c and medication use differed significantly by both Level 1 and Level 3 groupings. Level 1 mean HbA1c was higher in Māori and Pacific patients compared to European, Asian and MELAA (65–66 vs 57.2–58.5 mmol/mol; P < 0.001), though in line with this, clinically-indicated diabetes medication prescribing was higher in Māori and Pacific ethnic groups; P < 0.001). At Level 3, HbA1c and prescribing varied across ethnic subgroups. Mean HbA1c was significantly higher in Tongan and Vietnamese patients, for example, compared to other Pacific and Asian ethnic subgroups (all P < 0.01). SGLT2i/GLP1RA prescribing varied widely across groups (e.g. 7.7% Korean vs 35% Fijian Indian [Asian groups] and 38.9% Pacific Fijian vs 51.2% Tongan [Pacific groups]; P < 0.001) whist metformin ranged from 79.4–95.6%. Minor differences were noted for MELAA groups.

Implications: Ethnicity is a key variable to understand when measuring/reporting on health outcomes so that culturally relevant care can be designed and implemented to address health inequities.

15. A-Part of the Crowd: a crowdsourced exploration of young peoples’ experiences of loneliness during life transitions

Coe Amy^A and Palmer Victoria^B

^AUniversity of Melbourne.

^BUniversity of Tasmania.

Background: One in four young Australians aged 18 to 25, frequently experience feelings of loneliness. At this age, it is common to be finishing high school, going on to further education or university, leaving home, starting paid work or even become a parent. These ‘life transitions’ can exacerbate feelings of loneliness that further impact on young people’s health and wellbeing as well as their future careers, relationships and wellbeing. Currently, there is limited research evidence to understand loneliness in young people during life transitions. As such, it is essential to develop responsive supports for this population.

Aims/objectives: A-Part of the Crowd is an Australian first project that aims to: (i) develop a national picture on how Australian young people experience loneliness during life transitions; and (ii) co-create a model of care to support Australian young people experiencing loneliness during life transitions in primary care and community settings.

Methods: This presentation will describe the first of three phases of the A-Part of the Crowd project. In phase one, 400 young people will be invited to share their lived-experience stories of loneliness in life transitions via the ALIVE National Centre Crowdsourcing Space. Story formats may include poems, drawings, videos or audio recordings. This ‘crowd-call’ will be open between April to December 2024, Australia wide.

Findings: We will provide an overview projects’ approach to gathering stories and share the experiential knowledge emerging from the stories collected to date.

Implications: It is important to focus on the voices of young Australians to develop more targeted and empathetic strategies for addressing loneliness during pivotal life transitions. A-Part of the Crowd will provide experiential evidence from young people about how loneliness manifests at local levels and from diverse perspectives.

16. Are the medical students alright? How do medical students perceive their psychological safety in the teaching of sensitive topics in a medical school curriculum?

Coha Monika^A, Barton Chris^A, Kumar Arunaz^A and Neil Jennifer^A

^AMonash University.

Background: Medical students are exposed to sensitive clinical presentations throughout their training. Topics within the medical curriculum could be perceived as sensitive by a student given their individual life experiences. Examples such as domestic violence and mental health are covered in the General Practice curriculum and have high prevalence in the community. Teaching sensitive topics poses a risk to students of re-traumatisation, but educators typically receive little training in educational practices that can minimise the risk of harm to students while ensuring preparedness to handle distressing encounters on placement.

Aims/objectives: To understand (1) how medical students perceive their psychological safety in the teaching of sensitive topics in the existing medical school curriculum, and (2) effective ways to teach sensitive topics to enhance student engagement.

Methods: A descriptive, qualitative study design will be used. Semi-structured interviews will be conducted face-to-face or via Zoom with a small, purposefully selected group of students from the Monash University medical degree. All participants will have completed their General Practice rotation thus having exposure to sensitive topic teaching in the medical curriculum. Interviews will be audio recorded and transcribed verbatim. Reflexive thematic analysis of transcripts will be undertaken to identify common themes.

Findings: The findings will highlight teaching strategies that influence student learning experiences in sensitive topic teaching. It is anticipated that employing strategies in line with the Trauma Informed Medical Education framework, adapted from Trauma Informed Care principles in clinical practice, will be effective in promoting medical student psychological safety in sensitive topic teaching.

Implications: Insight into how students perceive and engage with sensitive topic teaching can be used to shape the medical curriculum to be more effective in adequately preparing students for managing sensitive presentations in the workforce, including General Practice where exposure to such presentations is common.

17. Analysis of medicinal cannabis prescribing for the treatment of mental health conditions in Australia

Cooling Sophie^A, Hallinan Christine^A and Bonomo Yvonne^B

^AUniversity of Melbourne.

^BSt Vincent’s Hospital Melbourne.

Background: The legalisation of medicinal cannabis (MC) in Australia in 2016 has led to a surge in its use for the treatment of mental health conditions (MHC), such as anxiety, depression, and PTSD. Though legalised, MC remains unapproved by the Therapeutic Goods Administration (TGA), raising issues due to the lack of definitive evidence for its effectiveness. Further concerns surrounding increased prescribing for MHC also exist, due to the absence of robust monitoring systems for post-marketing surveillance and detection of adverse events.

Aims/objectives: The aim of this study is to investigate medicinal cannabis prescribing for MHC in Australia, focusing on patient and prescriber characteristics, volume and type of MC products prescribed, and reports of side effects associated with MC use.

Methods: Our approach involves a secondary quantitative analysis of over 1.4 million de-identified TGA Special Access Scheme prescription approvals, and records from TGA’s database of adverse event notifications. The data, collected by the TGA, Australia’s regulator of quality, safety, and effect of therapeutic goods, includes details on prescriber location and specialty, patient demographics, prescribed cannabis categories, and adverse events linked to MC use. Descriptive analysis and linear regression of data will be performed.

Findings: Data has been received from the TGA; preliminary results are expected to be available by August 2024.

Implications: By providing clarity on how, where, when, and to whom MC is prescribed for mental health conditions, our findings will highlight the need for more robust evidence and stronger monitoring systems to track adverse effects. Additionally, the study will assess the feasibility of the use of TGA prescription approval and adverse event data for ongoing monitoring of MC. We also anticipate this comprehensive analysis of TGA data, which may also apply to other emerging unapproved therapeutics, will provide evidence for safer and more effective use of MC in Australia.

18. Changes in Australia’s medical workforce: trends in demographics and regions of work from 2013 to 2022

Cortie Colin^A, Garne David^A, Parker-Newlyn Lyndal^A, Ivers Rowena^A, Mullan Judy^A, Mansfield Kylie^A and Bonney Andrew^A

^AUniversity of Wollongong.

Background: The medical practitioner workforce is a vital component of health care in Australia, and future planning should consider how this workforce is likely to change over time.

Aims/objectives: To examine changes in the demographics and regions of work for Australian doctors in the years 2013–2022.

Methods: A retrospective study of registration data from the Australian Health Practitioner Regulation Agency (AHPRA) were examined using the Health Workforce Dataset Online Data Tool. Data was examined for years 2013 to 2022. Demographic factors examined were gender, age, and origin of qualification. Regions of work were defined using the Modified Monash Model (MMM) model.

Findings: The number of registered doctors and the total full-time equivalence (FTE) increased each year, but the mean number of hours worked per doctor decreased slightly in the nine-year period leading up to 2020. Trends in the age and origin of qualification of doctors remained largely stable, but changes in gender were seen with an increase in the number and proportion of female workers. Overall, female doctors were found to work a lower mean number of hours than males per week. The mean hours worked per week was consistent for females, but decreased for males over the period examined. In terms of geographic distribution, the number of registered doctors increased in metropolitan, regional and rural areas but not increased in remote and very remote regions.

Implications: An increase in gender parity and a decrease in the mean FTE worked suggests improvements in workforce participation and sustainability, but lack of growth in medical workforce was noted in remote and very remote regions of Australia.

19. Implementing work-related Mental-health guidelines in general PRacticE (IMPRovE): findings of a parallel cluster randomised controlled trial

Mazza Danielle^A, Costa Vera^A, Nolidin Karen^A, Chakraborty Samantha^A, Kenardy Justin^B, Brijnath Bianca^C, Enticott Joanne^A, Kidd Michael^D, Trevena Lyndall^E and Reid Sharon^E

^AMonash University.

^BUniversity of Queensland.

^CNational Ageing Research Institute.

^DUniversity of New South Wales.

^EUniversity of Sydney.

Background: General practitioners (GPs) encounter challenges in managing patients with work-related mental-health conditions. The Implementing work-related Mental-health guidelines in general PRacticE (IMPRovE) trial assessed the effectiveness of a multifaceted intervention in implementing the ‘Clinical guideline for the diagnosis and management of work-related mental-health conditions in general practice’ (the Guideline).

Methods: Using a pragmatic hybrid III parallel cluster randomised controlled trial, GP clinics committed to recruiting employed adults with work-related mental-health conditions, were allocated to either control or intervention group. Intervention clinics received academic detailing, enrolment into a virtual community-of-practice, and resources related to the Guideline. Control clinics were waitlisted until trial completion. The sum of GPs’ responses to simulated patient scenarios at baseline and 9 months post-baseline provided a measure of their adherence to the Guideline.

Findings: A total of 38 intervention clinics (52 GPs) and 36 control clinics (46 GPs) contributed to the primary outcome data. After adjusting for the stratification variables and clustering, GPs in the intervention arm had significantly higher adherence scores than those in the control arm, by 0.98 points on a 0 to 9 scale 95% confidence interval: 0.38, 1.58) with a Cohen’s d of 0.67; indicating a moderate to large effect.

Discussion: This study showed that GPs who received a multicomponent intervention tailored to support implementation of a ‘Clinical guideline for the diagnosis and management of work-related MHCs in general practice’ which combined academic detailing, enrolment in a virtual community of practice and the provision of resources had significantly higher guideline adherence scores than control GPs.

Conclusion: Tailored complex multicomponent interventions can improve guideline adherence by GPs. Purposively designed multicomponent implementation strategies to increase guideline-concordant care should be incorporated into guideline production activities and operationalised when guidelines are released.

20. Delivering end-of-life care in residential aged care facilities – what is the experience of Australian general practitioners?

Crawford Jordan^A, Manek Atish^A and Russell Grant^A

^AMonash University.

Background: Australia has an ageing population. Older Australians frequently require medical services in their later years, including palliative care at end-of-life. For individuals aged 85 years and older, residential aged care facilities (RACFs) are the most common place of death. Palliative care within RACFs is often provided by general practitioners (GPs). Despite this, little is currently known about the experience of the Australian GP when delivering this care.

Aims/objectives: The aim of this project is to understand the lived experience of Australian GPs in the provision of end-of-life care in the RACF setting.

Methods: This study will use a qualitative study design, set within RACFs in metropolitan Melbourne. A phenomenological approach to data collection and analysis will be employed. We will begin by contacting the RACFs individually. Each RACF will then assist in identifying up to five GPs responsible for providing end-of-life care to patients within their facility. We will ultimately recruit between 10 and 15 GPs in total, each of whom will participate in a semi-structured interview (either face-to-face or via Zoom). Interviews will be audio-recorded, transcribed and coded using NVivo. Data analysis will be conducted iteratively through a constant, comparative approach until thematic saturation is achieved.

Findings: Fieldwork is planned to commence in May, with completion of data collection by July. Preliminary findings will be presented.

Implications: It is expected that these findings will highlight the current experiences of Australian GPs delivering essential primary care services, including palliative care, to older Australians living in aged care facilities. Results will identify factors which influence the provision of quality end-of-life care within RACFs. Study findings may also indicate opportunities for future service optimisation with respect to the ongoing delivery of sustainable, high quality palliative care services for Australia’s ageing population.

21. Primary care-led cultural support with intermittent use technology (Freestyle Libre) improves glycaemic control in Indigenous patients with Type 2 diabetes

Crosswell Rebekah^A, Crocket Hamish^A, Moorehouse Suzanne^B, Morton Helen^C, Oehley Michael^C, Paul Ryan^A,D and Chepulis Lynne^A,E

^AUniversity of Waikato.

^BHauraki Primary Healthcare Organisation.

^CRaukura Hauora o Tainui.

^DHealth New Zealand Te Whatu Ora Waikato.

^EUniversity of Tasmania.

Background: Diabetes management is complex and involves appropriate care and education.

Aims/objectives: This study explores the intermittent use of continuous glucose monitoring (CGM) and wrap-around kaiāwhina (cultural support worker) education to support high-risk Māori patients with type 2 diabetes (T2D).

Methods: Using Kaupapa Māori informed research and Kaiāwhina, Māori participants (n = 23) with an HbA1c of ≥80 mmol/mol were recruited. Participants were provided with free CGM use for 4 weeks at time zero and again at 3 months. Kaiāwhina visited every 3 days to provide education on exercise, diet and lifestyle. HbA1c, lipids were measured every 3 months, and psychometrics, DSMQ and PROMIS were measured at baseline, and 3 months.

Findings: The use of Māori researchers along with adherence to cultural practices supported ongoing participant involvement. Mean (±SD) HbA1c significantly decreased from 93.4 ± 15.7 mmol/mol at baseline to 76.5 ± 14.8 mmol/mol at 3 months, with reductions maintained at 6 and 12 months (all P < 0.001 vs baseline). Diabetes self-management and LDL-cholesterol measures also improved significantly at 12 months. The DSMQ scores in two of the subscales, healthcare use and glycaemic control improved from a baseline mean of 4.0 ± 1.5 to 6.2 ± 1.1 at 12 weeks (P < 0.001), with 12 participants scoring above 6 (optimal control) at 3 months. No significant differences were observed in PROMIS scores.

Implications: Delivering T2D care based on Kaupapa Māori principles enables primary care to support Māori whānau. Our study highlights a promising new model of care to support Indigenous patients with T2D, though larger studies are required to understand how it can be embedded into ongoing primary care. Further, work is required to understand the importance of the different components (e.g. CGM vs kaiāwhina) and how it can be utilised to support patients living with other long-term conditions.

Authors’ note: Since submission to the Australian Association of Academic Primary Care Annual Research Conference, the work presented herein has now been published in the Journal of Primary Healthcare, https://doi.org/10.1071/HC24056.

22. Marae based, nurse practitioner lead clinics as a successful model of culturally competent care: a qualitative evaluation

Crosswell Rebekah^A, Tibble-Brown Keimarire^A, Loughlin Hine^B, Te Karu Leanne^B, Cassim Shemana^C, Mullins Hilde^A, Foxall Donna^A and Chepulis Lynne^A,D

^AUniversity of Waikato.

^BWhiria Te Tāngata, Turangi Te Huinga, Hirangi Marae, Taupō Te Rangiita Marae.

^CMassey University.

^DUniversity of Tasmania.

Background: Colonialism and a predominantly Westernised health system result in many Maori being poorly managed in primary care in Aotearoa New Zealand and initiatives to address these inequities are urgently required. Culturally-relelevant programs of healthcare delivery exist but have not been evaluated in an Aotearoa context.

Aims/objectives: This research evaluate the experiences of Maori patients with T2D who access Marae-based healthcare.

Methods: Kaupapa Māori-informed semi-structured interviews were completed in December 2023, involving 11 Māori participants (nine male, two female), who were accessing healthcare at Whiria Te Tāngata, nurse practitioner-led clinics in the central North Island region of Aotearoa. Whiria Te Tāngata healthcare delivery is grounded in Te Ao Māori (Māori worldview) and is patient-centric. Cultural expression is encouraged, with the use of Te Reo (Māori language), tikanga (protocols), wairuatanga (spirituality) and Rongoa (natural medicines/remedies), in combination with Western medicines. The collectivist nature of Maori culture is celebrated at the clinic, with all cultures being welcomed. Interviews were audio recorded, transcribed orthographically, and thematically analysed.

Findings: Six overarching themes were identified: whanaungatanga (relationship building), manaakitanga (support/care), aki (encouragement), mahi tahi (collaboration), whanau ora (whānau & community health) and tino rangatiratanga (self-determination). The removal of financial and transport barriers, lack of rigid appointment times, and involvement of whakapapa (familial) connections were enablers in service uptake. Further, participants identified the importance of initiatives including health education in kura (school), kai (food) sovereignty, and investment in Māori workforce representation.

Implications: While New Zealand’s mainstream model of healthcare delivery is failing many Māori with T2D, initiatives such as Māori-centric, marae-based health clinics may provide a promising adjunct model of care to reduce health disparities and improve health outcomes for Māori with T2D. Further, they provide culturally safe care, engage Māori whānau (family), and remove health system barriers.

23. ‘I had goals that I wanted to achieve, and they helped me achieve them.’ – Patients’ experiences of interprofessional collaborative practice for chronic conditions in primary care

Davidson Alexandra^A, Morgan Mark^A, Ball Lauren^B and Reidlinger Dianne^A

^ABond University.

^BUniversity of Queensland.

Background: High-quality healthcare for people living with chronic conditions requires a multifaceted approach. Interprofessional collaborative practice (IPCP) involves multiple professionals working with individuals, their family members, carers, and community to provide quality care. Patients’ experiences of this care in primary care settings are relatively unknown.

Aims/objectives: This study aimed to explore patients’ experiences of IPCP for chronic conditions in primary care. This work also aimed to consider the relevance and alignment of a theoretical framework developed from a previous study with patient advocates.

Methods: A constructivist grounded theory study included adults (≥18 years) receiving care within Australian primary care settings for at least one chronic condition. Individual interviews were conducted in-person, via telephone or videoconference, were recorded, transcribed, and inductively, thematically analysed using five steps: (1) line-by-line coding, (2) focused coding, (3) memo writing, (4) categorisation and (5) theme and sub-theme development. The themes and sub-themes from this study were compared to the theoretical framework from a previous similarly intended study conducted with patient advocates.

Findings: Twenty adults (n = 12 females) with a range of chronic conditions relating to disability and physical and mental health participated. Two themes and eight sub-themes were constructed. Theme 1: patients ‘Shifted across the spectrum of roles’, including five roles that may change and develop along a patient’s journey. Theme 2: patients are ‘Adapting to change’, integrating their care with life, and learning to grow and develop through their experiences with team members.

Implications: Definitions of patient roles from the original theoretical framework were enhanced by this research in patients with lived experience of IPCP. This research will give clinicians insights into how to assess their patients’ level of autonomy and control. It will inform future research about how best to assist patients reach an optimal level of control for the best health outcomes.

24. Formal carers’ experiences of interprofessional collaborative practice when caring for individuals with chronic conditions: a constructivist grounded theory study

Hui Teo Xiao^A, DCosta Stacia^B, Reidlinger Dianne^A and Davidson Alexandra^A

^ABond University.

^BNorthern Health, Victoria.

Background: Chronic conditions can lead to persistent physical, cognitive and social deterioration, functional impairment or disability. These effects can diminish quality of life and increase reliance on carers for ongoing healthcare support. Interprofessional collaborative practice (IPCP) involves multiple healthcare providers working collaboratively with patients, families, carers and communities to deliver optimal care. Despite IPCP’s importance, an understanding of formal carers’ perspectives remains limited.

Aims/objectives: To explore formal carers’ experiences of IPCP for individuals with chronic conditions in Australian primary care.

Methods: A constructivist grounded theory approach was taken. Nine formal carers were recruited for individual, semi-structured interviews lasting an average of sixty-six minutes. Themes were developed to reflect carers’ views and experiences of IPCP.

Findings: Interviewees had formal caring experience ranging from 3 months to 6 years. Three themes were developed: (1) ‘navigating interpersonal dynamics and collaborative practice’, highlighting the complexity of relationships within the caregiving environment; (2) ‘empowering care recipient’, emphasising the importance of enhancing an individuals’ sense of agency and dignity. (3) ‘creating a supportive and inclusive collaborative environment’, describing the essentiality of the IPCP team. These themes illustrate the roles, responsibilities and challenges faced by formal carers, including the feeling of being stuck in the middle, the need for training to define their scope of practice, and establishing clear communication channels to ensure all parties are well-informed and involved in decision-making.

Implications: Formal carers expressed the challenges they experienced in being part of the IPCP team. They perceived collaborative practice as commonplace but navigated collaboration in primary care carefully, involving healthcare providers, carers, the individuals they care for, and families. Findings highlight the importance of formal carers’ insights to enhance care delivery within IPCP. Future research should explore strategies for healthcare professionals to effectively collaborate and harness formal carers’ expertise for optimal primary care practice.

25. What are the common barriers and enablers to the use of evidence-based non-drug interventions in primary care? An overview of reviews.

Greenwood Hannah^A, Davidson Alexandra^A, Thomas Rae^B and Albarqouni Loai^A

^ABond University.

^BTropical Australian Academic Health Centre.

Background: Non-drug interventions, including psychological, dietary, and physical therapies, are often recommended for managing chronic conditions. Despite being effective and accessible through resources like the RACGP Handbook of Non-Drug Interventions, they’re underused in primary care.

Aims/objectives: We conducted an overview of reviews exploring the common barriers and enablers to using non-drug interventions in primary care.

Methods: We searched five databases (PubMed, Cochrane, Embase, CINAHL and PsycInfo) for qualitative and quantitative systematic reviews that reported on barriers and/or enablers to using non-drug interventions for chronic conditions in primary care. Two authors independently screened the results. One author used the Consolidated Framework of Implementation Science (CFIR) and the Theoretical Domains Framework (TDF) to code barriers and enablers, and a second author validated 10% of coding. These two frameworks were used to better understand factors influencing the implementation of non-drug interventions and to assist in identifying strategies to overcome barriers and utilise enablers.

Findings: After deduplication, 5354 articles were screened, with a final 25 included. We identified 130 subthemes (71 barriers and 59 enablers) across four CFIR domains and all TDF domains. Most data came from patient reports (92% of reviews) and used qualitative and/or mixed methods approaches. Physical activity was the most common non-drug intervention reported (40%). An enabler to implementing NDIs was a flexible and personalised intervention, and accessible equipment and services facilitate engagement from the patient’s perspective. Actual or perceived costs and negative societal attitudes towards their health condition were barriers to patients. From a clinician’s perspective, when NDIs are not prescribed, they are often not seen as useful, and medication prescription is more accessible.

Implications: Our overview of common barriers and enablers provides insight to inform the development of implementation interventions aimed at improving the uptake of effective non-drug interventions in primary care.

26. Upskilling primary care providers in best practice pain care through an interdisciplinary collaborative eLearning model – SA Chronic Pain ECHO Network

De Morgan Simone^A, Walker Pippy^A and Blyth Fiona^A

^AUniversity of Sydney.

Background: Multidisciplinary care underpinned by the biopsychosocial model of pain is considered best practice pain care. Upskilling primary care providers in best practice pain care is critical. Ensuring equity of access to pain management education is an important consideration as many primary care providers are unable to access face-to-face training, particularly those living in regional areas. Project ECHO is an interdisciplinary collaborative eLearning model that has been implemented in Australia and internationally to upskill healthcare professionals and reduce healthcare disparities. The SA Chronic Pain ECHO Network was established to improve knowledge, confidence, attitudes, and practice of primary care providers in best practice pain care and provide professional support.

Aims/objectives: The overall aims of this study were to assess the acceptability and effectiveness of the SA Chronic Pain ECHO Network and to understand the barriers to changing practice aligned to a biopsychosocial model.

Methods: A mixed method, participatory evaluation approach was undertaken. Methods included analysis of program records, and online surveys with healthcare professional participants.

Findings: The ECHO program was perceived as relevant to practice and provided a positive mentorship environment and professional support. The ECHO program improved perceived knowledge and confidence to manage patients with chronic pain. The most common key learning was incorporating psychological and social approaches to pain care. The ECHO program also improved attitudes towards patients with chronic pain and attitudes towards other healthcare professional disciplines with GPs indicating an intention to increase referrals to allied health practitioners. However, this study also highlighted barriers at the clinical, service and system level to applying the learnings.

Implications: The ECHO model was found to be an acceptable and effective model for upskilling primary care providers in best practice pain care. Primary care reform is needed to address the system barriers to implementing the biopsychosocial model identified in this study.

27. Skills and attributes of GPs with supraclinical advocacy positions in the Canberra region

Dickie Christopher^A, Barnes Katelyn^A,B, Sleiman Charles^A,B, Anderson Katrina^A,B and O’Brien Kathleen^A

^AAustralian National University.

^BACT Health Directorate.

Background: Supraclinical advocacy has been defined as ‘population-based activities aimed at practice- and system-level changes that address the social determinants of health’. Many GPs hold supraclinical advocacy positions however there is limited research on the personal skills and attributes required.

Aims/objectives: To identify and explore supraclinical advocacy positions for GPs in Canberra and the associated skills and attributes required to be successful in those positions.

Methods: We will use a mixed-methods approach combining semi-structured qualitative interviews with GPs in supraclinical advocacy roles in Canberra and a document review of available paid supraclinical advocacy roles. Convenience and purposive sampling will be used, the research team will identify and invite potential participants. Snowball sampling may be used where participants recommend new potential participants. Interviews will ask about previous experience, skills and attributes and may last up to 45 minutes. Interviews will be transcribed verbatim. Transcripts will be analysed using thematic analysis via constant comparison to identify similarities and differences in statements that could support development of themes. Documents for review will include job advertisements and/or position descriptions for supraclinical advocacy roles sourced from the potential participants. Content analysis will be used to identify and report on frequency of desired skills and duties.

Findings: Preliminary findings will be available to present at the conference. We expect to present common skills and attributes identified by our participants.

Implications: We believe results will be useful to: (i) inform competencies supporting development of supraclinical advocacy skills to be used for medical education curricula; and (ii) identify and define supraclinical advocacy roles for GPs to support expansion of non-clinical career pathways and portfolio careers. While we are limiting data collection to Canberra for feasibility, we hope findings can be built upon in future to gain a more national picture of supraclinical advocacy roles and careers for GPs.

28. Designing community nests: from theory to design

Eastwood John^A

^ASydney Local Health District.

Background: Increased understanding of the complex and interrelated issues contributing to poor outcomes for vulnerable, disadvantaged families has prompted researchers and service providers to express concern about the often fragmented and ineffective service response. A Southwestern Sydney study of neighbourhood context and maternal distress proposed the development of health and social care interventions in partnership with the affected populations.

Aims/objectives: To co-design an integrated care initiative for vulnerable families in Central and Inner West Sydney.

Methods: Previously developed realist causal theory, local empirical regression, latent class, and spatial studies informed the collaborative design of initiatives for vulnerable families. The collaborative design process included identifying outcomes and contextual factors, consultation forums, interagency planning, and developing interagency service proposals. The service proposals were then used to design the Healthy Homes and Neighbourhoods Integrated Care Initiative collaboratively.

Findings: The program theory mechanisms identified included family-provider trust, willingness to share power, cooperation, Information, and building self-help skills. The Design Elements included Wrap-around services, place-based initiatives, care coordination, sustained nurse home visiting, primary care support, family group conferencing, targeted parenting, social media, outcome monitoring, workforce development and realist program evaluation.

Implications: The collaborative design translated to a primary health care initiative that is person-centred, evidence-informed, socially and culturally appropriate to the context, universally accessible, and provided by multidisciplinary teams comprising community members and health and care practitioners. The integrated whole-of-system approach includes collaboration and partnership with other sectors to promote health and well-being at a population level that addresses health inequalities. The person-centred approach maximises individual self-reliance, participation and control where all personal goals and needs are in scope. The place-based components of the initiative are intended to maximise community participation and control in neighbourhoods experiencing significant adversity.

29. GP attitudes towards the potential utility of an AI-augmented clinical decision support tool for hypertension

Edwards Jessie^A

^AUniversity of Adelaide.

Background: Hypertension affects one-third of Australian adults, and is the most common condition seen in Australian general practice. Given both an increasing policy emphasis on reducing the burden of hypertension, and the emergence of artificial intelligence (AI)-augmented health technologies, primary care may represent an ideal setting for implementing innovative technologies as tools for blood pressure management.

Aims/objectives: Using hypertension as a case study, we aimed to explore GPs’ attitudes to the opportunities and challenges of using AI-augmented clinical tools for managing high blood pressure.

Methods: This qualitative exploratory study used purposive sampling to promote diversity of views. Semi-structured interviews were conducted with 14 GPs, recruited through existing research and teaching networks. As part of the interview, two scenarios of potential AI-augmented CDS for managing hypertension were discussed. A thematic analysis approach was used to assess the acceptability of AI-augmented CDS tools for hypertension.

Findings: Our preliminary findings suggest that GP attitudes towards the opportunities and challenges of AI in primary care reflected their pragmatic, patient-centred approach to hypertension management generally. While a potential AI tool was considered broadly acceptable and trustworthy (if endorsed by trusted clinical associations and free of vested interests), the utility of AI CDS for hypertension would be limited if it could not provide efficiencies that supported the role of the GP as the key mediator in the distinctive complexities of chronic condition management for their specific patients. Desired efficiencies included seamless integration into clinical software, and synthesis of patient data in relation to clinical recommendations. Scepticism towards the quality and local applicability of electronic patient records in an AI dataset was also expressed by some GPs.

Implications: To be taken up, AI CDS technology implementation in primary care will need to address the practical needs of GPs and facilitate the real-time, locally-appropriate care of individual patients.

30. Developing and optimising EMPathicO: a communication skills e-learning intervention for primary care practitioners

Everitt Hazel^A, Smith Kirsten^B, Vennik Jane^A, Morrison Leanne^A, Hughes Stephanie^A, Bostock Jennifer^C, Howick Jeremy^D, Stuart Beth^E, Leydon Geraldine^A, Mallen Christian^F, Ratnapalan Mohana^G, Lyness Emily^A, Steele Mary^A, Tiwari Riya^A, Misurya Pranati^H, Lockyer-Stevens Clare^A, Dambha-Miller Hajira^A, Little Paul^A and Bishop Felicity^A

^AUniversity of Southampton.

^BUniversity of Portsmouth.

^CPatient Representative.

^DLeicester Medical School.

^EQueen Mary’s University London.

^FUniversity of Keele.

^GUniversity of Nottingham.

^HUniversity of Exeter.

Background: Effective communication that incorporates clinical empathy and realistic optimism may help improve patient satisfaction, self-management and pain outcomes. However, enhancing and implementing these skills can be challenging in time-poor general practice.

Aims/objectives: To develop, optimise, and prepare for trial a very brief e-learning package ‘EMPathicO’, to enhance practitioner skills in communicating clinical empathy and realistic optimism.

Methods: The Person-Based Approach to intervention development and optimisation was used, alongside evidence and theory-based approaches. Intervention development involved conducting literature reviews to identify barriers, facilitators, and promising methods for enhancing clinical empathy and realistic optimism and conducting qualitative studies to explore practitioners’ and patients’ perspectives on clinical empathy and realistic optimism. Intervention optimisation involved conducting qualitative studies to explore practitioners’ use of EMPathicO prototypes and patients’ views on EMPathicO consultations. Further optimisation work drew on data from the feasibility trial about telephone and other remote consultations and consultancy work with patients from selected non-White British ethnic backgrounds. A feasibility trial tested and refined design of a full cluster-randomised trial in primary care.

Findings: A systematic, thorough, and rigorous approach to intervention development and optimisation has produced a very brief e-learning package that engages primary care practitioners to change their communication behaviours. EMPathicO consultations are acceptable to patients and existing evidence and theory suggest they should enhance patient pain management and enablement.

Implications: This paper illustrates the complexities of intervention development, optimisation, and feasibility work that puts practitioners and patients at the centre of the process. The person-based approach provided an essential organising framework. The EmpathicO intervention is now being evaluated in National Institute of Health Research (NIHR) School of Primary Care Research (SPCR) funded large cluster randomised controlled trial in UK general practice.

31. Treating chronic hepatitis B in a primary care service designed for refugees: perspectives of healthcare professionals

Fakhouri Amireh^A,B, Temple-Smith Meredith^A and Mascarenhas Lester^B

^AUniversity of Melbourne.

^BUtopia Refugee and Asylum Seeker Health.

Background: In Australia, refugee health remains a niche area, and general practitioners face significant challenges in meeting the diverse health requirements of refugees. Social determinants may impact access to treatment and affect overall long-term prognosis for chronic conditions like Chronic Hepatitis B (CHB). Understanding the value of managing such conditions within a specialised refugee general practice clinic can offer useful information for treating this population. Ultimately, the goal is to offer insights that can inform the development of patient-centered care tailored to refugees and contribute to reforms in healthcare policies pertaining to this disadvantaged population.

Aims/objectives: The research aims to explore the viewpoints of healthcare professionals (HP) regarding challenges encountered in treating refugees with CHB at a primary healthcare clinic specifically designated for refugees.

Methods: 20 semi-structured interviews will be conducted with diverse (HP) including general practitioners, specialists, nurses, receptionists, psychologists, social workers, and interpreters, with a focus on those associated with Utopia Refugee and Asylum Seeker Health, situated in the western suburbs of Melbourne.

Findings: The research is currently in its initial phases, with the ethics application recently submitted. It is anticipated that there will be some preliminary findings available by the time of the AAAPC conference.

Implications: Findings have the potential to support the creation of more primary care clinics dedicated to refugees nationwide, with a focus on improving Chronic Hepatitis B (CHB) management to suit the unique needs of refugees. Findings could influence government policy reform by recommending the introduction of a dedicated Medicare item number for CHB management. This initiative could serve as an incentive for general practitioners to provide comprehensive care for their CHB patients which could enhance patient engagement, ultimately resulting in better health outcomes. Such an approach may also prove to be more cost-effective compared to specialist and hospital-based clinics.

32. Experiences of Australian GP registrars as teachers: a qualitative study

Fisher Katie^A, Patsan Irena^A, Turner Alexandria^A, Runciman Dave^A, Klein Linda^A, Fielding Alison^A, Tran Michael^B, Guppy Michelle^C, Pond Dimity^D, Starling Chris^A, D’Amore Angelo^A, Davey Andrew^A and Magin Parker^A

^ARoyal Australian College of General Practitioners.

^BUniversity of New South Wales.

^CUniversity of New England.

^DUniversity of Tasmania.

Background: Research suggests that most GP registrars want to teach and there are considerable benefits to teaching during training, including increased reflection on practice. However, there are significant barriers for registrars as teachers, such as inadequate funding, time pressures, and need for teacher training. Current evidence does not include Medical Educator (ME) perspectives or compare teaching settings (e.g. university vs in-practice). Further evidence is needed to inform programs supporting registrar teaching roles.

Aims/objectives: To explore the experiences of Australian GP registrars as teachers in different contexts and from multiple stakeholder perspectives.

Methods: This qualitative study consisted of semi-structured interviews with GP registrars and GP supervisors and focus groups with MEs and medical students. Inclusion criteria: registrars and new Fellows (within 12 months) with teaching experience during training; supervisors who have supervised a registrar in the preceding 12 months; MEs; and medical students with experiences of being taught by registrars. Recruitment was open to participants nationwide and sampling was purposive, aiming for maximum variation sampling. Data collection was performed via videoconference (Zoom). Analysis employed reflexive thematic analysis using NVivo.

Findings: 15 registrars, 10 supervisors, and one ME were interviewed. Two focus groups were performed: one with four MEs and one with five medical students. Registrar participants taught in a variety of settings, including in-practice, universities, hospitals, and at educational workshop days. Three had experience in a GP Academic Post and one had experience in a Registrar ME role. Major themes are: (1) breadth of teaching context, (2) value of near-peer teaching, (3) teaching makes you a better GP, (4) multi-stakeholder engagement, and (5) strengthening the GP workforce.

Implications: We anticipate our findings having implications for relevant stakeholders, including teaching practices, medical educators, hospitals, and universities. These findings will also inform future pilot programs for GP registrar teaching.

33. Sample size estimation for clinical trials in primary care settings

Gonzalez David^A, Bernardo Carla^A and Nobre Fernanda^A

^AUniversity of Adelaide.

Aim and Intended Outcome/Educational Objectives: In this interactive workshop, we aim to offer early- and middle-career primary care researchers the essential information and practical skills they need to conduct sample size estimations for research studies in primary care, with an emphasis on clinical trials. By the end of the workshop, participants will be able to use proper parameters to determine appropriate sample sizes tailored to their research questions and with enough statistical power to draw robust conclusions from their study designs.

Format: The workshop will adopt an interactive format. We will engage participants through statistical/methodological explanations, real-world examples, and group exercises. Participants must bring their laptops to actively participate in the proposed hands-on activities and utilise free online sample size resources. The workshop will be run by the main presenter and two facilitators with expertise in statistics and sample size estimations, who will foster collaborative learning by providing opportunities for questions, discussions, and peer-to-peer interactions.

Content: The key topics covered in this 60 minutes workshop include: Methodological and statistical considerations influencing sample size calculations, Sample size calculation free tools and software, Sample size estimation for binary outcomes, Sample size estimation for numerical/continuous outcomes, Implications of clustered data (i.e. when individuals attend the same service/practice), Interpretation of results and implications for study design and data analysis, Common challenges and pitfalls in sample size estimations.

Intended Audience: This workshop is tailored for early- and middle-career primary care researchers, as well as master and PhD candidates, seeking to improve their methodological expertise in sample size estimations. The maximum capacity of the workshop is 25 participants. This will ensure all participants receive personalised support and a better learning experience through meaningful interactions.

34. A cautionary tale about using social media to recruit primary health care study participants

Gordon Julie^A, Noti Imelda^A, Mursa Ruth^B, Randall Sue^A, Halcomb Elizabeth^B, Henderson Joan^A, Lu Yang^A and Harrison Christopher^A

^AUniversity of Sydney.

^BUniversity of Wollongong.

Background: The Occasions of Care Explained and Analysed (OCEAN) tool has been adapted for use by general practice nurses (GPNs) to capture clinical activity (OCEAN-GPN). A convenience sample of GPNs beta tested OCEAN-GPN to assess its functionality and usability, recruited through Facebook.

Aims/objectives: This study aims to describe our experience using Facebook to recruit participants.

Methods: Participants tested the functionality of OCEAN-GPN through a 60-minute Zoom interview with a researcher, followed by a feedback survey. On completion participants were offered a monetary gift card. A study advertisement (including QR code link to an expression of interest (EOI)) was included in a presentation at a nursing conference in July 2023, and posted onto Facebook groups for local Primary Health Network GPN groups, all believed to be closed groups (where content is not publicly accessible). Anyone completing an EOI was sent a consent form by email. On receipt of consent, participants were contacted by phone or email to organise their Zoom interview.

Results: In July/August 2023, 88 EOIs and 40 consents were received. Concerns were raised when 12 consents were submitted without a corresponding EOI, and numerous consents contained discrepancies with the EOI. After contact by the research team, only 30 of 88 EOIs (34.1%) and 7 of 40 consents (17.5%) were genuine. Many phone numbers were invalid, disconnected, or contained another person’s phone number. Many addresses did not exist or were not a general practice (e.g. restaurants, dentists).

Implications: There is a significant risk of scammers using bogus details to participate in studies that have a financial incentive, especially surveys without verification. Fortunately, our team directly contacted participants, uncovering the scam early. We do not know how scammers found our study, given we believed that only closed Facebook groups were used.

35. How do general practitioners experience negotiating access to mental health care for children and adolescents? A qualitative study

Guitera Jade^A, Lane Riki^A and Russell Grant^A

^AMonash University.

Background: One in eight Australian children and adolescents live with a mental illness, which is a leading cause of mortality and morbidity for this age range. Only half of these children access appropriate mental health services, despite the existence of a large variety of options. As the most consulted health professional for this issue in youth, general practitioners (GPs) can play an essential role in helping these children access mental health care.

Aims/objectives: To understand how GPs experience negotiating access to mental health care for their child and adolescent patients.

Methods: This qualitative study used a phenomenological design. GPs based in Melbourne, Australia were recruited through purposive sampling. Semi-structured interviews focussed on their experiences in helping manage the care of children and adolescents with mental health problems. Interviews were audio-recorded via Zoom™ and transcribed and coded using NVivo. Analysis involved an iterative interpretative approach, including member checking of transcripts.

Findings: Twelve GPs in active clinical practice were interviewed by Zoom™ or face-to-face throughout May to July 2023. Their experiences fell into two themes: (i) GPs experiences as essential providers of mental health care and (ii) GPs guiding children through the ‘maze’ that is the mental health system. These also include subthemes which discuss key experiences of complex care such as diagnosing and rapport building in this patient population and the barriers faced when trying to fight for access in a fragmented system.

Implications: This study has highlighted the crucial but under-supported role of GPs within the paediatric mental health care system. They are providers of care and a gateway to the healthcare system, helping patients navigate the convoluted mental health space. Participant experiences supported the need for a range of policy and educational interventions such as fostering interprofessional partnerships, optimising remuneration and addressing systemic strain on psychological services.

36. Digital interventions for hypertension in primary care: an umbrella review of the evidence

Stephen Catherine^A and Halcomb Elizabeth^A

^AUniversity of Wollongong.

Background: Hypertension causes more deaths and disease than any other biomedical risk factor. Over the last 30 years, the number of people with hypertension has doubled to over 1.2 billion globally. Even in those known to have hypertension, blood pressure is often not effectively controlled. Digital interventions represent a potential strategy to support people to build the self-management capacity vital to risk factor reduction and effective blood pressure control. Despite the allure of digital interventions such as telehealth and digital applications, the implementation and impact of digital interventions are poorly understood.

Aims/objectives: This umbrella review sought to critically synthesise the current evidence around digital interventions in primary care to support hypertension management.

Methods: CINAHL and Medline databases were searched to identify peer-reviewed systematic reviews published between 2014–2024. Systematic reviews were included if they explored the use of digital interventions in primary care with people who had known hypertension. Papers were excluded if they focussed on specific patient groups (e.g. racial groups or specific co-morbidities). Data were exported into Covidence for screening.

Findings: Eight systematic reviews were included in the review. Three reviews focussed on telehealth, four on applications for education and self-care, and the remaining review on a combination of telemonitoring and app-based intervention. Included reviews demonstrated variable impact on blood pressure outcomes. Findings highlighted the importance of building capacity in primary care health professionals to deliver and participate in the interventions.

Implications: Digital interventions can potentially overcome key barriers in primary care-based hypertension management. However, understanding the lessons from the existing literature will ensure that future models are designed to incorporate best practice principles. Additionally, lessons from the literature help to guide future research on digital intervention for hypertension and other chronic conditions.

37. A trial protocol for infection prevention in below-knee flap and graft procedures in general practice

Heal Clare^A, Rosengren Helena^A and Hall Leanne^A

^AJames Cook University.

Background: Tropical North Queensland has a high incidence of skin cancer, contributing significantly to general practitioner workload, exacerbated by limited access to specialist care. Surgical site infection (SSI) rates after skin excisions are high in the region, particularly in complex flap and graft surgeries below the knee. Australian guidelines do not recommend antibiotic prophylaxis, despite global concerns about antibiotic resistance and evidence supporting pre-operative bacterial load reduction methods.

Aims/objectives: This trial aims to evaluate the effectiveness of antibiotics and bacterial load reduction in reducing SSI in patients undergoing flap or graft procedures for below-knee skin cancer treatment, potentially reducing patient morbidity and minimising oral antibiotic use.

Methods: This randomised double-blinded placebo-controlled trial, conducted at three primary care skin cancer clinics will recruit 155 participants over a nine-month period. Participants will be randomised to one of three groups: (1) 450 mg oral clindamycin pre- and post-surgery, (2) pre-operative chlorhexidine wash and nasal mupirocin, (3) standard care (control). The primary outcome will be incidence of SSI in the 30 days following surgery. Secondary outcomes include adverse reactions to clindamycin, mupirocin or chlorhexidine wash, patterns of antibiotic resistance, and cost analysis. Primary analysis will be by intention-to-treat.

Findings: Antibiotic resistance is of global concern and has a causal relationship to consumption. Australia’s antibiotic consumption is more than double that of the lowest prescribing Nordic countries, highlighting the urgent need to reduce it to combat antibiotic resistance globally. Through bacterial load reduction, our trial aims to minimise antibiotic usage, foster antibiotic stewardship, and lower the rate of surgical site infections, whilst enhancing patient outcomes.

Implications: Despite the trial’s focus on a rural setting with high baseline infection rates, its feasibility, demonstrated by previous studies, and potential to influence clinical practice underscore its significance and potential for immediate translation into broader healthcare contexts.

38. Navigating risk in general practice: unveiling clinical prediction rules for surgical site infection after minor surgery

Heal Clare^A and Hall Leanne^A

^AJames Cook University.

Background: Australia has the highest skin cancer incidence globally, predominantly treated surgically, where surgical site infections (SSI) can lead to prolonged healing and increased healthcare costs. While routine antibiotic prophylaxis post-dermatological surgery is not routinely recommended, identifying high-risk patients is crucial amidst emerging antibiotic resistance. Understanding patient and procedural risk factors is vital for accurately defining patient at high risk of SSI, particularly in general practice settings where infection rates may exceed the accepted norm, making risk stratification imperative for effective prophylaxis selection.

Aims/objectives: This study aimed to develop a clinical prediction rule to identify individuals at high risk of SSI, who might benefit from prophylactic antibiotic intervention.

Methods: Data (patient demographics, lesion characteristics and surgical details) from four randomized controlled trials were combined. Variables were selected based on bivariate analysis, clinical knowledge, pragmatism and model parsimony, with age, sex, histology, lesion site, excision type, and comorbidities considered. Logistic regression modeling and bootstrapping were used for internal validation. Patient infection probabilities were calculated, with sensitivity, specificity, positive and negative predictive values and number needed to treat determined at various thresholds, risk factor points assigned to generate scores, and the model’s net benefit compared to universal or no antibiotic treatment strategies.

Findings: From analysis of 3819 patients, age >55 years, premalignant/malignant histology, lesion site, and complicated excisions emerged as significant predictors of SSI. The final model demonstrated good discrimination (area under the curve = 0.704, C-statistic = 0.704) and calibration.

Implications: This prediction rule offers a pragmatic tool for general practitioners, aiding pre-surgical risk assessment and decision-making regarding antimicrobial prophylaxis. By targeting high-risk patients, unnecessary antibiotic use can be reduced, addressing concerns of antibiotic resistance while optimising patient outcomes. Future validation studies across diverse settings are warranted to enhance generalisability and support broader adoption of the prediction model.

39. Temporal trends in tranexamic acid prescribing for heavy menstrual bleeding by Australian general practice trainees

Hamilton Kristen^A, Magin Parker^B, Tapley Amanda^C, Davey Andrew^C and Hespe Charlotte^A

^AUniversity of Notre Dame.

^BUniversity of Newcastle.

^CRoyal Australian College of General Practitioners.

Background: Heavy menstrual bleeding (HMB) is common, and leads to iron deficiency, anaemia, and reduced quality of life. Tranexamic acid is more effective than oral hormonal medications to treat HMB, but less often prescribed by general practitioners (GPs).

Aims/objectives: This study investigated whether tranexamic acid prescribing by Australian general practice trainees (GP registrars) has increased over time.

Methods: Longitudinal analysis was completed within the Registrar Clinical Encounters in Training (ReCEnT) cohort study (2010–2023). In ReCEnT, details of 60 consecutive consultations are documented by Australian GP registrars 6-monthly. Temporal trends in tranexamic acid prescribing for HMB were examined using multivariable mixed effects logistic regression, both overall, and with respect to oral hormonal medications.

Findings: 4717 registrars documented details of 713,480 consultations. Medications were prescribed in approximately half the consultations with HMB as a problem or diagnosis (47%). Tranexamic acid was prescribed in 17% of HMB consultations. The adjusted odds of prescribing tranexamic acid increased annually by 12% among all HMB problems (OR 1.12, 95% CI [1.04, 1.20], P = 0.004), and 18% annually for HMB problems in which tranexamic acid or oral hormonal medications were prescribed (OR 1.18, 95% CI [1.03, 1.36], P = 0.019). When GP registrars sought advice from their GP supervisor, the odds of prescribing tranexamic acid were about one third the odds of prescribing oral hormonal medications (OR 0.36, 95% CI [0.14, 0.92], P = 0.034).

Implications: The increasing prescribing of tranexamic acid for HMB, both overall and compared to oral hormonal medications, suggests an appropriate evidence-based response during the study period. Future research could investigate whether a similar temporal trend has occurred in established GPs. The association between GP supervisor consultation and oral hormonal medication prescribing rather than tranexamic acid suggests GP supervisors may be slower to implement this evidence in practice than registrars.

40. CAC-GP: understanding the use of Coronary Artery Calcium scoring by Australian general practitioners

Hanna Shaddy^A, Laranjo Liliana^A, Kang Melissa^A and Chow Clara^A

^AUniversity of Sydney.

Background: General practitioners (GPs) have a pivotal role in primary prevention of cardiovascular disease (CVD). Recent guidelines on CVD risk assessment introduced recommendations on the use of Coronary Artery Calcium (CAC) scoring by GPs as a tool to improve risk assessment in situations where traditional risk calculators may underestimate risk. CAC scoring involves the use of a computed tomography scan of the heart to measure the amount of calcium in the coronary arteries. Higher scores correlate with increased CVD risk and can be used to improve CVD risk prediction accuracy for patients with low-intermediate CVD risk. It is highly specific, non-invasive, widely available in Australia, and relatively low in radiation dose. However, the current utilisation of CAC scoring by Australian GPs is not well understood.

Aims/objectives: To better understand how Australian GPs make decisions about utilising CAC scoring in CVD risk assessment.

Methods: Semi-structured interviews with Australian GPs working in NSW will take place between May–July 2024 via telephone, video conference, or in person. Initial, open-ended exploratory questions will include asking GPs about how they make decisions about CVD risk assessment, with probes such as patient, practice, and GP factors, including questions about their use of CAC scoring. De-identified written transcripts of interviews will be analysed inductively using thematic analysis via coding with QSR NVivo software. A small amount of quantitative demographic data will be collected before the interview and reported descriptively.

Findings: We expect preliminary findings from this study will be available in August 2024.

Implications: The primary implication of this study is to address a gap in the literature about GP perspectives on the use of CAC scoring in CVD risk assessment. We expect this will better inform future guidelines around the use of CAC scoring in CVD risk assessment within general practice.

41. From BEACH to OCEAN – the OCEAN GPN tool

Harrison Christopher^A

^AUniversity of Sydney.

Background: There are over 14,000 general practice nurses (GPNs) in Australia, making them one of our largest primary care workforces. However, little is known about GPN clinical activity. The 10-year Primary Health Care Plan emphasised the need for team-based care; accurate data are required for making evidence-based policy decisions to strengthen primary care. The Occasions of Care Explained and ANalysed (OCEAN) tool, an electronic adaptation of the Bettering the Evaluation and Care of Health (BEACH) methods, is an ideal data collection strategy.

Aims/objectives: (1) To adapt the validated OCEAN GP tool to the OCEAN GPN tool, (2) complete Alpha testing with GPN academics, and (3) complete Beta testing with clinical GPNs.

Methods: The OCEAN GP tool was reviewed in terms of questions and structure by nurse academic team members and items were modified to be GPN appropriate. Alpha testing involved interviews with seven GPN and/or primary care academics. It was conducted and recorded over Zoom with an RA. Each Alpha participant was asked to create an account and enter data from several hypothetical patient encounters. While entering this information they were asked to ‘think-aloud’ to identify aspects of the tool that were confusing or unintuitive. Improvements were made based on this feedback. For Beta testing, 15 clinical GPNs entered similar data from several vignettes of hypothetical patient encounters, using the ‘think-aloud’ method. Each Beta participant also completed a feedback survey about the tool’s usability and functionality.

Findings: Participants highlighted the value of encounter data to the profession, employers, and policy makers. The tool was rated as easy to use, although there was a need to include additional GPN-specific clinical terms.

Implications: The OCEAN GPN tool will facilitate collection of standardised GPN clinical activity data to inform policy and strengthen team-based care in general practice.

42. Assessing and managing patients with hypertension: current practices of Australian GPs

Hoon Elizabeth^A, Edwards Jessie^A, Frank Oliver^A and Stocks Nigel^A

^AUniversity of Adelaide.

Background: Studies consistently report that blood pressure (BP) control is not achieved for about half of those treated. In Australia, where there are current calls to employ population health approaches to improve BP control, the role of primary care in tackling this burden should not be underestimated as it represents the most frequent condition seen in general practice.

Aims/objectives: This study aims to gain an in-depth understanding of GPs’ current practices and attitudes to assessing and managing hypertension.

Methods: This qualitative exploratory study uses purposive sampling for range (rural/ urban, GP length of experience, varying patient groups). In-depth semi-structured interviews (via phone or online conferencing) with 14 GPs have been conducted and reflective thematic analysis completed. This study is part of a larger research program exploring the potential of using AI technologies as tools for BP management.

Findings: Three key themes were generated: (1) confidence in clinical judgement and approach to BP management: GPs have developed locally-appropriate diagnosis and management approaches, including ‘go-to’ agents, from their experience, informed by clinical guidelines/recommendations, and specialist support when occasionally required. (2) Treating the whole patient: GPs balance the patients’ complexity of needs (medical and other), capacities (including living circumstances, services and medication access), and preferences, such that achieving BP targets may not always be prioritized (especially for older people with co-morbidities). (3) A pragmatic approach to BP control in primary care is required: GPs recognized the need to treat high blood pressure but expressed a considered tolerance for not always achieving targets, balancing risk within their long-term clinical relationships with patients.

Implications: Given current policy discussions about therapeutic inertia in BP control, it may be worthwhile expanding this concept to account for GPs’ whole patient approach, including the GP and patient’s balancing of complex health and other needs.

43. All is not equal: multimorbidity varies across population groups

Hourigan Tim^A, Bayliss Tylie^A and Monahan Kevin^A

^AAustralian Institute of Health and Welfare.

Background: Estimates of multimorbidity (having two or more selected long-term health conditions) typically differ due to condition inclusions and cohort criteria. Previous Australian Institute of Health and Welfare (AIHW) reporting of multimorbidity has focused on 10 chronic conditions, common among older Australians.

Aims/objectives: This study used self-reported Australian Bureau of Statistics (ABS) 2022 National Health Survey (NHS) data to investigate and report on multimorbidity by demographic and geographic variables. The report builds on previous multimorbidity reporting by expanding the range of chronic conditions to include conditions commonly diagnosed at younger ages.

Methods: Estimates are based on analysis of 72 long-term health conditions self-reported to the NHS, to provide a more robust estimate of multimorbidity across all ages. Prevalence estimates of multimorbidity were analysed for the 2022 reference period, and reported by Australian Statistical Geography Standard (ASGS) Remoteness Structure, Socio-Economic Indexes for Areas (SIEIFA), age and sex.

Findings: The prevalence of multimorbidity differs across population groups. In 2022, the estimated prevalence of multimorbidity was: (i) higher among females compared with males (38%, and 37%, respectively), affecting 9.7 million Australians (38%); (ii) 1.4 times as high among those living in areas of most disadvantage compared with people living in areas of least disadvantage (44% and 31%, respectively); (iii) 1.3 times as high among people living in Outer regional and remote areas compared with major cities (45% and 35%, respectively).

Implications: Broadening the scope of conditions included in multimorbidity reporting to encompass Australians of all ages will increase demographic and condition coverage and will serve as a foundation for monitoring the prevalence of multimorbidity and disease trajectory across different life stages. Utilising the multi-morbid cohort identified in this study will enable the use of linked data to investigate the variation in treatment pathways and health service use across population groups.

44. Current practice and perceived role of optometrists in providing diabetes self-management education in the primary eyecare context

Hui Flora^A, Piano Marianne^B and Hart Kerryn^C

^AUniversity of Melbourne.

^BNational Vision Research Institute, Australian College of Optometry.

^COptometry Australia.

Background: In 2023, Australian optometrists could become accredited diabetes educators, due to their role in providing diabetic eyecare. Offering diabetes self-management education (DSME) in primary eyecare settings increases patient access for this established, proven intervention. However, the current extent of, and confidence in providing DSME by optometrists is unknown. Perceived feasibility of accreditation requirements, and opinions about optometrists’ role in providing DSME, may impact uptake of educator training.

Aims/objectives: (i) Explore current practice of Australian optometrists regarding providing DSME in routine eye examinations. (ii) Explore perceptions of Australian optometrists on optometrist’s role in providing DSME.

Methods: We conducted an online survey of Australian optometrists, advertised through professional body, Optometry Australia, flyers at Australian College of Optometry, and at a major national optometry conference.

Findings: Forty-one optometrists participated, seeing a mean 2.5 ± 1.5 people daily with diabetes. Optometrists spent mean 5.2 ± 3.8 minutes discussing diabetes eyecare. Regarding level of DSME provision, all respondents explained the impact of diabetes upon eye health, and majority emphasised importance of blood sugar control (92.7%). Fewer discussed nutrition (46.3%), smoking (41.5%) or physical activity (31.7%). Approximately half felt some confidence in providing this advice/education, three optometrists (7%) felt they lacked confidence. Only 31.7% felt able to meet credentialling requirements. Integrating DSME into a longer routine consultation was preferred (58.5%). When asked about perceived role in DSME provision, respondents described a variety of roles, including as part of primary eyecare services (61%) and/or in team care (65.9%).

Implications: Many Australian optometrists feel unable to meet current credentialling requirements, but majority already integrate some DSME into consultations. Education on key topics (nutrition, smoking, physical activity) are not provided by everyone. Optometrists may benefit from further training on DSME provision in routine eye examinations, but uptake of credentialling appears unlikely to be widespread in primary eyecare.

45. ‘Do they think I’m good enough?’: General practitioners’ experiences when treating doctor-patients

Hutton Claire^A, Kay Margaret^B, Round Penny^A and Barton Chris^A

^AMonash University.

^BUniversity of Queensland.

Background: When doctors seek medical care, there is evidence that the treating doctor can struggle to provide optimal treatment. Doctor-patients should be treated like any other patient, but this is challenging for the treating doctor.

Aims/objectives: To explore the experiences of general practitioners (GPs) caring for doctor-patients; to investigate whether GPs believe they treat doctor-patients differently to other patients and if so, in what ways, for what reasons, and how this impacts their provision of care.

Methods: In-depth interviews were conducted with 26 GPs. Analysis of deidentified transcripts followed the tenets of pragmatic grounded theory, with emergent concepts grouped under key themes. The evolving understandings were used to develop a model to make sense of GPs’ experiences caring for their doctor-patients.

Findings: Core aspects of GPs’ experiences of treating fellow doctors centred around concepts of respect and collegiality. These play a central role in mediating how a treating doctor experiences a consultation with a doctor-patient. GPs shared that the use of medical language (and assumptions about the doctor-patient’s knowledge/behaviours), decisions around testing, exploration of sensitive issues, and negotiating shared decision-making were areas in which their treatment could vary when caring for a doctor-patient. Treating doctors were often more anxious about errors and were concerned about scrutiny from medical peers. Decisions to treat the doctor-patient differently were driven by a desire to maintain a sense of collegiality, to meet their doctor-patient’s expectations, and to appear competent. These factors could influence the quality of care provided.

Implications: Medical socialisation, with its emphasis on collegiality and respect, plays a significant role in the dynamics of the therapeutic relationship when a doctor treats a doctor-patient. Current guidelines make little reference to these dynamics but doctors need evidence-informed training to navigate these challenges and ensure they can effectively deliver quality care to their doctor-patients.

46. Social prescribing in Western Sydney primary healthcare: a strengths-based approach

Jaja Jessica^A

^AWestern Sydney Primary Health Network.

Background: Social Prescribing pertains to non-pharmaceutical interventions, including social networks, food banks, and nature-based solutions. Prescribing non-pharmaceutical methods of care in the Primary healthcare space has been evidenced in Australia and worldwide, with implications for chronic disease and mental health condition management. However, many studies have established barriers, being the understandings and perceptions of social prescribing amongst both primary care practitioners, and their patients. Moving away from these barrier-focused views, and taking a strengths or assets-based approach, is pivotal. The Western Sydney region is home to many culturally and linguistically diverse, and Aboriginal and Torres Strait Islander groups; who, research has shown, benefit from social prescribing in the management of mental health and chronic metabolic diseases. Taking a strengths-based approach involves mapping, understanding, and empowering current community assets (community healthcare, NFP organisations, businesses, policy and legislative drivers), and investigating ways in which social prescribing can be integrated within these assets to increase disease prevention and management in the community.

Aims/objectives: To understand barriers to social prescribing in the region of Western Sydney – amongst primary care practitioners, and their patients. To pair these barriers with existing community assets and investigate ways that social prescribing can be integrated within these.

Methods: Mixed methods data collection. Quantitative: survey/questionnaire – understanding Western Sydney patients’ experiences, understandings, and perceptions of social prescribing. Data mapping – utilising data from publicly available sources (AIHW, ABS, HealthDirect) and PHN-collected data (Western Sydney PHN) to map community assets and strengths Qualitative: Focus Group 1 – consulting Primary care providers on the needs of their patients and communities regarding social prescribing, and their understandings of, and interactions with community service assets. Focus Group 2 and unstructured interviews – consulting with community leaders, community healthcare providers, and community/NFP organisation representatives in order to asset-map services in the region, and discuss feasibility of integration. Data analysis will follow Grounded Theory Methodology.

Findings: This Study is in progress. Preliminary findings show (i) community organisations are well-positioned to partner with primary healthcare to provide social prescribing initiatives, yet knowledge of these services amongst providers is not ubiquitous. (ii) Data of current community healthcare services is incomplete, and requires further investigation. (iii) First Nations community perceptions of social prescribing is more positive than non-Indigenous groups. This is due to alignment of non-pharmaceutical interventions with traditional Indigenous practices (i.e. focusing on spiritual health, connection to Country, engaging with social networks/mob etc.).

Implications: Social Prescribing recognises that health and well-being are influenced by more than the physical, including sociocultural, spiritual, economic, and environmental determinants. The focus of this research is to break cycles of disadvantage in health, through assets and strengths-based programs and policy in primary and community healthcare. This research will be used as an evidence base to formulate policies and advocacy to promote the increased adoption of social prescribing, in the community of Western Sydney, across NSW, and nationally.

47. General practitioner experiences of an online community of practice to support sexual and reproductive healthcare

James Sharon^A, Mazza Danielle^A, Melwani Satish^A, Black Kirsten^B, Bateson Deborah^B, Angela Taft Emeritus^C and Norman Wendy^D

^AMonash University.

^BUniversity of Sydney.

^CLa Trobe University.

^DUniversity of British Columbia.

Background: Long-acting reversible contraception (LARC) and medication abortion (MA) services are largely provided by general practitioners (GPs). The Australian Contraception and Abortion Primary Care Practitioner Support (AusCAPPS) Network is a national online community established to support GPs, practice nurses and community pharmacists in building the knowledge and confidence to provide this care. Some 60% of the 2500+ AusCAPPS members are GPs.

Aims/objectives: To explore GPs’ experiences of using AusCAPPS and how it supported LARC and MA provision.

Methods: Participants were AusCAPPS GP members for at least one year. Semi-structured interviews were conducted from October until December 2023. Following audio-recording and verbatim transcription of data, we conducted reflexive thematic analysis.

Findings: From 20 participants, they were mostly female (n = 19, 95%), and had provided LARC (n = 6, 30%) and/or MA (n = 10, 50%) for 1–5 years. AusCAPPS facilitated participant peer connection, collaboration, knowledge exchange and supported their professional development and confidence to provide LARC/MA care. Important components of this were being kept up-to-date about national developments and having access to evidence-based tools such as how to set-up/provide a LARC/MA service. AusCAPPS communications via email notifications and weekly newsletters supported participant engagement. Simplifying the login process and enhancing mobile-friendly usability were areas for improvement. Participants wanted more information about mentoring programs and requested summarised resources for practice use.

Implications: Participants were positive about AusCAPPS and how site features supported engagement through peer networking opportunities and access to expert advice and resources. To support site sustainability, the inclusion of participant content suggestions and improvements to site access and usability are needed. Future research could include more male perspectives. AusCAPPS supports primary care provision of LARC/MA services. Further research is needed to analyse site analytics, understand members’ engagement with site content, and to determine whether AusCAPPS has influenced broader uptake of these practices, increasing LARC and/or MA providers.

48. Strategies to address the implementation of management support for people at risk of frailty in general practice

Job Jenny^A, Clark Deb^B, Strauss Ruby^A and Nicholson Caroline^A

^AUniversity of Queensland.

^BSydney North Health Network.

Background: Frailty, linked with unnecessary hospital admissions and emergency department visits, is associated with substantial health care costs. Frailty often remains undetected in primary care and recommendations are to build frailty identification and management into primary care workflows to support those patients identified as pre-frail/frail. Incorporating screening into the 75+ health assessment is an effective method for identifying risk of frailty in primary care, yet barriers exist to patients accessing risk of frailty management options.

Aims/objectives: Our study aimed to understand (1) determinants, and (2) inform strategies to implement risk of frailty management in primary care.

Methods: Using the FRAIL Scale Tool practice staff screened eligible patients (≥75 yrs) for the five frailty indices (fatigue, resistance, ambulation, illness, weight loss), referred to the associated management options, and recorded patient barriers. Semi-structured qualitative interviews are being conducted with practice staff and patients to understand determinants to implementing risk of frailty management in primary care. Interview transcripts are being coded deductively guided by CFIR. The thematic analysis will inform ERIC implementation strategies.

Findings: The Tool was implemented by 33 general practices. Pre-frail and frail patients were predominantly referred for exercise interventions, medication reviews, and depression assessment. To date qualitative interviews have been conducted with 14 participants (n = 13 practice staff, n = 1 patient). Early analysis suggests determinants of risk of frailty management implementation are related to knowledge and information about available resources, and partnerships and connection with allied health. Barriers to uptake by innovation recipients are health, cost, access, motivation, and acceptance of current state. Key implementation strategies identified are to access new funding, develop and distribute resource materials, and promote networking with local allied health.

Implications: Identification of determinants of risk of frailty management in primary care will inform implementation strategies for primary care to support patients to reverse or reduce frailty risk

49. Improving access to specialist support via an asynchronous general practitioner-to-specialist eConsultant service in Australia

Job Jenny^A, Nicholson Caroline^A, Donald Maria^A, Byrnes Joshua^B, McIntyre David^A and Jackson Claire^A

^AUniversity of Queensland.

^BGriffith University.

Background: With rising demand for outpatient services and limited health resources across Australia, patients experience excessive delays for specialist input, linked with subsequent deterioration in health. eConsultant, an outpatient substitution model, has been implemented internationally. Providing an asynchronous, digital, provider-to-provider advice service, eConsultant gives general practitioners (GPs) remote access, using secure messaging, to specialist support for patient care within 3 business days. GPs send a Request-for-Advice (RFA) to the specialist and advise patients to schedule a timely follow-up appointment to discuss the eConsultant advice.

Aims/objectives: We evaluated eConsultant service implementation across Queensland to determine if it would improve patient access to specialist input compared to a traditional outpatient service. The service commenced for general medicine and expanded to eight specialties (Endocrinology, Dermatology, Cardiology, Respiratory/sleep, Neurology, Infectious diseases, Renal, Obstetric-Medicine). The main outcomes were adoption, and patient access to the service.

Methods: Administrative service data was used to track eConsultant adoption, patient access, and time to specialist input. Stakeholders completed an optional close-out survey on their perceived value and quality (ratings 1–5) of the eConsultant advice.

Findings: RFAs have been generated for 393 patients from 122 GPs in 45 general practices. The mean specialist response time was 1.7 (SD 1.8) days and 72 RFA were classified as category 1 (urgent) and 204 as category 2 (semi-urgent). Patient access issues related to living in rural and remote regions (n = 160) and travel issues (n = 8) due to disability (e.g. dementia, Parkinson’s) or mobility issues (residential care). In 84% (74/88) of cases GPs rated the advice as excellent value for their patient management (median rating = 5).

Implications: eConsultant provides a sustainable, equitable option to improve access to timely specialist patient support, cost/ environmental savings for subsidised patient travel, and reduced preventable hospital admissions. This research supports broader eConsultant implementation across Australia.

50. Health information needs of young adults about e-cigarettes

Kamoni Tasneem Mahdi Adam^A, Selamoglu Melis^A, Osadnik Christian^A, Mehta Nikhil^A, Madawla Sanduni^A, Afzali Roya^A, Kotwas Susan^A, Turudia Kim and Barton Chris^A

^AMonash University.

Background: The long-term health impacts of e-cigarettes are largely unknown. This raises concerns about rising e-cigarette use among young adults. Studies have inadequately addressed the e-cigarette health information needs of young adults and where they seek such information.

Aims/objectives: We determined (i) prevalence of e-cigarette use in domestic and international university students (ii) young adults’ knowledge, attitudes and perceptions about the harms of e-cigarette use (iii) intentions to use e-cigarettes in the future and (iv) e-cigarette health information sources university students accessed.

Methods: Participants completed a short, online survey that assessed (i) prevalence of e-cigarette use, (ii) knowledge and health beliefs (iii) social norms, (iv) preferred sources of e-cigarette information and (v) socio-demographic variables. Respondents were recruited either in-person at a major Victorian University, through online student groups or, in waiting rooms of the University Health Service. Data were analysed using SPSS version 28.0.

Findings: We analysed data from 1094 young adults aged 18–25 years (mean = 20.4, SD = 1.8). Most identified as women (n = 536, 62.5%) and domestic students (n = 563, 74.6%). ‘Ever’ e-cigarette use was reported to be 25.9%. E-cigarette use was predominantly when socialising, but 7.1% reported use upon waking. Overall e-cigarette knowledge was moderate (mean = 3/5, SD = 1.1). E-cigarette use amongst peer groups was common (n = 495, 51.2%) and a third of non-users were curious about future e-cigarette use (n = 337, 32.9%). Health information was predominately sought from reputable sources such as non-government websites (77.3%), government websites (72.9%), GPs (67.9%), or university health services (61.3%). International students favoured less reputable sources: social media (39.2%), e-cigarette retailers (20.3%) and manufacturers (19.2%).

Implications: This is the largest study of e-cigarette use in Victorian university students conducted to date. The data provides a rich resource to guide health promotion and e-cigarette cessation action by university student’s health and well-being services.

51. Hub building blocks for migrant and refugee families and their children in the first 2000 days of life

Kumar Roshika^A,B, Ostojic Katarina^B, Hodgins Michael^C, Lyle Kim^D, Lawson Kenny^E, Eapen Valsa^F, Rimes Tania^G, Hu Nan^C and Woolfenden Sue^H

^AIngham Institute, South Western Sydney Local Health District.

^BUniversity of Sydney.

^CUniversity of New South Wales.

^DChild, Youth and Family Health Services, Northern Sydney Local Health District.

^EWestern Sydney University.

^FAcademic Unit of Child Psychiatry (AUCS) and Clinical Academic, South Western Sydney Local Health District.

^GChild, Youth and Family Services, South Eastern Sydney Local Health District.

^HThe Sydney Institute for Women, Children, and their Families, Sydney Local Health District.

Background: Evidence is emerging on the efficacy of Integrated Health and Social Care hubs (Hubs) to improve access to child and family health nursing services for developmental surveillance among priority populations including migrant and refugee populations. Hubs typically involve co-located and integrated public child and family health services and non-government organisations offering psychosocial services. There remains a dearth of evidence on successfully establishing and sustaining Hubs, which support service integration at a client and system level applicability, while maintaining relevance to migrant and refugee communities.

Aims/objectives: Our project aimed to identity establish the organisational design elements thar are used required to create Hubs, that are acceptable for to migrant and refugee populations, in across three sites (Miller, West Ryde and Rockdale) in Sydney, Australia.

Methods: Guided by the Consolidated Framework for Implementation Research by Damschroder et al. (2009), semi-structured interviews were conducted with service providers from health and social services (32 participants) and migrant and refugee parents (14 parents) of children who had accessed Hubs.

Findings: Interview findings were organised as step-by-step building blocks needed to establish migrant and refugee family health and social care hubs. These include the establishment phase steps of buy-in and partnership development to foster collaboration between health and social services, Hub coordination and navigation activities that enhance a Hub’s relevance for migrant and refugee families, and extended integration mechanisms, such as engagement of same language general practitioners.

Implications: This is the first study to explore the building blocks required to successfully establish Hubs for migrant and refugee families to optimise child health and development in the first 2000 days of a child’s life.

52. GPs’ experiences of managing patients in clinical trials carried out in secondary care: a qualitative study

Lam Tran^A, Shahab Yasin^A and Lau Phyllis^A

^AWestern Sydney University.

Background: Although the majority of clinical trial patients are monitored and followed up by specialised clinics or hospital specialists during the studies, general practitioners (GPs) continue to be their primary contact for general health advice and managing their other comorbidities. Our literature review found little research on the experience of GPs managing clinical trial patients, specifically when community-based care is not part of the trial protocols. Anecdotal evidence nonetheless seems to suggest that GPs are often not informed of their patients being enrolled in clinical trials, and there is lack of information from clinical trial researchers and perceived impact on optimal care provision for patients. Australian GPs already spend a significant amount of unpaid time on patient care between consultations and should be well-supported to manage patients in clinical trials.

Aims/objectives: (i) to explore the experiences of GPs who have cared or are caring for patients enrolled in specialised clinic or hospital-based clinical trials; (ii) to explore GPs’ roles and their views about being involved as researchers in such clinical trials; and (iii) to make recommendations to address any challenges identified.

Methods: This phenomenological study will use in-depth semi-structured interviews with eligible GPs recruited using purposive, snowballing and convenience sampling approaches. Interviews will be transcribed, inductively coded and thematically analysed.

Findings: Ethics approval is currently being sought. It is envisaged that recruitment and interviews of GPs will commence in May. Findings will be presented at the AAAPC Conference.

Implications: Findings can potentially inform future designs of secondary care clinical trial protocols to support GPs in their management of patients and to ensure patient’s safety during and after clinical trials. This study may also provide further evidence to support the active involvement of GPs as researchers in such clinical trials.

53. Charting the path: early lessons learnt from establishing the Western Sydney Primary Care Practice-Based Research Network (WestReN)

Lau Phyllis^A, Abbott Penny^A, Alofivae-Doorbinnia Olataga^B, Brooks Miriam^A, Burke Michael^C, Cochrane Natalie^D, Cosgriff David^E, Seng Lim Kean^D, Lo Winston^A, Osuagwu Uchechukwu L^A, Perry Tim^F and Shahab Yasin^A

^AWestern Sydney University.

^BPowell Street Family Practice.

^CKildare Road Medical Centre.

^DMt Druitt Medical Centre.

^EAllambie Medical Practice.

^FWestern Sydney Primary Health Network.

Background: Practice-based research networks (PBRNs) are defined as ‘sustained collaborations between practitioners and academicians dedicated to developing relevant research questions, working together on study design and conduct, and translating new knowledge into practice’. In the Australian context, they function to ‘foster research in general practice through opportunities to learn more about how to undertake and participate in research, and assist in translating new knowledge into practice’ and ‘offer clinicians the chance to contribute to research by posing questions of importance to quality clinical care’. PBRNs play a significant role in bridging the gap between research and practice to generate and apply knowledge to improve the quality of primary care and impact the health and well-being of Australians. Following 2 years of a slightly informal system of engagement with affiliated general practices and Aboriginal Medical Services in collaborative research, Western Sydney University (WSU) systematically established a PBRN in 2023 – WestReN. Greater Western Sydney and surrounding regions are areas of fast growth and rapid development, with distinctive health care needs associated with culturally diverse populations, including high burden of chronic and complex health conditions. A PBRN based at WSU facilitates participation from practices associated with the university, particularly practices from local regions, in high-quality research on issues that matter to the Australian community.

Aim and intended educational outcomes: We will share and discuss the insights from establishing WestReN. Our workshop aims to equip participants with a comprehensive understanding of the challenges, accomplishments, and lessons learnt from this endeavour. Through interactive sessions and engaging discussions, attendees will gain practical knowledge and strategic insights essential for fostering similar initiatives in their academic institutions.

Format: Our workshop will integrate presentations from WestReN members and various interactive elements such as ‘post-it notes’ brainstorming sessions, and fun and engaging online interactive activities (e.g. online quizzes, word clouds) to foster active participation and collaborative learning, and explore the audience’s perspectives, and encourage reflections and idea generation. This creative approach ensures that attendees actively engage to develop real world insights.

Content: The workshop will provide a comprehensive overview of the multifaceted aspects of establishing a PBRN. From conceptualization and strategic planning to implementation and sustainability, each stage of the process will be discussed and explored in-depth. It will highlight the importance of enhancing stakeholder engagement, particularly in research capacity building, improving understanding of research processes and the value and use of general practice and primary health care data, and identifying opportunities in driving the success and sustainability of PBRNs. Participants will have the opportunity to ask questions, share best practices and their own experiences, and engage in interactive exercises to gain practical insights into overcoming common challenges and maximising opportunities in establishing PBRNs.

Intended Audience: We aim to empower participants to initiate and sustain impactful practice-based research networks within their academic communities. This workshop is designed for a diverse audience comprising academics, researchers, practitioners, administrators and policymakers interested in networking with like-minded colleagues to resolve some of the barriers to enhancing collaborative PHC research and research outputs.

54. General practitioners’ attitudes towards prescribing psychostimulant medication for management of ADHD in adults

Lau Jasmine^A and Kang Melissa^A

^AUniversity of Sydney.

Background: There is increasing awareness of attention deficit hyperactivity disorder (ADHD) persisting beyond childhood, as well as new diagnoses made in adulthood. In Australia, there are systemic barriers for adults with ADHD in accessing prescriptions for psychostimulants, which are recommended as the most effective means of reducing core symptoms. The current model of care relies on psychiatric specialist availability, which is limited by a lack of publicly funded services, prolonged wait times for appointments and increasing out-of-pocket costs. This inequity in access is exacerbated by varying regulations regarding psychostimulant prescribing that differ across states and territories. It has been suggested that general practitioners (GPs) could take on a greater role with expanded prescribing rights to initiate, adjust and vary psychostimulants. However, there is no recent qualitative research on GPs’ views on their role in ADHD care.

Aims/objectives: This qualitative study explores GPs’ attitudes towards this potential expansion of prescribing rights in comparison to current prescribing restrictions and explores their perspectives on alternative models of care for adults with ADHD.

Methods: We will interview Australian GPs with an interest in ADHD care from metropolitan, regional and rural NSW, in semi-structured one-to-one and/or focus group interviews. GPs will be recruited via professional networks using purposive sampling and passive snowballing. After interview transcription and data coding, reflexive thematic analysis will be applied to the data.

Findings/Implications: The study is currently being reviewed by the Human Research Ethics Committee at the University of Sydney. We anticipate that data collection and analysis will begin in June 2024, with both the research protocol and any preliminary findings available at the time of the conference. Findings will provide GP-led insights to inform potential new models of care, to address current inequities adults with ADHD experience in accessing timely and appropriate care.

55. A general practice toolkit to promote physical activity among people living with cancer

Lawrence Renae^A, Burton Nicola^B, Uebel Kerry^A, Ansari Sameera^A, Markoff Sonia^B, Farley Morgan^A and Vuong Kylie^C

^AUniversity of New South Wales.

^BConsumer Representative.

^CGriffith University.

Background: People living with and beyond cancer into survivorship are at an increased risk of long-term sequalae of their primary disease and treatment, and other chronic diseases. Physical activity is an important strategy to reduce the risk of cancer recurrence, cancer-specific and all-cause mortality, and for the management of disease- and treatment-related side effects. Despite established benefits, most patients don’t receive physical activity recommendations and few meet the exercise oncology guidelines. Barriers to general practice staff promoting physical activity to cancer survivors include limited knowledge and access to relevant resources. As such, there is a need to build capacity in general practice to support cancer survivors to engage in and maintain physical activity.

Aims/objectives: This pilot project aims to develop, implement and evaluate the acceptability, feasibility, and utility of a general practice toolkit to assist general practitioners (GPs) and practice nurses (PNs) to promote physical activity among cancer survivors.

Methods: We will develop, implement and evaluate a toolkit for GPs and PNs to promote physical activity to cancer survivors. We will recruit 15 GPs and PNs across general practices based in NSW and Queensland and will provide the toolkit for a 3-month period. Evaluation will use a mixed-methods approach including pre- and post-intervention surveys and a semi-structured interview.

Findings: We plan to begin data collection from June 2024.

Implications: This research will provide information on the acceptability, feasibility and utility of a targeted, prevention intervention to build capacity among GPs and PNs and address an area of need within cancer survivorship. The research findings will inform future implementation trials.

56. Avoiding anti-inflammatories: a randomised controlled trial testing the effect of an eHealth information package on primary health care patient medication knowledge and behaviour in Aotearoa New Zealand

Leitch Sharon^A, Smith Alesha^A, Zeng Jiaxu^A and Stokes Tim^A

^AUniversity of Otago.

Background: Patient medication knowledge and health literacy affects patient safety. Taking angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin II receptor blockers (ARBs), with diuretics and anti-inflammatory medications (NSAIDs) is nephrotoxic. An eHealth information package was developed in conjunction with with a wide range of stakeholders for patients, who may not know of this risk.

Aims/objectives: To assess the impact of the eHealth information package on patient knowledge and behaviour.

Methods: This is a two-arm, parallel, randomised control trial. Participants were primary health care patients prescribed an ACE-i or ARB plus a diuretic. A knowledge quiz and NSAID use survey were undertaken at baseline and repeated after 2 weeks. An eHealth information package was made available to participants in the intervention group after completing the baseline assessment. Both intervention and control groups could access normal GP care throughout the study. The primary outcome measures were change in knowledge scores and in NSAID use between pre-intervention and post-intervention assessment.

Findings: The 201 participants who completed the study had high baseline NSAID medication knowledge, which did not change at follow-up. The difference between the study arms in knowledge score change was 0.57/10 (95% CI −0.42, 1.57). NSAID use decreased in both study arms but reduced by a greater amount in the intervention group. The difference between study arms for NSAID use reduction was 7.8% (95% CI 1.4, 14.2). The information package was considered acceptable and useful.

Implications: This tailored eHealth information package may reduce NSAID use in patients at increased risk from NSAID-related harm. The package was initiated independently from any primary care setting, which holds promise for reducing the burden of in-person medication information sharing in general practice and pharmacy settings. Further development and testing of eHealth educational interventions for patients may prove similarly beneficial.

57. Demystifying the publishing journey

Lewis Virginia^A, Sturgiss Liz^B, Ratnaike Deepika^A, Peart Annette^C, Williams Anna^D and Preston Robyn^E

^ALa Trobe University.

^BMonash University.

^CTurning Point.

^DWestern Sydney University.

^ECentral Queensland University.

Aim and intended outcomes: This workshop is presented by the Australian Journal of Primary Health (AJPH) and CSIRO Publishing. An important aspect of knowledge dissemination is publishing about research and innovation in research journals. Many researchers find the publishing process mysterious and are disheartened after their experience of the peer review process. The role of the peer reviewer is crucial in academic publishing. Timely publication of high-quality research and innovation depends on responsive, effective peer review. Acting as a reviewer is a highly effective way to develop academic writing skills, including how to evaluate manuscripts for quality, and communicate appropriately to authors. Potential peer reviewers may not understand the nature of the task or be aware of the potential benefits and an opportunity to actively engage with academic publishing. This interactive workshop presented by the editorial team at the AJPH is for researchers and health professionals who have a desire to publish in academic journals and/or be actively involved in the publishing process. The purpose of the workshop is to enable participants to get the most out of the peer review process – whether this is an author or a reviewer. The workshop will accelerate the acquisition of skills, knowledge and confidence that are usually gained over time through experience. The learning outcomes of this workshop include: (i) greater understanding of the publishing journey and the roles of editors, publishers, authors and reviewers; (ii) improved skills in preparing articles for targeted journals; (iii) improved skills in responding to reviewers’ feedback; (iv) increased skill and confidence to be an effective reviewer; (v) increased motivation to share skills with the broader primary care research community; (vi) increased connectedness with the broader research community.

Format: The workshop will be engaging and focused on knowledge and skill building. The format of the presentation will be: (i) 40% didactic presentation; (ii) 30% task-driven work including individual and small group work (approximately five people); and (iii) 30% group discussion with support/facilitation from AJPH editors.

Content: The workshop will consist of two main parts: an overview of the publishing process, followed by activities focused on the peer review process from the perspective of authors and reviewers. Members of the AJPH editorial team will provide an overview of the academic publishing process. Participants will have hands-on experience considering what a good (and bad) review looks like and how to respond to both. Participants will take part in a group activity targeting knowledge, skills and confidence to prepare a (high quality) review of a manuscript.

Intended audience: This conference workshop aims to build skills in early to mid-career researchers by introducing them to the publishing journey. The material will be relevant to participants who have commenced their publishing journey and those who are well on their way. The workshop has capacity for 50–75 participants.

58. Trends in diabetes monitoring and diabetes control among Aboriginal and Torres Strait Islander Peoples attending general practice: a comparison between urban and rural locations in Australia

Liddell Antoinette^A, Pink Natalie^A, Nobre Fernanda Baldim Jardim^A, Williams Susan^A, Gonzalez-Chica David^A, Stocks Nigel^A and Bernardo Carla^A

^AUniversity of Adelaide.

Background: Aboriginal and/or Torres Strait Islander Peoples have a high burden of diabetes, which is the second leading cause of death among this population, particularly in rural and remote areas.

Aims/objectives: To determine the proportion of Aboriginal and/or Torres Strait Islander Peoples with diabetes who were monitored according to recommended national guidelines and had their clinical parameters within recommended targets. We also examined trends over time (2011–2022) and compared urban and rural areas.

Methods: We used a national general practice database (MedicineInsight) and included all Aboriginal and/or Torres Strait Islander Peoples aged 18+ years diagnosed with diabetes, who had regular visits to their practice (≥1 visit for three consecutive years). Clinical parameters investigated: blood glucose, lipids, blood pressure (BP), renal function and BMI/waist circumference (WC). Recommended targets included: HbA1c ≤7.0%, fasting glucose 4–7 mmol/L, random glucose 5–10 mmol/L, total cholesterol ≤4.0 mmol/L, LDL <2.0 mmol/L, BP ≤130/80 mm Hg, eGFR >60 ml/min/1.73 m², uACR <2.5 mg/mmol (men) and <3.5 (women), BMI <25 kg/m², WC <80 cm (men) and <94 (women). Adjusted analyses explored trends and differences in monitoring or achieving targets according to the person’s rurality.

Findings: Regardless of rurality and year, for any investigated clinical parameter, 70–80% of individuals were monitored, except for BMI/WC that was slightly lower (55–75%). Monitoring showed a slight increase in the first years (2012–2013) but declined rapidly from 2019, similarly across urban and rural areas. In any year, among those monitored, 55–85% achieved recommended targets for blood glucose and lipids, 60% for renal function, 40% for BP and only 10% had normal BMI/WC. Like previous years, in 2021, achieving blood glucose (68.2%, 95% CI: 60.6; 75.9 vs 86.1%, 95% CI: 81.6; 90.6) or lipids (61.5%, 95% CI: 54.4; 68.6 vs 79.4%, 95% CI: 73.7; 85.1) targets were lower in rural than urban areas.

Implications: Results suggest areas for improvement in managing diabetes among Aboriginal and/or Torres Strait Islander Peoples, particularly BP, as this will reduce the risk of chronic kidney disease and other diabetes complications.

59. General practice registrars’ current knowledge, awareness, and utilisation of clinical prediction rules and other antimicrobial stewardship strategies, in the context of respiratory infections: a qualitative study

Malawaraarachchi Nimath^A, Bakhit Mina^A and Smith Jane^A

^ABond University.

Background: Antimicrobial resistance is a growing public health crisis, with implications both clinically and economically. A key factor in its reduction is prescriber-led antimicrobial stewardship. The 2017 RACGP position statement on antimicrobial stewardship stresses its importance in primary care, but also acknowledges that tailored approaches have to be developed to assist general practitioners (GPs). During their training years, GP Registrars build upon their knowledge to create a strong evidence-based foundation for the rest of their clinical careers. This period is an extremely important time to develop good prescribing habits, especially regarding antimicrobial use – thus making them a crucial link in the antimicrobial stewardship chain.

Aims/objectives: To evaluate general practice registrars’ approaches to antimicrobial stewardship in the context of respiratory tract infections, particularly through the use of existing validated clinical prediction rules (e.g. the Centor criteria for streptococcal pharyngitis). Other antimicrobial stewardship strategies will also be explored.

Methods: A qualitative descriptive study of purposefully sampled GP registrars will be undertaken. Data collection will be performed through focus group interviews, aiming to continue until saturation of themes has been achieved. The data will then be analysed using a reflexive thematic analysis approach.

Findings: This study is still being undertaken, but preliminary results from data collection and analysis will be available by the conference date.

Implications: The authors will aim to explore potential gaps in knowledge, and barriers to application of antimicrobial stewardship strategies. This will then potentially be used to inform future medical education – both within the RACGP curriculum and within medical school teaching.

60. Experience of HPV primary screening utilising self-testing: a cross-sectional survey of ‘Let’s test for HPV’ study participants in Aotearoa New Zealand

McBain Lynn^A, Innes Carrie^B, Bell Rebecca^B, Sykes Peter^B and Rose Sally B^A

^AUniversity of Otago Wellington.

^BUniversity of Otago Christchurch.

Background: A multi-region pilot study (Let’s test for HPV) ran in primary care during 2022–2023 to inform the national roll-out of HPV primary screening.

Aims/objectives: This follow-on research was conducted to enable Let’s test for HPV participants to share their experience with HPV primary screening.

Methods: Data were collected via an online survey during September–November 2023. Questions focussed on five main aspects of the screening pathway: information provision, self-sample collection, receipt of results, follow-up for an HPV detected result and future screening intent. Data were analysed using descriptive statistics and thematic analysis.

Findings: Of 2349 people invited to take part, 969 (41%) completed or partially completed a survey, with 921 people included in analyses. Respondent characteristics broadly reflected those of the main study group, with inclusion of 176 Māori (19%) and 95 (10.3%) participants with HPV detected. Participants mostly felt well-informed and chose the self-taken HPV test for reasons including comfort, convenience and privacy. The experience of self-sampling was acceptable and welcomed by most, and they would opt to screen this way again. Despite feeling well informed, participant comments indicated that key messages about HPV, the new test and meaning of results are not yet universally understood. Around 15% of respondents identified something in the pathway they disliked, found unclear or felt could be improved. People with HPV detected mainly understood next steps and felt supported, but some lacked clarity or had reservations about their recommended follow-up. Most participants (92.4%) intend to screen again expressing a preference for self-sampling at home (48.2%) or at their practice (33.5%).

Implications: The shift from cytology-based screening to HPV testing is recognised as a pro-equity change to the NCSP for under- or un-screened people. Our findings highlight practical considerations for screen-takers that could support their delivery of an informed and affirming cervical screening experience.

61. Filling a gap: development and delivery of an oral health clinical skills module for medical students

McBain Lynn^A, Hitchings Liz^B, Yang Belinda^C and Smith Moira^A

^AUniversity of Otago.

^BTe Whatu Ora Capital, Coast and Hutt Valley.

^CTe Whatu Ora Southern.

Background: There is a strong relationship between a person’s oral health and their general health. General practice is often the first port of call for dental complaints, however general medical practitioners’ knowledge and confidence to address this is lacking.

Aims/objectives: This project aimed to develop and evaluate a self-directed oral health education module and a practical clinical skills session for undergraduate non-oral health professional students.

Methods: A self-directed education module was designed and tested with undergraduate non-oral health professional students. Practical clinical examination sessions were developed using a co-design method with undergraduate medical students.

Findings: The self-directed education module was well received and is now an expectation for all undergraduate medical students at the University of Otago. The clinical skills session was developed in 2023 and is now a routine part of teaching for University of Otago Wellington students. Plans are underway to introduce clinical skills sessions for students at the other Otago medical campuses.

Implications: Oral health is a neglected area in general health care. There is unmet need in practitioner training, knowledge and confidence, and a known lack of funding for services. Oral health issues affect a substantial proportion of the NZ population, with a disproportionate burden on Māori and Pacific peoples. By embedding knowledge and skills in primary medical care there is a greater opportunity to reach populations who have difficulty accessing oral health care. Intervening early will likely contribute to reduced health burdens and inequities, and improve patient health and wellbeing. The undergraduate educational modules will support knowledge acquisition and confidence in future health professionals. A similar approach could be used for knowledge and skill development for practicing primary health care professionals and other members of the primary health care team.

62. GP registrars’ experiences of providing abortion care: a qualitative descriptive study

McDonald Bronwyn^A, Cross Jarrod^A, Mazza Danielle^A and James Sharon^A

^AMonash University.

Background: General practitioners (GPs) are ideal providers of early medical abortion (EMA) care, yet relatively few Australian GPs provide this. Insufficient knowledge, training and mentoring opportunities have been identified by GPs as barriers to provision. Exploring GP registrars’ experiences with abortion care during their specialist training can improve understanding of education gaps.

Aims/objectives: To explore Australian GP registrars’ experiences of providing abortion care.

Methods: A qualitative descriptive study was undertaken. GP registrars were recruited nationally using convenience and purposive sampling between June and August 2023. Semi-structured interviews were conducted via Zoom, audio-recorded and transcribed verbatim. Themes were constructed using reflexive thematic analysis.

Findings: Of the 20 participants, most identified as women (n = 16; 80%). Abortion care was perceived to be a common clinical encounter for registrars, especially for female registrars. Participants’ experiences with abortion care primarily related to providing pregnancy options counselling, referrals, and follow-up. Although participants viewed EMA as an important part of health care, few were providers. Most felt that registrars had insufficient preparation or ongoing support to provide EMA. Core GP training rarely addressed abortion but rather required registrars to ‘opt-in’ to additional training. Practical training and mentorship opportunities with experienced EMA providers were seen as difficult to access, with unclear supervision requirements further complicating registrars’ ability to provide EMA. Supportive GP supervisors and other practice staff were identified as facilitators to EMA provision.

Implications: GP registrars in our study were interested in providing abortion care but needed better preparation and support to provide EMA. Following recent national policy changes to expand EMA prescribing, all GP registrars must be equipped with the knowledge, skills and confidence to manage abortion care in their future independent practice. To support EMA provision by the GP workforce, core GP training should provide opportunities for practical training and mentoring.

63. Experience of receiving care from a community-based health service for people with frequent hospital admissions – the voice of lived experience

McGowan Deirdre^A, Morley Claire^A, Hansen Emily^A, Richardson Linda^B, Palmer Andrew^A, Radford Jan^A, Shaw Kelly^A and Winzenberg Tania^A,B

^AUniversity of Tasmania.

^BPrimary Health Tasmania.

Background: A small portion of the population disproportionately use high amounts of healthcare resources, termed high healthcare service use. Healthcare Connect North is a co-designed, nurse-led, multidisciplinary community-based service for people with high healthcare service use defined by frequent hospital admissions.

Aims/objectives: To explore the experiences and perceptions of clients of Healthcare Connect North as to how they manage their health and access care, and how this changed after receiving care from Healthcare Connect North.

Methods: We invited any person who had enrolled in the service to participate (n = 29). Interviews took place in participants homes, were audio-recorded, transcribed verbatim and checked for accuracy. Participants received a copy of their transcript and given the opportunity to revise their comments. Using components of grounded theory, data were independently and iteratively analysed by two investigators. Constant comparative analysis was used to organise codes and themes and to develop a final theory.

Findings: Twenty participants took part in semi-structured interviews between September and December 2023. The themes of (i) relationships are central to receiving health care, (ii) complex care needs require intensive multidisciplinary holistic care, and (iii) the challenges of aging together formed the final theory: time to care. Participants described complex bio-psychosocial care needs and identified that time to develop trusting and respectful relationships was important to them when receiving care. Time enabled healthcare workers to provide person-centered, holistic care and assist with the challenges of aging.

Implications: People with frequent hospital admissions often have strong psychosocial needs and face challenges related to aging. Consequently, time to build therapeutic relationships should be considered central to service design and delivery for people with high service use. Models of care should incorporate multidisciplinary teams who have time to provide person-centered and holistic care.

64. Testing positive in the National Bowel Cancer Screening Program: developing novel technology to improve screening follow up

Sursock Sandra^A, Jenkins Mark^A, Campbell Tina^B and McIntosh Jennifer^A

^AUniversity of Melbourne.

^BHealthily Pty Ltd.

Background: The National Bowel Cancer Screening Program (NBCSP) aims to increase early detection and treatment for bowel cancer by sending a screening kit to Australians between 50 and 74 years. Positive results require a colonoscopy, but despite a State-based Participant Follow-up Program (PFUF) still 14% of people are never followed up. Digital interventions have been postulated to improve the PFUF process.

Aims/objectives: To develop and evaluate a digital Conversational Voice AI intervention to support people who test positive to the NBCSP test, to provide information, guidelines, and help triage people to have follow-up. To provide a safe, effective method for efficiently increasing diagnostic assessment for people who test positive to the NBCSP.

Methods: This presentation will outline the methods used for the development and evaluation of the Conversational Voice AI intervention. This is a novel tool that will be co-designed and developed with implementation science methodology so that it can be translated to other cancer follow up services (e.g. breast cervical and potentially lung cancer). The methods will include: (i) co-design of the Conversational Voice AI content based on input from experts including clinicians, behavioural scientists, consumers and policy makers; (ii) acceptability and feasibility of the prototype with focus groups including consumers and PFUF staff; and (iii) evaluation using a randomised control trial for effectiveness of the intervention.

Findings: The research will determine if Conversational Voice AI is effective for increasing the uptake of diagnostic assessment for people who test positive to the NBCSP.

Implications: This has the potential to increase colonoscopic investigation for people with potential bowel cancer but also reduce the workload on the existing PFUF team. Implications for general practice are that they will be supported to manage positive cases more effectively.

65. Determinants of time to initial care in accepted workers’ compensation claims for low back pain in Australia: a multi-jurisdiction retrospective cohort

Hambisa Mekonnen Tesfaye^A, Sheehan Luke R.^A, Collie Alex^A, Russell Grant^A and Di Donato Michael^A

^AMonash University.

Background: Low back pain is a leading cause of disability. Early and effective care can generally facilitate quicker recovery and reduce work disability. The timing of first care and its impact on worker outcomes following the reported onset of low back pain has received little focus in Australia.

Aims/objectives: To investigate the determinants of time to first care following the onset of compensable low back pain.

Methods: A retrospective cohort analysis was conducted using a multi-jurisdiction database of accepted workers’ compensation claims for low back pain with a patient-reported onset between July 2011 and June 2015. Time-to-event analysis was employed to examine the determinants of the time to first care.

Findings: The median (interquartile range (IQR)) time to first care was 3 (IQR 1–9) days, with general practitioners (GPs) consulted sooner (median 3, IQR 1–8) days than physical therapists (median 5, IQR 2–14) days (P < 0.001). The median time to first care was consistent between South Australia and Western Australia (median 3, IQR 1–9). The time to first care was significantly shorter for female workers (time ratio (TR) = 0.87; 95% CI (0.78, 0.97)), year of injuries 2013 (TR = 0.80; 95% CI (0.72, 0.89)) and 2015 (TR = 0.76; 95% CI (0.65, 0.88)). Workers who first consulted with physical therapists took twice as long to be seen as those consulting GPs (TR = 2.12; 95% CI (1.88, 2.40)), professionals (TR = 1.33; 95% CI (1.09, 1.62)), those working in sales (TR = 1.33; 95% CI (1.09, 1.63)), and remote workers (TR = 1.27; 95% CI (1.02, 1.60)) experienced a significantly longer time to first care than labourers.

Implications: This study suggests early back pain care should be tailored to the individual needs and consider contextual factors to support rehabilitation and facilitate return to work following the onset of work-related back pain. Differences in return-to-work outcomes following back pain onset require further exploration.

66. Exploring the complexities of final-year medical students’ readiness to screen for and respond to persons experiencing family violence

Mollenhagen Krystel^A, Rogers Gary^A and McLeod Janet^A

^ADeakin University.

Background: Family violence (FV) is the most rapidly emerging epidemic facing our nation, with one woman a week (average) killed by an intimate partner. Doctors may be the only person to whom those affected disclose, with 82% in Victoria having never contacted Police. It is critical that graduating doctors are trained to address this crisis. Research into FV education overwhelmingly finds clinicians underprepared, with low confidence addressing FV, but debate remains regarding solutions. Utilising thought experiments transcends traditional ‘barriers and enablers’, and ‘readiness’ scales to discover the rich internal experiences of final-year medical students (FYMS) when facing this challenge.

Aims/objectives: To explore FYMS multi-dimensional experience of applying FV education to screen and respond to persons experiencing FV, by asking FYMS to describe their subjective state when responding, through reality-inspired thought experiments. This approach allows a learner-derived exposition of what works or doesn’t regarding their experience of FV education.

Methods: Phenomenological qualitative semi-structured interviews will be used to ascertain current understanding, internal/external responses and self-perceived skills in screening for and responding to FV. Utilising hermeneutic phenomenology for analysis of interview transcripts will afford insights into ‘in the moment’ anticipated internal experiences of participants as they imagine realistic scenarios from their immediate professional future.

Findings: This protocol is submitted for ethics review, with interviews likely commencing in June 2024. Findings are anticipated to detail FYMS understanding of FV education, its progress, and outstanding problems as ‘the preparing clinicians’ see it.

Implications: These insights will inform improvements to teaching and tools provided in medical programs, with the overarching aim of improving the care and support of individuals and communities experiencing and disclosing FV by better preparing our doctors.

67. Longitudinal patterns of service use and outcomes for people who are high users of healthcare services: a Tasmanian data linkage study

Morley Claire^A, Kitsos Alex^A, McGowan Deirdre^A, Neil Amanda^A and Winzenberg Tania^A

^AUniversity of Tasmania.

Background: High healthcare service utilisation (HSU) is a marker of potential unmet patient need as well as a contributor to inefficient use of healthcare resources. Lack of appropriate targeting of interventions is well-recognised as a potential reason for the paucity of effective interventions to address HSU. Despite this, little is known about the longitudinal patterns of service use and outcomes of people with HSU.

Aims/objectives: To investigate the longitudinal patterns of health service use and mortality of people with different forms of HSU.

Methods: We analysed three years (2017–2019) of Tasmanian linked hospital admission, emergency department (ED) presentation and death data (n = 230,957). High service use was defined in three ways: >4 hospital admissions (HSUA), >5 ED presentations (HSUED), and the top 5% of healthcare costs (HSUC) in a 12-month period. The mortality and service use of adults with each type of HSU over 12 and 24 months was determined.

Findings: In the 3-year study period, 2.04%, 5.2% and 7.2% of people experienced HSUA, HSUED and HSUC, respectively. In approximately one quarter of cases HSU resolved within a year, regardless of how defined. HSU was persistent (over a 12-month period) in 10.4%, 23.4% and 15.9%, and recurrent in 2.9%, 5.0% and 2.1% of people with HSUA, HSUED and HSUC, respectively. Mortality within 1 year in people with HSUA or HSUC was over double that of people with HSUED (11.5% and 10.2%, respectively, vs 4.6%).

Implications: These findings suggest that targeting interventions for HSU to those with persistent and recurrent high service use could maximise benefits for people with HSU, health systems and other health system users. The high 1-year mortality of people with frequent admissions and high costs suggest that clinicians should be alert to the potential need for care targeted to support end-of-life needs.

68. Co-location of non-medical women’s health services in community pharmacy: a rapid review

Moss Kimberley^A, Assifi Anisa^A and James Sharon^A

^AMonash University.

Background: Community pharmacy (CP) plays a pivotal role in supporting the health and wellbeing of women, due to their convenient location and ease of accessibility. This renders CP an ideal environment for collaboration between pharmacists and other healthcare professionals to promote women’s health initiatives. Whilst non-medical co-location is frequently observed within other community health environments, there is a need to assess whether co-location and collaboration would be acceptable and feasible within the CP setting.

Aims/objectives: To understand the acceptability and feasibility of the co-location of non-medical women’s health services in CP through the exploration of stakeholder perspectives.

Methods: A rapid review was conducted, guided by Cochrane rapid review methodology. Five databases were searched using key terms relating to community pharmacy, primary care, acceptability and feasibility. Manual searches of references and a Google Scholar search for grey literature were also conducted. Articles were included if published from 2004–2024 in English and if full-text was available. Data were then extracted and reflexive thematic analysis, informed by Braun and Clark, was undertaken.

Findings: A combination of database and manual reference searching identified 670 references, three of which were eligible for inclusion in this review. Studies were undertaken in Australia (n = 2) and Portugal (n = 1). All studies were qualitative. Three main themes were identified relating to the need for extensive integration of healthcare services in CP, the associated benefits, and the challenges.

Implications: This review provides an overview of the acceptability and feasibility of co-location within CP from the perspectives of key stakeholders, including consumers and non-medical service providers. Participants embraced the uptake of these services but raised concerns about the motives of CP in relation to their financial incentives and partnerships. The limited literature on this topic necessitates further research into the acceptability and feasibility of implementation to support patient access to women’s health services.

69. Adjusting for confounding introduced by lockdowns during the COVID-19 pandemic

Mundy Benjamin^A

^ARoyal Australian College of General Practitioners.

Background: The COVID-19 pandemic resulted in considerable disruptions to research projects globally. While research unrelated to COVID-19 continued during this time, it was unclear what confounding effects may be introduced by the pandemic, particularly during government imposed stay-at-home orders (lockdowns), where services and movement within the community were heavily restricted.

Aim/Objectives: To create a variable for adjusting for confounding introduced by the COVID-19 lockdown periods in multivariable analyses.

Methods: The variable was constructed for use in a particular project – the Registrar Clinical Encounters in Training (ReCEnT) study, using publicly available information sources. Dates and locations of COVID-19 lockdowns were accessed from the Australian Department of Education and the Fair Work Commission. These dates and locations were used to corroborate lockdown events via official state government media dissemination sites. The information available varied between media releases. Information provided included: Local Government Areas (LGAs), council areas, suburbs and whole states. Postcodes were later obtained for these locations. Postcodes for lockdown areas were obtained using a number of publicly available information sources: Australian Bureau of Statistics; NSW government elections site: Syndey Local Health District government site; and the Australia Post lookup tool. Location and date of lockdown were then matched to the postcodes of practices participating in ReCEnT and date of consultation, resulting in a dichotomous variable that reflected whether a consultation was conducted within an area undergoing lockdown at a particular time. Data extraction was performed using R version 4.3.1.

Findings: A robust variable was constructed and its use and potential will be presented and discussed.

Implications: Australian lockdown periods may have a confounding effect on outcomes observed during these times, making them an important consideration when adjusting for confounding in multivariable analyses.

70. Men’s lifestyle risks and preventive healthcare engagement: a cross-sectional survey

Mursa Ruth^A, Halcomb Elizabeth^A, Patterson Christopher^A and McErlean Gemma^A

^AUniversity of Wollongong.

Background: Males have a shorter life expectancy than females and are dying earlier due to preventable causes and lifestyle factors. Effective preventive healthcare delivered in general practice reduces preventable morbidity and mortality and enhances quality of life.

Aims/objectives: To explore men’s health status and lifestyle risk profile and understand how they engage with preventive healthcare.

Methods: An online cross-sectional survey of adult males, working or volunteering for the New South Wales Rural Fire Service explored their lifestyle risk profile and how they engage with preventive healthcare.

Findings: Of the 431 survey respondents, only 18.6% were in the healthy weight range. However, just 29.9% reported having been advised by their doctor that they were overweight. Most respondents (79.8%) identified having a regular general practitioner (GP). Older respondents (P ≤ 0.001) and those on lower incomes (P = 0.028) were most likely to have a regular GP. Having a regular GP/general practice was significantly associated with all preventive and screening activities (P < 0.05), except having a dental check (P = 0.174).

Implications: The effective communication of lifestyle risk factors is imperative in supporting men to reduce risk through behavioural changes. The identification of men’s engagement in general practice demonstrates an opportunity for greater preventive activities to be driven by the health professionals within general practice.

71. Australian men’s health literacy: a cross-sectional survey

Mursa Ruth^A, Halcomb Elizabeth^A, Patterson Christopher^A and McErlean Gemma^A

^AUniversity of Wollongong.

Background: Males have a lower life expectancy than females and are dying earlier due to preventable causes and lifestyle factors. Health literacy impacts health behaviours including help-seeking and engagement with preventive care, leading to changes in health outcomes. Gender influences health literacy and both help-seeking and engagement patterns.

Aims/objectives: This study sought to explore health literacy and the characteristics affecting this among Australian men.

Methods: A cross-sectional survey of 431 adult males engaged with the New South Wales Rural Fire Service (NSW RFS) was undertaken. The survey captured demographic data, health status and lifestyle risk characteristics. Health literacy was measured using the 44-item Health Literacy Questionnaire (HLQ).

Findings: The lowest scores on the HLQ related to ‘Appraisal of health information’ (Mean 2.81) and ‘Navigating the healthcare system’ (Mean 3.74). However, the highest scores were on the sub-scales of ‘Feeling understood and supported by healthcare professionals’ (Mean 3.08) and ‘Reading and understanding health information enough to know what to do’ (Mean 4.10). Health literacy was significantly related to participants’ age, income, education level and living in an urban/rural location.

Implications: Understanding factors impacting health literacy can inform future strategies to improve engagement in health promotion and healthcare. In particular, it can identify groups to target with specific interventions. It can also help health professionals to understand some of the barriers to engaging with men in the community.

72. Doctors’ own experiences of domestic and family violence: a scoping review

Neil Jennifer^A,B, Bulford Eleanor^B, McLindon Elizabeth^B, Delany Clare^B and Hegarty Kelsey^B,C

^AMonash University.

^BUniversity of Melbourne.

^CRoyal Women’s Hospital.

Background: Domestic and family violence (DFV) is any violence that occurs in a family or intimate relationship that causes physical, sexual or psychological harm. DFV has a high prevalence amongst health professionals in Australia. Previous studies have shown the rate of adult intimate partner violence (IPV) exposure to be 6–24% in doctors. However, few studies have examined the professional and personal impact of DFV on doctors who themselves have experienced DFV in their past.

Aims/objectives: This paper will report the findings of a scoping review of the literature discussing the personal and professional impact of DFV for practising doctors.

Methods: The methods followed Arksey and O’Malley’s framework for conducting a scoping review. Search terms were identified and five databases searched. Articles were included if they were in English, about a doctor’s own experiences of DFV and if doctors made up at least 40% of the population if not analysed separately.

Findings: Twenty reports were included in the review, 17 quantitative and 3 qualitative. Rates of DFV in women doctors mostly ranged from 3.7% to 45.2%, with one study finding a rate of 97.7%. Rates among male doctors ranged from 2.9% to 24.3%. Within this literature, key themes were feelings of shame and embarrassment, increased risk of vicarious trauma, low help-seeking rates and a lack of supports.

Implications: The review highlights how common it is for doctors to have a past experience of DFV and that survivor doctors commonly do not seek support. Findings demonstrate the need for increased supports and destigmatisation of this issue in the medical community. It is common for general practitioners (GPs) to manage survivor patients in their clinics so we need to better understand the personal and professional effects of DFV on GP survivors in Australia through further research.

73. Implementation and sustainability of involving Bilingual Community Navigators (BCNs) in general practice to improve equity

O’Callaghan Cathy^A, Harris Mark^A, Harris Elizabeth^A and Mistry Sabuj^A

^AUniversity of New South Wales.

Background: Patients from culturally and linguistically diverse (CALD) backgrounds with low English proficiency and low health literacy are especially vulnerable to health and social care navigation barriers. Although general practitioners (GPs) can provide culturally responsive care, there is inadequate time to address needs in consultations. Community health workers (CHWs) have been demonstrated overseas to effective in helping patient navigate health services prevent admission, promote self-management and reduce health service demands. In Australia, exploratory research on the potential role of bilingual CHWs in health care was generally positive, leading to co-design of a training program and a subsequent pilot study.

Aims/objectives: This research evaluated the implementation of a model of training and attachment of BCNs in a range of practices providing care for patients from divers cultural and language backgrounds.

Methods: The model includes recruitment of practices and BCNs from matching cultural and language backgrounds, training which includes online and face to face learning activities and placement in general practice and supervision of their navigation assistance to patients. Evaluation used mixed methods to assess feasibility, appropriateness, acceptability, and sustainability of the program on patients, navigators and practice staff.

Findings: The pilot study was very successful with BCNs providing navigation support to patients in two practices and demonstrating the feasibility and acceptability of the role of BCNs by both staff and patients. In our implementation study, the BCNs have performed well following the revised training, being accepted by practice staff and patients. However, the frequency and type of referral to the BCNs varied greatly between practices reflecting differences in the organisation of the practices and the characteristics and needs of the practice populations.

Implications: BCNs have an important emerging role in Australian primary care. Lessons learned through this study will support the continued training and adoption of BCNs in a more diverse range of primary care settings.

74. Co-design and evaluation of clinical educational resources and national recommendations to address inequity of access to rare disease care in Australia

McKnight Lauren^A, Roberts Natalie^A, Recsei Krista^A, Lissiman Elizabeth^B, Gundru Hiba^C, Knight Andrew^D, Tam Michael^A, Balasooriya Chinthaka^A, Farrar Michelle^A, Millis Nicole^E, Healy Louise^E, Baynam Gareth^F, Gannon Sian^F, Zurynski Yvonne^G, Jaffe Adam^A and Emma Palmer Elizabeth^A

^AUniversity of New South Wales.

^BWestern Obstetrics, Western Australia.

^CKey Health, New South Wales.

^DPrimary and Integrated Care Unit, South Western Sydney Local Health District.

^ERare Voices Australia.

^FPerth Children’s Hospital.

^GMacquarie University.

Background: Rare diseases (RD) affect 2 million Australians, posing unique challenges in primary care due to diagnostic complexity and the need for integrated care pathways. The Australian Government’s National Strategic Action Plan for Rare Diseases calls for the establishment of policies and standards for integrated care and support, informed through consultations with clinical and consumer RD experts.

Aims/objectives: The clinical educational stream of the Rare Disease Awareness, Education, Support, and Training (RArEST) Project, a three-year partnership funded by the Australian Government, aimed to co-design and evaluate educational resources and National Recommendations to address inequity of access to RD care in Australia.

Methods: A mixed-methods evaluation approach was undertaken alongside co-design of the resources. An initial learning needs analysis surveyed 183 health professionals including 27 general practitioners. Consultations with a panel of 12 people living with RD and the 18 members of a multi-disciplinary clinical working group further shaped the themes and collaboratively developed the project deliverables. Further evaluation data was gathered from education participants and endorsing bodies.

Findings: Key themes from initial consultations were mapped to the Action Plan and other national and international frameworks. The collaborative development process resulted in learning resources for health professionals that have been accredited for Continuing Professional Development by the RACGP, and the National Recommendations for Rare Disease Health Care, endorsed by numerous national bodies. Feedback from participants and other stakeholders emphasised the importance of the voice of lived experience and the interdisciplinary nature of the resources.

Implications: The tangible outcomes from RArEST underscore the effectiveness of the project’s consultative approach in delivering resources that promote the adoption of equitable, person-centred, evidence-based, and integrated models of RD care that respond to the needs and preferences of people living with RD, whilst leveraging existing services and expertise.

75. Data quality in general practice EMRs – is it sufficient for building clinical decision support tools for type 2 diabetes risk?

Paramanantham Janani^A, Manski-Nankervis Jo-Anne^B, Chidgey Christine^A, Hallinan Christine^A and Boyle Dougie^A

^AUniversity of Melbourne.

^BLee Kong Chian School of Medicine.

Background: Type 2 diabetes mellitus (T2DM) affects over 1.3 million Australians and is a risk factor for cardiovascular disease, chronic kidney disease, and limb amputations. Early diagnosis can improve health outcomes. Despite readily identifiable risk factors for T2DM and a validated risk profiling calculator, such as AUSDRISK, the condition remains significantly under diagnosed. GPs play a key role in identification and management of people with, or at risk of T2DM. However, due to time constraints and competing medical concerns, it can be challenging to determine at-risk patients during consults. Clinical decision support systems integrated with electronic medical records (EMRs) can offer an opportunity to help GPs assess patient risk during the clinical encounter using EMR patient data. However, to facilitate such clinical decision support, EMR data must be of sufficient quality and completeness.

Aims/objectives: The aim of this study is to assess the quality of GP EMR data to develop a clinical decision support tool for early T2DM detection and management.

Methods: We will conduct secondary analysis of EMR data stored in Patron, a repository of de-identified patient data from Australian general practices. Patients with T2DM will be detected within Patron and risk factors from 10 years of past medical history recorded. Risk factor data fields will be analysed for data quality using a standardised framework to assess completeness, plausibility and validity. Descriptive statistics will be used for data quality parameters.

Findings: We anticipate data collection commencing in May 2024 with preliminary results available by August 2024.

Implications: The findings will determine if the quality of GP EMR data is suitable for non-clinical uses, such as algorithm development and T2DM prediction within GP EMRs.

76. What do GP supervisors want to teach? A survey

Penna Gabriella^A, Fitch Jessica^A, Fletcher Joseph^A, Grotowski Miriam^A, Jolly Brian^A, Pond Dimity^B and Guppy Michelle^B

^AUniversity of Newcastle.

^BUniversity of New England.

Background: Clinical supervision is an integral part of medical practice across all specialties, including general practice. It involves educating, observing, and assessing students. General practice (GP) is a unique environment in its pace, challenges, and interactions, which presents unique teaching opportunities for students. We aimed to identify key topics GPs believe they are best placed to teach medical students, in order to integrate them into the undergraduate curriculum for a more cohesive educational experience.

Aims/objectives: This survey explored GP perspectives on what content is important to teach undergraduate medical students and the most common methods by which GPs deliver clinical teaching. Methods: We undertook mixed methods research comprising a survey with free response questions and a Likert scale based on previous qualitative interviews. The survey was distributed electronically to GPs who taught medical students within the Universities of Newcastle and New England Joint Medical Program (JMP) footprint.

Findings: Forty-three GPs responded to the survey. Basic demographic data and information on GP’s work environment was obtained. GPs’ perceptions of the importance of 19 topics listed and how often GPs use several education techniques were explored.

Implications: Our research gives university medical educators an enhanced understanding of topics that GPs feel are important and specific to general practice for medical students to learn. We have greater knowledge of what techniques GPs prefer to use in clinical supervision and education. The information obtained from this survey will be used to improve the general practice curriculum at the JMP and at other educational facilities.

77. Postpartum contraception counselling and provision: general practitioners views and experiences

Perkins Jenna^A, Botfield Jessica^A, Mazza Danielle^A and James Sharon^A

^AMonash University.

Background: The postnatal check, typically occurring six-to-eight weeks after birth, is primarily conducted by general practitioners (GPs) in Australian primary healthcare (PHC) settings. This presents an optimal opportunity for offering contraceptive counselling and provision to prevent unintended pregnancies and reduce short inter-pregnancy intervals. Whilst integrating postpartum contraceptive counselling into the postnatal check is important, it does not always occur. Limited research exists on GPs views and experiences providing postpartum contraception in Australia.

Aims/objectives: To explore Australian GPs’ views and experiences of undertaking postpartum contraception counselling and provision during the 6–8-week postnatal check.

Methods: This qualitative-descriptive study recruited practicing Australian GPs. Following purposive, convenience and snowball sampling, semi-structured interviews were conducted via Zoom. Data was transcribed verbatim. Analysis was conducted using thematic analysis, with the Theoretical Framework of Acceptability guiding the synthesis of key themes.

Findings: Twenty-three GPs were interviewed across all Australian states. Participants had differing views on the best time to discuss postpartum contraception, with some deeming the postnatal check too early and others considering it too late. Although most participants recommended long-acting reversible contraceptive methods to postpartum women, only approximately half were trained to insert intrauterine devices. All had undertaken implant training. Collaboration among different healthcare professionals such as GPs, practice nurses and midwives, and forming networks to support contraceptive counselling, were perceived to enhance postnatal care and support contraception provision. However, time constraints, limited access to training opportunities, low Medicare rebates, lack of guidelines for postnatal checks and postpartum contraceptive options were viewed by participants as barriers.

Implications: There is a clear need for enhanced professional, organisational, and policy support for postnatal checks and postpartum contraception. Educational initiatives and the development of evidence-based guidelines are necessary to improve patient access and service provision. Additionally, improved service remuneration and innovative models of care are required.

78. Promoting wellbeing among family medicine and general practice trainees. Which interventions work?

Patel Divyaben^A, Dorstyn Diana^A and Prentice Shaun^B

^AUniversity of Adelaide.

^BRoyal Australian College of General Practitioners.

Background: It is recognised that family physicians experience occupational stress, prompting increasing research to explore burnout prevention strategies. To date, few meta-analyes have evaluated intervention effects and none have focused on trainees or junior doctors in family medicine or general practice (FM/GP) per se.

Aims/objectives: To synthesise available literature on interventions to decrease burnout and improve wellbeing among FM/GP speciality trainees.

Methods: Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were followed for this study. Online bibliographic databases (Embase, Medline, PsycInfo, ProQuest) were systematically searched (no date limits) for published studies and dissertations involving an intervention to manage burnout and/or improve well-being among FM/GP trainees. The reporting quality of included studies was reviewed (QualSyst tool), and pre-post changes (Hedges’ g, with associated 95% confidence intervals and p values) in perceived distress, burnout, and wellbeing examined.

Findings: The quality of included studies was heterogenous, as were intervention, content, delivery, and length. The data did not favour a single type of intervention, although most reported positive results for training individuals in the detection of depression, stress, and burnout symptoms, as well as combating the stigma of seeking professional support.

Implications: There is currently a lack of evidence about the best ways to improve wellbeing in FM/GP trainees. Findings from controlled studies are promising but highlight a need for more rigorous research to confirm the value of a multi-pronged approach to address medical burnout.

79. Burnout in postgraduate medical trainees before and during COVID – evidence from a meta-analysis of 232 cohorts

Prentice Shaun^A, Dorstyn Diana^B, Massy-Westropp Nicola^C, Benson Jill^A and Elliott Taryn^A

^ARoyal Australian College of General Practitioners.

^BUniversity of Adelaide.

^CUniversity of South Australia.

Background: Postgraduate medical trainees (i.e. interns, residents, registrars) previously faced elevated levels of burnout. The COVID-19 pandemic introduced considerable uncertainty to the medical landscape internationally, which may have increased burnout levels in this group further.

Aims/objectives: To synthesise studies examining burnout amongst postgraduate medical trainees before and during the COVID-19 pandemic, with particular emphasis on the impact for primary care specialties.

Methods: A protocol for this review was prospectively registered on PROSPERO (CRD42023404618). Embase, Medline, PsycInfo and the Cochrane library were searched in May 2023, with email alerts monitored until April 2024. Title/abstract and full-text screening were performed to identify studies that administered the Maslach Burnout Inventory (MBI) to postgraduate medical trainees. Study reporting quality was assessed with the QualSyst tool. Individual study results were compared with normative data from the MBI and data were meta-analysed using a random effects model. Moderator analyses examined potential differences in burnout scores based on pre- and intra-COVID time collection periods, as well as across primary care specialties and countries.

Findings: 232 studies, spanning 45,323 trainees, were included. Overall results confirmed that trainees displayed significantly elevated burnout levels relative to MBI normative data. Whilst emotional exhaustion and depersonalisation did not significantly differ before and during COVID, there was a significant decrease in trainees’ sense of personal accomplishment. Subgroup analyses confirmed increased burnout (i.e. emotional exhaustion and depersonalisation) among emergency medicine trainees’ during COVID. In comparison, surgical trainees’ depersonalisation and personal accomplishment significantly declined.

Implications: Burnout continues to be a major concern for trainees, with COVID impacting on the domain of personal accomplishment in particular. Specialty-based differences in the effects of COVID reinforce the need for holistic measurement of burnout and consideration of discipline-specific factors in burnout intervention design.

80. Understanding vaping intention of Monash international students to inform health promotion campaigns

Rahadiansyah Farhan^A, Selamoglu Melis^A and Barton Chris^A

^AMonash University.

Background: Previous research from our group identified prevalence of ‘ever’ e-cigarette use (25.9%) among Monash University students aged 18–25 and daily use of e-cigarettes (7.8%) among international students. This work established that international students were more likely to seek health information about e-cigarettes from less reputable sources compared to domestic students, suggesting the need for tailored strategies to deliver health information about e-cigarettes.

Aims/objectives: To gain insights regarding needs and preferences of international students in receiving health information about e-cigarettes and tailor strategy for distribution of health promotion messages.

Methods: This qualitative study will consist of approximately 30 international students from Monash University recruited with help from the international office and Monash Residential Services. We will conduct 4–6 focus groups of approximately 60 minutes in duration. A semi-structured interview guide will be developed to cover topics on the intention to use e-cigarettes, trusted sources of health information on e-cigarettes, and channels through which trusted information is received about e-cigarettes. Additional interviews with key stakeholders such as the University Health Service and International Students Association will be conducted to understand how health information to support students stop vaping can be effectively delivered to international students. Focus groups and interviews will be audio recorded and transcribed verbatim. Content and thematic analysis will be used to analyse the data.

Findings: The protocol has been developed and we will seek ethics committee approval in April 2024. Focus groups and interviews with stakeholders will be conducted between May–July. It is expected this information will reveal intentions of international students to use e-cigarettes and how health promotion action can best be directed, to provide international students with health information about vaping.

Implications: Results from this research will provide greater insights to international students use of e-cigarette and how health promotion messages can be tailored effectively.

81. Associations of low-value care: the QUIT-CA (Questionable In-Training Clinical Activities) Index

Ralston Anna^A, Tapley Amanda^A, van Driel Mieke^B, Davey Andrew^A, FitzGerald Kristen^C, Mitchell Ben^B, Fisher Katie^A, Tran Michael^D, Fielding Alison^A and Magin Parker^A

^ARoyal Australian College of General Practitioners.

^BUniversity of Queensland.

^CGeneral Practice Training Tasmania.

^DUniversity of New South Wales.

Background: Previous studies have observed that GPs, including GP registrars, perform non-evidence-based and low-value clinical activities, e.g. inappropriate antibiotic prescribing for asthma. Using data from the Registrar Clinical Encounters in Training (ReCEnT) project, this study examined the associations of multiple low-value clinical activities.

Aims/objectives: To develop the QUIT-CA (Questionable In-Training Clinical Activities) index and establish registrar, patient, practice, and consultation factors associated with registrars’ QUIT-CA scores.

Methods: An expert panel reviewed Choosing Wisely recommendations to determine those relevant to general practice and measurable by ReCEnT data for inclusion in the index. ReCEnT data includes in-consultation clinical and educational experiences of GP registrars during 60 consecutive encounters three time across training. Data from five states and one territory from 2010–2020 were included. We calculated, at the registrar-term level, QUIT-CA scores as the number of low-value activities the registrar performed throughout the term, offset by the number of times a registrar was at risk of performing a low-value activity (e.g. asthma presentations). To establish the associations with QUIT-CA score, negative binomial regression within the generalised estimating equation was used.

Findings: 47 recommendations informed the QUIT-CA index. Data from 3,206 registrars were included. 15,560 QUIT-CAs were performed during 406,812 ‘at-risk’ consultations. Term 2 and Term 3 registrars had lower QUIT-CA scores (adjusted incidence rate ratio (aIRR) 0.91 [95% CIs 0.87, 0.95], P < 0.001 and 0.85 [95% CIs 0.80, 0.90], P < 0.001, respectively) compared to Term 1 registrars. Later graduation year was also associated with lower QUIT-CA scores (aIRR, 0.97 [95% CIs 0.97, 0.98], P < 0.001). Registrars with greater proportions of patients they had not seen before had higher QUIT-CA scores (aIRR, 1.27, [95% CIs 1.12, 1.45], P < 0.001).

Implications: The QUIT-CA index is a new tool to measure questionable practice. Later stage of training and continuity of care were associated with registrars performing fewer low-value clinical activities.

82. What is DD in patients with type 2 diabetes mellitus (T2DM)? Identification, influencing factors and intervention. A narrative review

Rathgama Udantha^A and Lau Phyllis^A

^AWestern Sydney University.

Background: Life with diabetes mellitus (DM) is challenging with multiple medications, regular blood glucose monitoring, physician visits, restricted diets, frustration, discouragement, burnout, etc. These emotional burdens and worries related to DM, and the complex and long-term DM management are recognised as diabetes distress (DD). DD is a global burden associated with reduced treatment adherence and poor glycemic control leading to heightened risks of DM-related complications. Healthcare professionals including GPs are recommended to screen for DD according to international and Australian guidelines. And yet, it is common for patients and doctors to confuse DD symptoms with depression and/or anxiety.

Aims/objectives: This literature review aimed to explore the identification, influencing factors, and management interventions of DD in type 2 diabetes mellitus (T2DM).

Methods: A narrative review was performed. A search was performed on PubMed, Web of Science and CINAH. Only papers available in English, published within the last 10 years, peer-reviewed, and described primary research were included.

Findings: A total of 1010 papers were identified in the search. Forty-nine quantitative studies, 10 randomised controlled trials and 6 qualitative studies from across the world were finally selected for review. DD is commonly assessed and identified using diagnostic instruments. The main ones are Problem Areas in Diabetes (PAID20) Scale and Diabetes Distress Scale 17 (DDS17). People more likely to experience DD include females, those living alone and those with higher HbA1c, and multimorbidity. Severity is correlated with number of diabetes-related complications, duration of T2DM and insulin use. Interventions like mindfulness, T2DM self-management education and interventions, social support, problem-solving therapy, and cognitive behavioral therapy addressing DD help to improve both self-care and glycemic control.

Implications: This review enhances our understanding of DD and significance of routinely assessing DD in patients with T2DM. More qualitative research is warranted to explore patients’ experience and understanding of DD.

83. Living with Diabetes Distress (LiDD) – a mixed method study among patients with type 2 diabetes

Rathgamage Udantha^A, Seelan Thava^A,B and Lau Phyllis^A

^AWestern Sydney University.

^BBridgeview Medical Practice.

Background: Life with diabetes mellitus (DM) is a challenge with multiple medications, regular blood glucose monitoring, physician visits, restricted diets, frustration, discouragement, burnout, etc. These emotional burdens and worries related to DM, and the complex and long-term DM management are recognised as diabetes distress (DD). DD is a global burden associated with reduced adherence to treatment and poor glycemic control leading to heightened risks of DM-related complications. Healthcare professionals including GPs are recommended to screen for DD in patients with DM annually, if glycemic control is not achieved or when more diabetic complications were identified according to the international and Australian guidelines. And yet, it is common for patients and doctors to confuse DD symptoms with depression and/or anxiety.

Aims/objectives: To explore patients’ understanding of DD and describe the manifestation of DD.

Methods: A mixed methods study will be conducted with adult patients with type 2 diabetes (T2DM), purposively and conveniently recruited from a general practice in western Sydney. Participants will be asked to complete the Diabetes Distress Scale (DDS17), and, if assessed to have DD, will be invited to further participate in a semi-structured in-depth interview. We estimated that the DDS17 scale will need to be applied to about 50 patients in order to recruit 12–15 patients eligible for interviews or until theoretical sufficiency is achieved. Quantitative DDS17 data will be descriptively analysed, and interview data will be thematically analysed.

Findings: Ethics approval for this project is pending. Data collection is planned to start in May for 2 months. Preliminary results will be presented at this conference.

Implications: The study will contribute to increasing our understanding of DD and strategies that may facilitate the disclosure of DD to their healthcare providers. Findings will have potential to improve timely identification and management of DD and ultimately enhance quality of life.

84. Access to primary health care in university students who are at risk of harm from sexual practices or sexual experiences

Ratten Jenni-marie^A, Sanci Lena^A and Trevena Judy^A

^AUniversity of Melbourne.

Background: As young people progress through university, they continue to develop their identity, which includes their sexual preferences, practices, and experiences. It is known that many university students experience unwanted sex-related outcomes that range from the contraction of sexually transmitted diseases, pregnancy, regrettable encounters to sexual violence. Young people in Australia face many barriers to accessing health care, especially when it comes to sensitive matters such as sexual and mental health. So far it is not known what proportion of students who are at risk of harm from sexual practices or sexual experiences access primary health care services.

Aims/objectives: We aim to establish what proportion of university students is at risk of harm from sexual practices or sexual experiences, what proportion of that cohort accesses primary health care services and whether access to care differs across students with different demographic characteristics such as gender, age and international vs local student status.

Methods: A subset of the Towards a Health Promoting University survey of 14,880 Melbourne University students (26.4% of the cohort), is being analysed (Sanci et al. 2022). Using logistic regression analysis of the cross-sectional data, we are using STATA to establish what proportion of students are at risk of harm from sexual practices or sexual experiences, whether these students are accessing primary health care services, and whether this differs between age groups, gender and residency status.

Findings: We will show what proportion of students that is at risk of harm from sexual practices or sexual experience, and whether they access primary care and break down results by demographics.

Implications: Establishing the prevalence of sexual related harms in university students will inform primary health care providers about appropriate risk screening in this cohort. It is also an opportunity for universities to explore targeted health promotions and student support services.

85. The ongoing evolution of a collaborative PBRN

Russell Grant^A, Neil Jennifer^A, Hunt Emiko^A, Clifford Sharon^A and Barton Chris^A

^AMonash University.

Background: Australia’s Practice-Based Research Networks (PBRNs) face an uncertain future, with insecure funding and minimal support for infrastructure. Monash University’s PBRN, the Monash Research and Education Network (MonREN) is in its second year of a program of revitalisation that aims to increase its relevance and accessibility to clinicians, community members, academics and Primary Care Organisations (PCOs).

Aims/objectives: To describe challenges and potential solutions encountered in the evolution of a revitalised PBRN.

Methods: Reflexive case study involving personal reflection by PBRN management group assisted by narrative review of minutes of management, member and stakeholder meetings.

Findings: MonREN continues to follow its developmental design informed by a program logic model developed in 2022. MonREN has over 2000 primary care members; 55 of these are ‘MonREN+ members’. These members can join regular journal clubs, research studies and needs-identification workshops. The workshops have informed MonREN priorities and generated three ‘evidence briefs’ and one honours project. Consumers and key regional PCOs continue as stakeholders and we are fostering collaboration with large clinical trials groups working in East and south-east Melbourne. External researchers seeking access to MonREN GPs have struggled at times to meet our conditions of primary care participation in study design/implementation, ethics approval and appropriate remuneration for study participants. 2024–2025 objectives include further articulation of member needs; optimisation of resources (database, communications and web presence); and building on relationships with PCOs and the Monash Partners Advanced Health Research and Translation Centre. Consultation and member engagement will continue to underpin the work.

Implications: PBRNs have multiple potential contributions to improving translation of research into primary care. Our consultative approach has been productive, but challenges in funding persist as we work to secure MonREN as a regional asset for general practice. Our experience can help other PBRNs wanting to develop and expand their network.

86. Feasibility of a novel GP-pharmacist collaborative health service model for antimicrobial stewardship in Australia

Kumar Saha Sajal^A and Athan Eugene^A

^ADeakin University.

Background: General practitioner-pharmacist collaborative antimicrobial stewardship (GPPAS) model can play an important role in optimising antimicrobial use and preventing antibiotic resistant infections in primary care. However, GPPAS model has not been firmly established in Australia.

Aims/objectives: This study aimed to assess feasibility of GPPAS model to optimise antibiotic use in patients with acute respiratory tract infection (ARTI).

Methods: Two pairs of general practices and community pharmacies in Geelong with a pair co-located in the same building and a pair distantly located were recruited. The GPPAS model allowed routine use of point-of-care testing C-reactive protein CRP testing (POCT-CRP) by GPs and community pharmacists to improve optimal antibiotic use, collaboration, patient referral, and patient education for 2 months in October–November 2023. Data included audits of medical records and surveys. Outcomes included uptake of CRP testing, reduction of antibiotic prescribing and implementation feasibility. Descriptive statistics were used for data analysis.

Findings: In total, 60 RTI-patients were tested by POCT-CRP; 45 by GPs and 15 by pharmacists. The rate of antibiotic prescriptions for patients tested in GP practice was 12%. Clinical outcomes: CRP levels among the 60 participants recruited were: <5 mg/L (n = 24; 45.8%); 5–19 mg/L (n = 24; 39.7%) and 20–100 mg/L (n = 8; 14.5%). Pharmacists immediately referred patients to general practitioner (GP) (5, 11.5%). Participants had positive attitude about collaboration, but timely communication, study pharmacists shift at work and nurse’s availability for testing were challenging to increase test uptake. GPs believed that if patient came to GP after having test result from a pharmacist would help optimise antibiotic prescription.

Implications: GPPAS model is feasible to implement in routine patient care. GPs and patients’ confidence in the pharmacists’ advice, supported by CRP testing, potentially can reduce unnecessary GP visits and antibiotic prescribing.

87. Australian general practitioners’ experience and perception about Artificial Intelligence in general practice

Sedaghat Najafadeh-tabrizi Neysan^A, Rhee Joel^A and Tran Michael^A

^AUniversity of New South Wales.

Background: Artificial Intelligence (AI) is a field that has made great progress in the last few years in its capacity for higher-level cognitive tasks. Its healthcare applications hold both promises and concerns, prompting efforts to establish coherent policies and roadmaps for its implementation in Australia. Understanding general practitioners’ (GPs) experience and perceptions towards AI is crucial, given their role in the healthcare system. Yet there is a literature gap in this area.

Aims/objectives: We aim to explore GPs’ experiences with AI applied to general practice, and their views on its potential benefits, concerns and challenges.

Methods: Semi-structured interviews will be conducted with a range of GPs exploring experience and perceptions about AI until thematic saturation is achieved. A prospective approach to screening will ensure diversity in age, rurality, geography, experience and perceptions towards AI.

Findings: We will report on the experiences of Australian GPs with AI applied to general practice, including positive and negative experiences. We will explore their attitudes towards AI, identifying their perceptions about potential benefits and their concerns about the challenges it may bring.

Implications: The findings will provide a greater understanding of the perceptions of Australian GPs with respect to the role of AI in clinical work and other domains. These insights will provide a framework for, and help guide, the development of AI tools in general practice.

88. Factors affecting provision of medical abortion services in Australian primary care: a systematic review

Skahill Greta^A and Shankar Mridula^B

^AUniversity of Melbourne.

^BNossal Institute for Global Health.

Background: Medical abortion refers to the use of mifepristone and misoprostol for pregnancy termination. Subsidisation of mifepristone on the Pharmaceutical Benefits Scheme in 2013 was anticipated to expand abortion provision in primary care and enhance progress towards universal access. More than a decade on, significant access issues remain.

Aims/objectives: The aim of this systematic review is to describe the individual, service and system-level factors affecting medical abortion provision in Australian primary healthcare.

Methods: We searched four databases from 1 January 2013 to 25 February 2024 to identify primary qualitative, quantitative and mixed-methods studies which describe factors affecting medical abortion provision in Australian primary care. We undertook thematic synthesis of qualitative data to identify analytical themes. We assessed confidence in these findings using the GRADE CERQual approach. We evaluated quantitative data against these findings to identify areas of agreement and disagreement. We critically appraised included studies using the Mixed Methods Appraisal Tool.

Findings: Eighteen studies met our inclusion criteria. We identified five overarching barriers to abortion provision: (1) medical abortion is a gendered service, (2) primary healthcare systems are urban-centric, (3) abortion service delivery is presently financially unviable (4) a culture of secrecy surrounds abortion provision, and (5) abortion lacks a health systems-based approach to service provision. We identified facilitators at individual, service and system levels, including (1) personal commitment to enhance equity in access, (2) inter-service resource sharing, and (3) geographic decentralisation of abortion training.

Implications: Our review identifies factors affecting the under-utilisation of Australian primary care for medical abortion provision and underscores the implications for geographically and economically disadvantaged populations. Our findings highlight key policy areas to address including funding geographic decentralisation of medical abortion training and services, and development of national and state-wide strategies to support integration of abortion provision as an essential primary care service.

89. Preparing primary care for precision diabetes: a systematic review

Sleaby Rochelle^A, Sanci Lena^A and Ekinci Elif^A,B,C

^AUniversity of Melbourne.

^BAustralian Centre for Accelerating Diabetes Innovations.

^CAustin Health.

Background: As of 31 December 2023, there were 1,270,865 people with type 2 diabetes (T2D) registered with the National Diabetes Services Scheme, and this number is expected to increase. A growing body of evidence supports the idea that variation exists not only in T2D presentation and progression, but also in individual responses to therapy. This suggests that a one-size-fits-all approach to diabetes management is inappropriate and will have an adverse impact on provision of health services, expenditure and health outcomes as the population with diabetes increases. Precision diabetes evolves the existing one-size-fits-all approach, into one in which data enhances clinical decisions at the subgroup, if not at the individual level.

Aims/objectives: The aim of the systematic review is therefore the identification, appraisal and synthesis of the international evidence base for precision diabetes.

Methods: The systematic review protocol will be pre-registered on PROSPERO. Multiple databases will be searched using a prespecified strategy. Two review authors will independently screen titles, abstracts and full texts, and a third reviewer will resolve conflicts, using Covidence software. Two reviewers will undertake risk of bias assessment using checklists appropriate to study design. The primary outcome will be glycaemia as measured by glycated haemoglobin (HbA1c). Secondary outcomes will be response to glucose lowering treatments and onset of cardio-renal complications. A narrative synthesis and meta-analysis will be conducted.

Findings: Results will be presented using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis checklist.

Implications: The systematic review (in progress) will underpin future mixed methods research to explore how precision medicine can enhance diabetes management. Findings will provide insights for clinical and research practice and policy, considering the varying availability, quality and utility of data across clinical and research settings; and the careful interpretation of data to avoid digital overdiagnosis, and to support inclusivity and equity.

90. Protective factors for psychological wellbeing: a cross-sectional study of young people attending an urban Aboriginal and Torres Strait Islander primary healthcare service

Spurling Geoffrey^A, Askew Deborah^A, Hayman Noel^B and Schluter Philip^C

^AUniversity of Queensland.

^BSouthern Queensland Centre of Excellence, Inala.

^CUniversity of Canterbury.

Background: While much has been written about factors associated with psychological distress in Aboriginal and Torres Strait Islander youth, there is a need to change the deficit and risk-based approaches and better understand factors that contribute to Aboriginal and Torres Strait Islander youths’ wellbeing.

Aims/objectives: To measure associations between protective factors associated with positive psychological outcomes for Aboriginal and Torres Strait Islander youth living in an urban area.

Methods: A positive-outcomes approach was employed to analyse health assessment data from a cohort of Aboriginal and Torres Strait Islander youth aged 15 to 24 years attending an urban Aboriginal and Torres Strait Islander health service (2016–2021). A modified Poisson regression approach was used to analyse the association of protective factors measured by health assessments with absence of depression.

Findings: Health assessments from 710 participants were analysed, with 72.1% of young people found to not be experiencing depression. More males (81.6%) than females (63.3%) were not experiencing depression (Fisher’s exact test P < 0.001). Exercise, sport, and absences of marijuana use, smoking cigarettes, difficulty getting a job, homelessness, trouble with the police and experience of violence were associated with an absence of depression.

Implications: Most young people were not experiencing depression. A positive outcomes approach provided evidence to support avenues to success which need to be developed with Aboriginal and Torres Strait Islander communities. Policy makers, clinicians and health services need to address specific social determinants to support young people’s social and emotional wellbeing.

91. Implementation of the Virtual Integrated Practice (VIP) Partnership Program: supporting access to primary care in rural Queensland

Strauss Ruby^A, Job Jenny^A and Jackson Claire^A

^AUniversity of Queensland.

Background: The Virtual Integrated Practice (VIP) Partnership Program was co-created as a strategy to address workforce shortage in areas of rural/remote Queensland experiencing a critical shortage of general practitioners (GPs). In this program urban GPs join a rural/remote general practice to provide ongoing care to patients remotely via secure telehealth 1–2 days/week, with biannual 3- to 5-day face-to-face visits to the practice.

Aims/objectives: This study aimed to evaluate the implementation of the VIP model in general practices across rural/remote Queensland.

Methods: Service and billing data were collected to assess fidelity of intervention delivery. Acceptability was assessed using anonymous patient surveys and qualitative interviews were conducted with practice staff/providers to identify barriers and enablers to implementation guided by Consolidated Framework for Implementation Research.

Findings: Since 2021, seven GPs have been recruited for six rural/remote practices (MM4–MM7) and have provided 4732 services. Patients were majority female (63%), had an average age of 49.5 years (SD 21.8) and 3.9% identified as Aboriginal or Torres Strait Islander. Over half of the appointments were repeat patient encounters and 68% were delivered via video health. Two thirds of patients attended the appointment at the practice, of which 39% were conducted with support from the practice nurse. Patient survey feedback (n = 213) found 98% would use the service again, 94% said that VIP GP improved their access to primary care and 23% reported that the consult prevented a visit to the emergency department. Key determinants of implementation identified were digital infrastructure, practice staff support, and triaging of appointments suitable for telehealth.

Implications: This evaluation is informing strategies to promote ongoing implementation of a virtual GP model with demonstrated benefits of improved access to a GP and continuity of care for rural Queensland communities. Data collection is ongoing to assess the cost efficiency of the Virtual Integrated Practice model.

92. Prevalence and associations of provision of nursing home visits and home visits by early-career specialist general practitioners: a cross-sectional analysis of the New alumni Experiences of Training and independent Unsupervised Practice (NEXT-UP) study

Tait Jordan^A, Turnock Allison^B, Fielding Alison^C, Moad Dominica^C, Blowes Ashley^D, Tapley Amanda^C, Davey Andrew^C, Bentley Michael^A, FitzGerald Kristen^E, Kirby Catherine^F, van Driel Mieke^G and Magin Parker^C

^ARoyal Australian College of General Practitioners.

^BUniversity of Tasmania.

^CUniversity of Newcastle.

^DGP Synergy.

^EGeneral Practice Training Tasmania.

^FEastern Victoria General Practice Training.

^GUniversity of Queensland.

Background: Nursing home visits (NHVs) and home visits (HVs) are important general practice services for delivering care in older patient age groups and in patients with chronic disease and multimorbidity. However, previous research suggests that, compared to longer-established GPs, fewer early-career GPs participate in NHVs and HVs.

Aims/objectives: We sought to establish the prevalence and associations of provision of NHVs and HVs by early-career specialist GPs.

Methods: A cross-sectional questionnaire-based study of early-career GPs was conducted in conjunction with routinely collected vocational training program data. Participants were early-career GPs (6–24 months post-Fellowship) who completed vocational training in NSW, ACT, Tasmania, or Eastern Victoria. The study outcomes were participants’ provision of any NHV and HV in their current practice. Multivariable logistic regression was used to examine associations with a range of demographic, practice, and training characteristics.

Findings: 354 alumni responded (response rate 28%), of whom 34% reported providing NHV (59% in rural areas), 41% reported providing HV (60% in rural areas), and 26% reported providing both (48% in rural areas). Practising in a remote, rural, or regional area was strongly associated with provision of NHV (OR 5.87 [95% CI: 2.73, 12.6]) and HV (OR 3.64 [95% CI: 1.63, 8.11]) as an early-career specialist GP. Rurality of GP training (pre-Fellowship) was significantly univariably associated with provision of NHV and HV as an early-career specialist GP. However, on multivariable analyses, these were no longer statistically significant.

Implications: Early-career specialist GPs in regional/remote areas are more likely than their urban counterparts to provide NHVs and HVs. Overall, however, the modest proportion of participants providing any NHVs and HVs as part of their practice is less than that of GPs within 5 years post-fellowship and longer-established GPs. These findings have implications for general practice’s future capacity to accommodate the needs of an ageing population.

93. Quality improvement in primary care – pursuing health equity through quality improvement

Green Jennifer^A and Tam Grace Wai Shan^A

^ASouth Western Sydney Primary Health Network.

Background: Delivering equitable and high-quality health services is a challenge in South Western Sydney (SWS), a region characterised by socio-economic diversity and complex healthcare needs. General practices play an important role in meeting this challenge by engaging in continuous quality improvement (QI) processes, which are essential for raising patient care standards. SWSPHN is leading the way in supporting general practice to identify improvement opportunities by encouraging QI through our Quality Improvement in Primary Care (QIPC) program. QIPC facilitates the embedding of QI systems, enhancing data quality, analysing practice data to identify improvement areas, and assisting with QI activities.

Aims/objectives: The evaluation of QIPC aims to determine its impact on patient and provider satisfaction, practice efficiency, and overall performance.

Methods: A mixed-methods evaluation was conducted, combining qualitative and quantitative analyses. An anonymous survey was distributed to staff across participating practices, complemented by an analysis of de-identified practice data to assess the program’s effectiveness.

Findings: Overall, 85% of participating practice staff indicated that the learning outcomes of QIPC were entirely met and 100% of respondents are planning or have already implemented practice changes. Majority of respondents also found the program has enhanced patient experience (78%), improved provider experience (71%), improved practice efficiency (75%), and improved practice data (84%). Patients with chronic conditions who have an active care plan increased by 2.18% in 2022–2023 compared to 2021–2022.

Implications: Our results advocate for the QIPC’s potential to elevate care standards, bridge care disparities, boost overall practice performance, and enhance healthcare delivery in SWS. The program has proven effective in motivating providers to change practices and achieving substantial learning outcomes. The modest increase in active chronic disease care plans indicates a need for further investigations to identify trends as well as facilitators and barriers to enhance patient management.

94. Adolescent anxiety and depression care: a qualitative study of Australian general practitioners experiences and perspectives

Tesfu Kisanet^A, Johnson Caroline^A, Coe Amy^A and Kaylor-Hughes Cath^A

^AUniversity of Melbourne.

Background: Approximately one in five Australian adolescents experience mental health conditions, primarily anxiety and depression. General practitioners (GPs) play a pivotal role in providing adolescent mental healthcare, yet an evidence gap exists in understanding the intricacies of their caregiving approaches.

Aims/objectives: This study explored Australian GPs’ clinical experiences and perspectives in delivering care for adolescent anxiety and depression in general practice.

Methods: A qualitative study was conducted using semi-structured, one-on-one interviews with 14 GPs from regional and metropolitan Victoria, Australia. Two vignettes featuring fictitious adolescents with anxiety and depressive symptoms were designed and presented to investigate the GPs’ approaches to navigating the delivery of adolescent mental healthcare. Interviews were transcribed verbatim and thematically analysed via NVivo. Demographic surveys were administered to all participants and analysed for descriptive statistics.

Findings: Four themes encapsulating the delivery of adolescent mental healthcare were identified. Theme 1, termed ‘therapeutic alliance’, underscored the initial importance of fostering engagement and connection between the GPs and adolescents. Theme 2, ‘assessment’, delved into the biopsychosocial approach GPs had towards patients’ issues, while theme 3 emphasised considerations surrounding ‘treatment approaches’. Theme 4, ‘Medicare’, overlapped across all stages of care, and explored the alignment of GP practices with the Medicare descriptors for mental health treatment items.

Implications: GPs face complex challenges in managing communication with referral pathways, compounded by prolonged waitlists for mental health services. Enhanced support for GPs is critical. Introducing time-based mental health item numbers tailored for longer consultations can facilitate comprehensive patient discussions and effective mental healthcare delivery. Long-term objectives include revising MBS descriptors to empower GPs to deliver holistic, patient-centred care and promote multidisciplinary approaches, aligning with best practices and their GP training. Future research should assess the impact of these changes on stakeholders across various levels, including cost-effectiveness and health outcomes for adolescents.

95. Composite narratives: a novel method of presenting qualitative findings about social connections of older people with chronic conditions

Thompson Cristina^A, Halcomb Elizabeth^A and Montgomery Amy^A

^AUniversity of Wollongong.

Background: As Australia’s population ages the risk of chronic disease and functional impairment increases, which may limit older peoples’ social engagement. Reduced social connections result in loneliness and social isolation which have adverse mental and physical health impacts for older people. Using the voices of older research participants to illustrate their experience of social connection may increase visibility of the needs of this group.

Aims/objectives: This study explored the experience of social connection in older people living with chronic conditions and the factors influencing their social participation.

Methods: Using a qualitative descriptive approach we conducted semi-structured interviews (n = 19) with a purposive sample of older chronic care program participants from regional New South Wales. The older peoples’ perceptions of their social connections, the effect of chronic conditions and views about the role of General Practice relating to loneliness and social isolation were explored. An inductive approach to thematic analysis was undertaken. A composite narrative method privileging participant voice provided a novel and robust method of orally presenting qualitative findings.

Findings: Five themes were identified: (i) the experience of loneliness, (ii) managing diminishing social contacts (iii) living with chronic conditions, (iv) barriers to social connection, and (v) facilitators of social connection. The composite narrative was structured to accurately reflect these themes and participants’ views. Loneliness and social isolation arose from diminished social networks, loss of function, and transport difficulties. Family assistance, community ties and staying well facilitated social engagement. General practice has a key role in supporting older people living with chronic conditions.

Implications: A composite narrative provides an engaging format to share findings about the ability of older people to maintain social and community engagement despite ageing with chronic conditions. Future research should explore the impact of this data presentation method for policymakers and practitioners.

96. Fixing the leaky general practice training pipeline: identifying placement barriers and enablers

Toukhsati Samia^A, Kippen Rebecca^B, Taylor Carla^A, Morgan Simon^A and McArthur Lawrie^C

^AGeneral Practice Supervision Australia.

^BMonash University.

^CRoyal Australian College of General Practitioners.

Background: High quality placement experiences in general practice are instrumental in attracting medical students and junior doctors to general practice as a speciality of choice. The experience of a positive placement for the supervisor and practice team inspires them to provide more learning opportunities, which may in turn influence that learner’s career decisions. Advancing understanding of the attitudes held by supervisors’ and practice teams towards learners on placement in general practice is important to optimise this cycle.

Aims/objectives: To explore the attitudes of supervisors and practice teams towards supervising/hosting medical students and junior doctors in general practice and the perceived norms and barriers influencing their intentions to continue in the future.

Methods: Invitations to participate in the General Practice Supervision Australia (GPSA) annual national survey titled ‘ENGAGE 2024 – Building a better future together’ were emailed to GPSA members and advertised in social media, eNews, and on GPSA’s online community platform. Consenting respondents anonymously completed questions about their socio-demographics and supervision experience, their attitudes, perceived norms and barriers relating to supervising/hosting learners on placement, and intentions to supervise learners in the future.

Findings: Data collection occurred in April–May 2024. Descriptive analyses will be used to explore the socio-demographic characteristics of the sample. Repeated measures ANOVA will be used to evaluate differences in supervisor/practice team attitudes across learner groups. Regression modelling will be used to explore factors that predict intentions to supervise/host learners in the future.

Implications: Attracting and retaining medical students and junior doctors to general practice as a speciality of choice is crucial to safeguard the long-term sustainability of the Australian primary care. Outcomes from this study will advance understanding of the attitudes supervisors and practice teams have towards learners on placement in general practice, enabling the identification of key targets to optimise and support high quality placement experiences.

97. ‘It’s the vibe’: quantifying ‘quality’ in the general practice clinical learning environment

Toukhsati Samia^A, George Tina^A, Greenfield Leila^A, Kippen Rebecca^B, O’Sullivan Belinda^C, Denniston Charlotte^D, Flynn Kay^E and Taylor Carla^A

^AGeneral Practice Supervision Australia.

^BMonash University.

^CUniversity of Queensland.

^DUniversity of Melbourne.

^EChristies Beach Medical Centre.

Background: The consensus-based General Practice Clinical Learning Environment (GPCLE) framework describes six key elements of high-quality learning environments in general practice. Research is needed to translate the GPCLE framework concepts into quantifiable indicators to enable the practical application of the GPCLE as a quality improvement tool supporting best practice.

Aims/objectives: To translate the GPCLE framework into quantifiable indicators that can be practically applied to benchmark, monitor and guide quality improvement in the clinical learning environment.

Methods: An expert panel of stakeholders involved in GP training were invited to participate in a Delphi-style process comprising two phases: (1) a pre-workshop activity, facilitated via email, asking respondents to identify and describe key indicators, behaviours, and actions demonstrating various levels of quality in relation to one of six GPCLE elements; (2) a face-to-face, one-day workshop using brainstorming, reflection, review, and group discussion to reach consensus about valid, objective indicators.

Findings: A total of 16 stakeholders participated in both phases, including GPs, GP supervisors, GP registrars, practice managers, and medical educators. Pre-workshop data were analysed in NVivo, categorised by GPCLE elements across a quality continuum: foundational (at a level acceptable for training accreditation), commendable (above accreditation standard), exemplary (above commendable standard), and descriptions of quality indicators were used to inform workshop activities. The workshop validated consensus-driven quality indicators for each GPCLE element, across a performance continuum, organised into items.

Implications: Use of a consensus-based Delphi-style process involving expert stakeholders from general practice successfully translated the conceptual GPCLE framework into a useful benchmarking and planning tool to show foundational to exemplary practice, based on quantifiable indicators. Future research aims to promote engagement and feasible implementation of this tool for quality improvement in general practice.

98. Digital health technology use in Australian general practice consultations: a cross-sectional analysis of the Medicine in Australia: Balancing Employment and Life study

Tran Michael^A, Rhee Joel^A and Blazek Katrina^A

^AUniversity of New South Wales.

Background: The use of technology including electronic clinical decision support (eCDS) tools has become more ubiquitous in general practice. Technology has impacted the way a general practice consultation is run, and the teaching and learning of general practice registrars as well as continuing professional development. This is independent of the shift to telehealth services.

Aims/objectives: We aimed to quantify Australian general practitioners’ (GPs) eCDS use, related sentiments, and its associations with practitioner and practice characteristics. Positive and negative sentiments were considered facilitators and barriers to the uptake of eCDS tools.

Methods: A cross-sectional study was undertaken analysing data from the Medicine in Australia: Balancing Employment and Life (MABEL) survey. From a total of 27,829 participants of all types of physicians, 3,126 GPs responded, surveyed in September 2018. Descriptive statistics was used to examine facilitators and barriers to general practice uptake of eCDS and logistic regression was used to examine its associations with practitioner and practice characteristics.

Findings: Of the GPs that responded, 2,240 GPs (83.8%), reported using eCDS tools with largely positive sentiments regarding technology use in consultations. Reservations include privacy concerns, system incompatibility and lack of support. Those using eCDS were more likely to be female, younger and bulk-billing.

Implications: Facilitators outweighed barriers regarding eCDS use in an Australian setting with higher uptake among bulk-billing practitioners. Unlike previous studies, our respondents did not report difficulties with the use of eCDS. However, they reported concerns regarding data privacy, both personal and for the patient, as barriers to eCDS adoption. Specifically, there were concerns around the lack of clarity regarding privacy and consent requirements for access to data. Further research on the clinical usefulness of eCDS and its impact on decision-making in general practice would be of value.

99. Factors associated with retention of early-career general practitioners in former training practices

Tran Michael^A, Fielding Alison^B, Moad Dominica^B, Tapley Amanda^B, Davey Andrew^B, Bentley Michael^B and Magin Parker^B

^AUniversity of New South Wales.

^BRoyal Australian College of General Practitioners.

Background: Retention of general practice registrars in their training practices is important for addressing the general practice workforce deficit and maldistribution of general practitioners (GPs), particularly in rural areas. Understanding which factors impact registrar retention will help incentivise retention and attenuate the urban-migration of the rural workforce.

Aims/objectives: We sought to establish the prevalence, and associations, of retention of general practice registrars in their training practices.

Methods: A cross-sectional questionnaire-based study of early-career GPs was conducted in conjunction with evaluation of data contemporaneously recorded as part of vocational training. Participants were former registrars, attaining general practice fellowship between January 2016 and July 2018, of three regional training organisations delivering general practice training in NSW, Tasmania, the ACT and eastern Victoria. Multivariable logistic regression estimated associations between relevant explanatory variables and the outcome of previously working at current practice during vocational training.

Findings: 354 alumni responded (response rate 28%), of whom 322 provided data regarding previous training practice retention. 190 (59%) had previously trained at their current practice as registrars. GPs were more likely to be retained by a training practice if it was located within an area of relative socioeconomic disadvantage (adjusted odds ratio (aOR) 0.82 [95% confidence interval 0.73, 0.91], P < 0.001 for each increased decile of socioeconomic status) and if the practice provided two or more of home visits, nursing home visits, or after-hours services (aOR 4.29 [2.10, 8.75], P < 0.001). Participants were less likely to be retained by the practice if training was completed in a rural area (aOR 0.35 [0.17, 0.72], P = 0.004).

Implications: Rural training location is associated with reduced odds of subsequent retention of general practice registrars at the training practice. Provision of out-of-practice and after-hours care were strongly associated with registrar retention. There may be altruistic or work satisfaction, rather than monetary, reasons to explain this finding.

100. Medical student feedback literacy in a primary care rotation

Tran Michael^A, Smith Oliver^A and Rhee Joel^A

^AUniversity of New South Wales.

Background: Medical student education in primary care is unique in being community-based and providing multiple sources of feedback on consultation skills. Constructivist approaches with observation of GP supervisors, and behaviourist approaches with discussion and reflection guiding students’ development of clinical reasoning and management skills, are combined. Meaningful and demonstrable utilisation of this feedback by students remains an educational challenge.

Aims/objectives: We aimed to showcase achievable changes to educational tasks in an established university curriculum, improving student feedback literacy and create a feedback loop to counter previous unidirectional, terminal feedback.

Methods: We sought to provide multiple instances of feedback, and opportunities for students to reflect on, and action, this feedback. Existing assessments in clinical reasoning and consultation skills were modified with oral presentations and provision of actional feedback, requiring reflection, to create a feedback loop.

Findings: Feedback was introduced to a series of tasks, including written assessments, mini clinical evaluation exercises, written case logs and OSCE-type assessment with roleplaying actors (simulated patients). Changes included (i) converting a written task on teamwork processes to an oral presentation with follow up reflection, (ii) written reflection and discussion about learning from mini-clinical evaluation exercises, (iii) students teaching learning points of interest to each other and (iv) allowing students to incorporate feedback and demonstrate improvement in consultation skills at their final summative role play assessment.

Implications: The changes have been well-received, with student and educator engagement being positive. Students have demonstrated critical reflection on feedback, and development in consultation and clinical reasoning skills. The higher workload reported by medical educators is balanced by increasing student requests for their insights into community-based patient care processes, clinical cases, and consultation skills. There is greater student acceptance of constructive criticism, and strengthening of supervisory relationships within an educational, primary-care focused community of practice.

101. Perspectives on the experience of transition in postgraduate general practice training

Tran Michael^A, Rhee Joel^A, Hu Wendy^B, Magin Parker^C and Shulruf Boaz^A

^AUniversity of New South Wales.

^BWestern Sydney University.

^CRoyal Australian College of General Practitioners.

Background: Transitions are a period and a process, through which there is longitudinal adaptation in response to changing circumstances in clinical practice and responsibilities. While the experience of the transition in medical student learnings and in hospital-based specialty training programs are well-described and researched, the experience of transition from hospital to community-based general practitioner (GP) training has not been described comprehensively.

Aims/objectives: We aimed to identify both formative and adverse experiences of transitions in GP training as enablers and barriers to successful transition and their impacts on personal and professional development.

Methods: PubMed and MEDLINE databases were searched in June 2023 with no date limits for empirical studies on the transition experiences of GP into, and through, training. Of 1543 retrieved records, 76 were selected for data extraction. Based on socio-ecological and multiple and multi-dimensional theories of transitions, data were organised into contextual themes: physical, psychosocial, organisational cultural, and chronological experiences of transitions.

Findings: Our findings describe both formative and adverse experiences which are context-dependent. Comfort with uncertainty, and time, are significant modulators of factors contributing to negative experiences of transitions. Some initially-negative experiences may become more positive with time. Identification of the inflection points that represent shifts from negative to more positive experiences may help moderate expectations for learning and performance at different stages of training.

Implications: Challenges in training can either be developmental, contributing to professional identity formation and clinical competency, or detract from learning and potentially contribute to negative experiences and their consequences such as burnout and attrition from training programs. These findings will assist future research in identifying predictive factors experiences of transitions and may strengthen existing and nascent GP training programs whilst also promoting the transferability of findings to other community-based specialty training programs.

102. Undergraduate primary care education and effects on professional identity, feedback literacy, tolerance of uncertainty and readiness for interprofessional learning

Tran Michael^A, Smith Oliver^A, Lawrence Renae^A and Rhee Joel^A

^AUniversity of New South Wales.

Background: Considered critical to development as a physician and general practitioner, are tolerance of uncertainty and capacity for interprofessional learning and work. The primary care program is delivered to undergraduate medical students in their final years at UNSW. The primary care program is community-based and there is emphasis on consultation skills and appreciation of teamwork processes. Assessments are focused on observed consultations, a role play assessment, presentations to other students of clinical cases and reflections on team care processes and completion of case logs of cases with self-identified need for further learning.

Aims/objectives: We aim to determine whether participation in a primary care rotation has any impact on feedback literacy, tolerance of uncertainty, readiness for interprofessional learning and overall professional identity. This is especially important knowledge in the context of declining interest in general practice as a career.

Methods: Pre- and post-course questionnaires will be administered to 40 students with questions focusing on the domains on feedback literacy, professional identity, tolerance of uncertainty and interprofessional learning. Analysis will be quantitative and qualitative, with the use of validated scales enabling statistical analysis of Likert-type responses and free text responses to questions posed in each domain analysed thematically.

Findings: Results will centre around the feedback received as well as results of the use of validated scales including the feedback literacy behaviour scale, clarity of professional identity, medical student and junior doctor’s tolerance of ambiguity scale, growth mindset scale and readiness for interprofessional learning.

Implications: The findings from this study will help to inform about the impact of a community-based undergraduate placement where students engage more comprehensively with patient consultation and management in the context of a healthcare team. The findings will inform design of the current course and future curriculum in the context of declining interest in general practice as a career.

103. Self-identified learning needs of medical students in a primary care rotation

Tran Michael^A, Smith Oliver^A, Lawrence Renae^A, Rhee Joel^A and Shulruf Boaz^A

^AUniversity of New South Wales.

Background: Self-directed learning, based on questions generated during clinical placements, is a valuable formative learning exercise for medical students These questions may be generated by students, patients, or supervisors, with students given freedom of topic choice.

Aims/objectives: We seek to develop a taxonomy of self-identified learning needs in primary care, to understand drivers of student learning, and potential pedagogical implications for medical educators and curriculum design.

Methods: A retrospective case log analysis was conducted of submission from 2023. Cases were grouped into a broad taxonomy by learning topic. Frequency of topics were compared against the twenty most common reasons for presentation to GPs in the Bettering the Evaluation and care of Health (BEACH) study.

Findings: One hundred and eighty-nine students contributed to 1524 logs. 71.78% were focused on a clinical topic, 14.04% on medications, 9.71% on diagnostic questions and testing, 2.17% on health systems, 1.31% on vaccinations and 0.33% on consultation and communication skills. Overall, a minority, being 15.62% of student logs, focused on issues commonly seen in general practice as per the BEACH study. Understanding this and developing a taxonomy of self-identified learning needs provides insight into potential motivations for student learning and development of self-directed learning skills.

Implications: Where assessment does not drive learning, medical students prefer sating the desire to know about the unusual and uncommon, rather than common topics. Can focusing on obscure and rare cases, and broad inquiry, be helpful as a form of learning? If this type of exploration is more engaging, then to what extent should topic choice be moderated by educators? What balance is required to allow students to develop skills for future self-directed learning and continuing professional development? Pedagogical implications include the contrast between competency-based assessment and development of professional identity.

104. GP registrars’ antibiotic prescribing in telehealth vs face-to-face consultations; results from the ReCEnT study

Turner Alexandria^A, Gao Yu^A, Magin Parker^B, Tapley Amanda^A, Davey Andrew^A, Fisher Katie^A, Moad Dominica^A and van Driel Mieke^C

^ARoyal Australian College of General Practitioners.

^BUniversity of Newcastle.

^CUniversity of Queensland.

Background: Antimicrobial resistance is a global threat. Australia has high antibiotic prescribing rates with the majority of antibiotics prescribed by general practitioners (GPs) for self-limiting acute respiratory tract infection (ARTIs). Australian GP trainees’ (registrars’) prescribing for ARTIs may have been affected by the introduction of remunerated telehealth consultations in 2020. Understanding of the impact of telehealth on antibiotic stewardship may inform registrar educational programs.

Aims/objectives: This study aimed to compare the prevalence of antibiotic prescribing by GP registrars for ARTIs via telehealth versus face-to-face (F2F) consultation modalities.

Methods: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing, multi-centre inception cohort study of registrars’ in-consultation clinical and educational experiences. The outcome variable was ‘antibiotic prescribed’ for new presentations of, respectively, upper respiratory tract infection (URTI)/common cold, acute bronchitis, acute sore throat, acute otitis media, and acute sinusitis. The covariate of interest was consultation type (telehealth or F2F). Analysis employed univariable and multivariable logistic regression of 2020–2023 ReCEnT data.

Findings: 2392 registrars participated (response rate 93.4%). Antibiotics were prescribed in: 1685 (51%) sore throat, 880 (6.9%) URTI, 1140 (64%) bronchitis, 1067 (61%) sinusitis and 1278 (73%) otitis media consultations. On multivariable analysis, antibiotics were less often prescribed in telehealth than F2F consultations for sore throat (Adjusted OR 0.69, 95% CI: 0.55–0.86, P = 0.001), URTI (Adjusted OR 0.64, 95% CI: 0.51–0.81, P < 0.001) and otitis media (Adjusted OR 0.47, 95% CI: 0.26–0.84, P = 0.011). There were no significant differences for acute bronchitis (Adjusted OR 1.07, 95% CI: 0.79–1.45, P = 0.66) or acute sinusitis. (Adjusted OR 1.00, 95% CI: 0.76–1.32, P = 0.99).

Implications: The impact of telehealth on antibiotic prescribing may be condition specific. There was no evidence in this study that telehealth consultations were associated with greater registrar antibiotic prescribing for ARTIs – and, thus, no deleterious effect on antibiotic stewardship.

105. GP registrars’ antibiotic prescribing for acute bronchitis: a pragmatic prospective non-randomised controlled trial

Turner Alexandria^A, Magin Parker^B, Tapley Amanda^A, Holliday Elizabeth^B, Dizon Jason^C, Fisher Katie^A, Fielding Alison^A, Moad Dominica^A, Davey Andrew^A and van Driel Mieke^D

^ARoyal Australian College of General Practitioners.

^BUniversity of Newcastle.

^CHunter Medical Research Institute.

^DUniversity of Queensland.

Background: Inappropriate antibiotic prescription (with its consequence of antibacterial resistance) for self-limiting non-pneumonia respiratory tract infections (RTIs) is less common in the GP registrar population than in established GPs, but is still considerably in excess of international and Australian benchmarks. In 2014, an educational intervention delivered face-to-face to GP registrars and supervisors reduced registrars’ antibiotic prescription for acute bronchitis by a statistically significant 16% (absolute reduction).

Aims/objectives: To establish the efficacy of an updated registrar-supervisor intervention (delivered at distance) to reduce registrars’ antibiotic prescribing.

Methods: A pragmatic non-randomized trial with non-equivalent control group design nested within the ReCEnT cohort study of GP registrars’ clinical practice. The intervention, focussed on acute bronchitis as an exemplar RTI, consisted of webinars, on-line educational modules, and materials for registrar-supervisor in-practice educational sessions. It was underpinned by the Behaviour Change Wheel framework and delivered to registrars of a single educational/training organisation. Controls were other educational/training organisations. It was delivered annually from mid-2021. Pre-intervention data was from 2017 to training-semester one, 2021. Post-intervention data from training-semester two 2021 to training-semester two, 2023. The primary outcome was antibiotic prescribing for acute bronchitis. Statistical analysis used multivariable logistic regression with predictors of interest: time (before/after intervention), treatment group, and an interaction term for time-by-treatment group. The p-value of the interaction term determined statistical significance.

Findings: Of 4612 acute bronchitis presentations during the study period, 70% were prescribed antibiotics. There was a 6.9% absolute reduction (adjusted) of prescribing in the intervention group compared to the control group. This was not statistically significant (P-value of the interaction term, 0.22).

Implications: Failure to find a significant difference with the educational intervention (and smaller effect size compared to that of the earlier smaller-scale face-to-face intervention) suggests challenges with scalability of this (and similar educational) innovations in the expanded national GP training program.

106. Fat shaming: exploring the perspectives of GP maternity care providers towards weight and body size

Van Den Heuvel Jessica^A, Wallis Katharine^A, Kearney Lauren^A,B and Callaway Leonie^B

^AUniversity of Queensland.

^BRoyal Brisbane and Women’s Hospital.

Background: Pregnant women living in larger bodies experience weight stigma and discrimination from health care providers when accessing maternity care. Stigma and discrimination are fundamental causes of health inequality. General practitioner maternity care providers (GPMCPs) are usually the first contact that a woman has with the healthcare system during her pregnancy, thus must examine their own biases, to ensure best practice care and improved health outcomes.

Aims/objectives: To explore and describe the attitudes and beliefs of GPMCPs towards weight and body size in pregnant patients.

Methods: Participants are general practitioners who provide pregnancy related care (GPMCPs), selected from a larger group of survey respondents that included midwives, obstetricians and allied health practitioners. Participants were recruited to complete the cross-sectional survey through purposive sampling and a snowballing strategy. A subsection of participants who have consented to be contacted for further research will be invited to participate in semi-structured interviews. The data will be analysed descriptively as well as thematically to identify patterns of meanings.

Findings: We expect findings from this study will provide insights into the attitudes and beliefs of GPMCPs towards weight and body size in pregnancy.

Implications: Findings could inform development of guidelines and policy that support clinicians to provide safe, inclusive and best practice care for pregnant women living in larger bodies.

107. ‘What about me?’ – Rare disease patients lost in a complex health system. How can general practice be supported to implement integrated rare disease care?

Vidic Nada^A, Palmer Elizabeth (Emma)^A, Natalie Taylor Scientia^A and Harris-Roxas Ben^A

^AUniversity of New South Wales.

Background: Approximately two million (8%) Australians live with a rare disease. Each Australian full-time GP averages 72 individuals, with a rare disease, on their books, some of whom may not yet have a diagnosis. Despite their clinical heterogeneity, people living with rare disease face similar remediable inequities in terms of health care and outcomes. These inequities have resulted in an average 10-year lag between symptom onset and diagnosis. Navigating the health system remains a central challenge. Primary care provides a comprehensive and longitudinal point of contact with the health system. Primary care is well placed to support integrated rare disease care.

Aims/objectives: This scoping review sought to investigate how integrated rare disease care is delivered in the general practice setting in OECD countries, and what factors support or inhibit implementation.

Methods: PRISMA and JBI protocols for scoping reviews, with two level co-screening at 80% or greater agreement. A pre-developed data extraction instrument, based on the quadruple aim and the Consolidated Framework for Implementation Research version 2 (CFIR 2.0) was applied.

Findings: 26 articles were included. The GP (or equivalent) role varied from providing routine primary care to shared-rare-disease-care. Reportedly, individuals whose GP was actively involved in their rare disease care had a shortened diagnostic delay, improved transitions of care, reduced unplanned emergency and hospital service use, comprehensive psychosocial care, improved quality of life and improved palliative care experiences. Sufficient communication from specialists, information, resources, time and reimbursement for complex care are still needed. GP perspectives are poorly described.

Implications: Despite low prevalence of rare diseases, the level of GP involvement in care is high. This study describes components needed in a rare disease model of care for primary care, which includes GP perspectives. This study provides valuable insights into contextual factors affecting practical implementation of the same.

108. Why do Australian general practitioners leave the profession? A qualitative study

Vuong Kylie^A,B, To Au-Yeung Yin^A, Moses Dianne^A, Johnston Kate^C, Brumpton Kay^A,D and Vasiliadis Sophie^E

^AGriffith University.

^BUniversity of New South Wales.

^CGold Coast Health.

^DRural Medical Education Australia.

^EMurdoch Children’s Research Institute.

Background: Primary care and general practice are essential to the delivery of a sustainable and affordable healthcare system; however, general practitioners (GPs) are leaving the discipline for new career directions, both during and after vocational training. The reasons for GPs leaving the discipline are important for devising strategies for strengthening workforce retention programs.

Aims/objectives: We aimed to investigate why GPs leave the discipline, in particular clinical general practice, to pursue alternative career pathways.

Methods: Individual, semi-structured interviews were conducted in-person or online. Those who have attained vocational registration or previously enrolled in an accredited general practice training program within Australia were eligible. Interviews were recorded and transcribed, and then were analysed thematically.

Findings: Ten interviews were conducted, with seven former GPs with vocational registration and three former GP trainees. Reasons for leaving clinical general practice include lack of support, both professional and personal; and alternative opportunities. The participants expressed a keen desire to contribute to patient care and health outcomes, making the decisions to leave difficult. Some participants maintained an openness to returning to clinical general practice, while for others, the decision was final.

Implications: Systematic change is needed to improve general practice retention. We recommend changes to general practice training and pathways to return to general practice.

109. Effectiveness of an education program to train primary care physiotherapists and exercise physiologists in the delivery of pulmonary rehabilitation

Walsh Jessica^A, McKeough Zoe^A, Dale Marita^A, Alison Jennifer^A and Dennis Sarah^A

^AUniversity of Sydney.

Background: Pulmonary rehabilitation (PR) is recommended for people with chronic respiratory diseases. Most PR programs are provided within hospital settings, but participants report travel and timing barriers to attendance. Provision of PR in primary care close to participants’ homes may mitigate these barriers. Physiotherapists and Accredited Exercise Physiologists (AEPs) are suitably qualified to conduct PR programs but many report no experience in PR.

Aims/objectives: To investigate the efficacy of a PR education program for physiotherapists and AEPs to develop the knowledge, skills and confidence necessary to conduct a PR program in primary care.

Methods: Primary care physiotherapists or AEPs undertook an education program consisting of 6–8 hours online training and a half-day day face-to-face workshop. Participant knowledge (objective test) and self-rated knowledge, confidence and skills (5-point Likert scale) were measured before, after and 3months post education.

Findings: 15 clinicians (six physiotherapists, nine AEPs), 9 (60%) male, mean (SD) 5.8 (4.5) years of clinical practice, were recruited and completed the program. The mean (SD) knowledge test score (out of 11) was 7.1 (1.2) pre-training, 9.5 (1.7) post-training and 8.8 (1.5) at 3-months. The mean (95% CI) improvement in knowledge scores from baseline was 2.5 points (1.6–3.4, P < 0.001) at post-training and 1.8 points (0.9–2.7, P = 0.001) at 3 months. 80% of participants met the pre-defined knowledge competency threshold of 80% questions correct post-training, compared to only 13% pre-training. 93% of participants met the pre-defined competencies for the practical workshop post-training. Participant self-rated knowledge, confidence, and skills all improved across all domains before and after training and was maintained at 3 months follow-up.

Implications: A short education program improved PR knowledge, confidence and skills in primary care clinicians. Educating primary care clinicians in PR is essential to build the workforce to provide PR in this setting and improve accessibility.

110. GP trainees’ engagement with research: an interview study

Wang Neil^A, Lau Phyllis^A and Hu Wendy^A

^AWestern Sydney University.

Background: Research evidence is a crucial component of quality general practice. While using research evidence in clinical practice is well accepted by general practitioners (GPs), they are less well known for generating research. Reasons include lack of: research skills training, GP research visibility during training, and academic general practice positions. Our preliminary study aimed to understand these reasons from the perspective of GP trainees.

Aims/objectives: To explore the views and experiences of GP trainees on research skills education and training.

Methods: We conducted semi-structured interviews with three GP registrars between April and August 2023. Interviews were transcribed using transcription software, manually checked and then underwent open coding and thematic analysis. The project was conducted as part of a Western Sydney University medical student project over 8 weeks.

Findings: Three themes were elicited: research education, barriers and facilitators to do research and perceptions of the Academic GP positions. Participants reported insufficient research education from medical school to specialty training, which contributed to low interest in doing research. Added barriers included lack of dedicated time and future remuneration. In contrast, personal interest and experience of a research culture were facilitators. Participants found the academic post useful for improving research knowledge and providing protected time to attempt research.

Implications: Our early findings suggest that research skills education for GP trainees is limited by structural factors such as limited research education in GP trainee curricula and lack of dedicated time and remuneration. These suggest that strategies to improve the quality and quantity of research education and its relevance to clinical practice may increase research engagement. Further research on trainee experiences in different contexts, especially where there is a strong GP research culture, would provide further evidence for designing strategies.

111. Exploring the contribution to public health by general practitioners in Australia

West Kellie^A, Ball Lauren^B, Barton Christopher^A and Sturgiss Elizabeth^A

^AMonash University.

^BUniversity of Queensland.

Background: Australian general practice training involves taking a ‘population health perspective’ when seeking to improve the health of patients and communities. In line with the global effort to integrate general practice and public health, some general practitioners (GPs) also engage in public health work. According to the Levesque framework, these public health roles may include policy work, service planning and assessment of impact, and advocacy for health care access and health equity. However, the nature of this public health work has not been well defined.

Aims/objectives: This study aims to identify the ways in which GPs are involved in public health work and to explore barriers and facilitators to their involvement.

Methods: Semi-structured interviews are being conducted with GPs with public health experience and will be completed in May. Eligible participants include registrars in vocational training, practising GPs, recently retired GPs, those in advanced study and other roles that contribute to public health. Recruitment is purposive, information about the study has been distributed via professional networks. The project uses an inductive, reflexive thematic analysis of interview transcripts following the Braun and Clarke approach in NVivo 14. Lincoln and Guba’s trustworthiness framework will be used to guide rigour.

Findings: Early data analysis suggests that barriers to GPs’ public health activities include lack of time, lack of funding, and the private nature of much of general practice. Some GPs expressed concern that certain public health activities may be seen as attempting to ‘drum up business’ or even a violation of consumer law. Facilitators include salaried positions with an agreement facilitating health promotion activities, collegiate relationships, and strong community connections.

Implications: The project aims to fully explore the potential public health role that GPs can play, interweaving the learnings of GPs with further training and experience. This has broad implications for GP job satisfaction, workforce retention, potential delivery of community health interventions and broader debates about GP models of care.

112. General practice registrar evaluation of long COVID in patients presenting with fatigue

Wilkins David^A, Tapley Amanda^B,C, Dizon Jason^D, Holliday Elizabeth^C, Magin Parker^B,C and Stocks Nigel^A

^AUniversity of Adelaide.

^BRoyal Australian College of General Practitioners.

^CUniversity of Newcastle.

^DHunter Medical Research Institute.

Background: Long COVID is a condition of persistent symptoms after an acute COVID-19 infection. As it has a significant health and economic burden, increasing attention is being directed towards diagnosis and management of the condition, which is mostly performed by GPs. However, there is little available evidence on whether or how GPs have adapted their approach to common presenting symptoms, including fatigue, that may lead to a diagnosis of long COVID.

Aims/objectives: This study aimed to investigate (1) how often GP registrars consider long COVID as a differential for fatigue presentations; (2) how often GP registrars conclude that long COVID is a likely cause for fatigue; (3) the patient, registrar, practice, and consultation factors associated with these outcomes.

Methods: A cross-sectional study nested within the ReCEnT cohort study. Patient, registrar, practice, and consultation factors were collected in each of two rounds of sixty consecutive registrar consultations in 2022–2023. Descriptive statistics addressed aims 1 and 2, and multivariate logistic regression models were constructed to address aim 3).

Findings: 969 registrars participated. Fatigue was a presenting symptom in 3,193 (4.1%) consultations. In 2,563 (80.3%, 95% CI 78.9–81.6%) consultations, the registrar considered long COVID a differential diagnosis. In 465 of these (18.1%, 95% CI 16.7–19.7%) long COVID was considered the ‘likely’ or ‘very likely’ cause for fatigue. Several factors including a telehealth consultation modality were associated with at least one outcome, although no patient factors were associated with either outcome.

Implications: This study provides evidence that GP registrars are considering long COVID in their diagnostic approach to fatigue. Non-clinical factors including telehealth consultations are associated with diagnostic consideration. Further work is needed to explore other long COVID symptoms, and the diagnostic processes GPs are using to assess these patients.

113. Trends in concurrent prescribing of long-term opioids and sedative-hypnotic drugs in Australian general practice, 2011–2017

Williams Susan^A, Rositano Josie^A, Haeusler Claudia^B, Bhat Meghana^C, Omond Kimberley^D, Stocks Nigel^A and Gonzalez-Chica David^A

^AUniversity of Adelaide.

^BSouth Australia Health.

^CAustralian National University.

^DPartridgeGP.

Background: The long-term and concurrent prescribing of opioids and benzodiazepines/Z-drugs (BZDs) increases the risks of overdose, hospitalization, and death.

Aims/objectives: To examine trends in concurrent prescribing of long-term opioids and BZDs in Australian general practice, according to rurality, and to explore the influence of sociodemographic characteristics, and mental health and musculoskeletal conditions.

Methods: An open cohort study using national general practice data (MedicineInsight) for 1,515,402 regular patients attending 547 practices in metropolitan and rural areas between 2011 and 2017. The annual adjusted prevalence of concurrent prescribing of a long-term opioid and a long-term BZD (per 1000 patients) was estimated using adjusted Poisson regression models. The influence of sociodemographic factors, mental health, and musculoskeletal conditions on concurrent prescribing prevalence in 2017 was reported as adjusted prevalence ratios (adjPR).

Findings: The prevalence of concurrent long-term opioid and BZD prescribing increased over time in metropolitan [from 0.9 (95% CI 0.8; 1.0) in 2011 to 4.5 per 1000 (95% CI 4.2; 4.9) in 2017] and rural areas [from 1.2 (95% CI 1.1; 1.4) to 6.4 per 1000 (95% CI 5.8; 6.9)]. The median duration of concurrent prescribing was 490 and 506 days in metropolitan and rural areas, respectively. In metropolitan practices, concurrent prescribing was higher in individuals over 65 years (adjPR = 4.9; 95% CI 4.3–5.5), females (adjPR = 1.3; 95% CI 1.21–1.37), smokers (adjPR = 4.1; 95% CI 3.8–4.4), and those with mental health (adjPR = 2.7; 95% CI 2.3–3.2) or musculoskeletal conditions (adjPR = 2.4; 95% CI 2.0–2.8). Post-traumatic stress disorder, insomnia and back pain were the primary conditions associated with higher concurrent prescribing. Similar associations were estimated in rural areas. The highest prevalence of concurrent prescribing was in patients with both mental health and musculoskeletal conditions (19.2 and 29.1 per 1000 patients in metropolitan and rural, respectively).

Implications: Increased access to non-pharmacological interventions and de-prescribing strategies are needed to reduce the concurrent management with long-term opioids and BZDs.

114. Using general practice medical records to support preconception care: a qualitative study

Withanage Nishadi^A, James Sharon^A, Botfield Jessica^A, Black Kirsten^B, Wong Jeana^A and Mazza Danielle^A

^AMonash University.

^BUniversity of Sydney.

Background: Preconception care (PCC) reduces preconception health risk factors and improves pregnancy outcomes. General practice electronic medical records (EMRs) contain preconception health risk factor data, and could therefore potentially be used to identify and invite reproductive-aged females with underlying medical or lifestyle preconception health risk factors to receive PCC.

Aims/objectives: To investigate general practitioners’ (GPs) and practice nurses’ (PNs) perceived acceptability and feasibility of using EMR data to identify, invite and improve PCC provision to reproductive-aged female patients at risk of adverse pregnancy outcomes.

Methods: GPs and PNs were recruited using convenience, purposive and snowball sampling. Semi-structured interviews were conducted via Zoom between May and August 2023. Interviews were audio recorded, transcribed verbatim and coded using inductive reflexive thematic analysis.

Findings: Twenty participants were recruited (10 GPs and 10 PNs). Identifying patients with preconception health risk factors using Ewas deemed acceptable and feasible to most. To enhance acceptability and feasibility, participants recommended developing strategies to improve EMR data quality and currency of preconception health risk factors, recording reproductive intent in the EMR, directing invitations only towards women with reproductive intent, referring only to generic risk in the invitation to avoid stigmatising individuals and raising awareness about the importance and availability of PCC amongst women.

Implications: While sending PCC invitations based on an EMR-generated risk profile was perceived to be feasible and acceptable to GPs and PNs, improving EMR data quality and currency of preconception health risk factors together with a means of recording reproductive intent would enhance this. Patient perspectives on receiving PCC invitations based on their EMR-generated risk profile are required before proceeding with the implementation of a system that sends PCC invitations based on an EMR-generated risk profile.

115. General practice preconception care invitations: a qualitative study of women’s acceptability and preferences

Withanage Nishadi^A, James Sharon^A, Botfield Jessica^A, Black Kirsten^B, Wong Jeana^A and Mazza Danielle^A

^AMonash University.

^BUniversity of Sydney.

Background: Electronic medical records (EMRs) in general practice could be used by primary care providers to identify and invite reproductive-aged women to participate in preconception care (PCC). However, the acceptability of receiving PCC invitations and women’s preferences regarding this process are not well understood.

Aims/objectives: To investigate women’s perceptions of acceptability and preferences for receiving PCC invitations from general practice settings.

Methods: Participants (women aged 18–44) were recruited via convenience, purposive and snowball sampling. Audio-recorded semi-structured interviews were conducted via Zoom from August until November 2023. Interviews were transcribed verbatim and inductive reflexive thematic analysis was undertaken.

Findings: 20 women participated in the interviews. PCC invitations sent from general practice were considered acceptable, provided that the language used was sensitive and not stigmatising to prevent offending women who may have infertility issues, have completed their families or may not want to have children. Participants preferred to receive PCC invitations via text message or email that outlined the importance of PCC and details of what the PCC consultation would encompass. They also preferred to receive PCC invitations after discussing their reproductive intentions with their general practitioner or practice nurse. It was raised that PCC appointments would be of particular interest to women with preconception health risk factors and those who were actively trying to conceive. Key strategies to enhance engagement in PCC invitations in general practice included advertising in waiting rooms, introducing PCC through new patient registration forms and offering and providing PCC as part of holistic care.

Implications: Utilising EMRs to identify and invite eligible women to participate in PCC appears to be acceptable to women. While sending PCC invitations in the form of text messages or emails is preferred, it will be important to ensure appropriate language is used to avoid stigma.

116. Emotional care for those experiencing miscarriage: developing a patient-centred guide for health care professionals

Wong Joanne^A, Smith Sarah^B and Frayne Jacqueline^A,B

^AUniversity of Western Australia.

^BKing Edward Memorial Hospital.

Background: Miscarriage is a common complication of pregnancy, affecting up to 1 in 4 pregnancies in Australia. As many as 50% of women suffer from psychological distress after the loss, with a significant proportion meeting the criteria for depression, anxiety and post-traumatic stress disorder (PTSD). Studies have shown that women who have lower levels of emotional support from their partners and health care professionals (HCPs) tend to have stronger grief reactions and mental health diagnoses. Despite the high prevalence of miscarriage, there remains a lack of clinical guidance for HCPs providing emotional care to women experiencing miscarriage.

Aims/objectives: To develop a co-designed patient-centred communication guide for HCPs counselling women and their partners experiencing miscarriage.

Methods: This is a co-designed qualitative sequential study. A qualitative literature review was conducted to examine women and HCP perspectives to guide development of the initial framework of the patient-centred communication guide. Following this, co-opted expert and consumer review occurred with refinement of the guide. We plan to conduct two separate focus groups with HCP and consumers. These will be audio-recorded, transcribed, and inductively analysed using NVivo Computer Aided Qualitative Data Analysis Software. Iterations of the guide will occur following each focus group to further refine the guide.

Findings: A qualitative literature review was undertaken, identifying 13 studies, one systematic review, one scoping review and one integrative review. Supporting evidence from the research was used to develop the initial framework and co-design principles were applied to further refine the communication guide prior to the focus groups. Preliminary data from both HCP and consumer focus groups will be presented.

Implications: A co-designed patient-centred communication guide for those who have experienced miscarriage has the potential to lower the risk of developing adverse psychological outcomes, and support HCPs in providing an emotionally sensitive framework for clinical use.

117. Improving access to contraception and abortion in primary care: a systematic review of interventions delivered by nurses and midwives

Wong Jeana^A

^AMonash University.

Background: Primary care nurses and midwives play an important role in delivering sexual and reproductive healthcare. Amid global healthcare workforce shortages, fully harnessing the capabilities of nurses and midwives is vital for facilitating equitable access to these critical healthcare services. However, our understanding of how these clinicians can better support access to contraception and abortion care remains limited.

Aims/objectives: To understand the impact of interventions delivered by primary care nurses and midwives on access to contraception and abortion care.

Methods: A systematic review was conducted. We searched five electronic databases in September 2023 for articles published in English up to 10 years prior. Randomised controlled trials assessing interventions delivered by primary care nurses or midwives that reported findings related to access to contraception and/or abortion care were included. Data was extracted and tabulated, followed by a narrative synthesis informed by the Levesque et al. (2013) framework for access.

Findings: We identified 284 articles, of which 25 met the inclusion criteria. Interventions could be categorised into five types – home visiting, community outreach, telehealth, reproductive counselling, and procedural training and upskilling. Access was predominantly facilitated through supporting consumers’ ability to perceive healthcare needs and engage in healthcare utilisation. Interventions improved women’s knowledge of reproductive health and increased uptake of long-acting reversible contraceptives (LARCs), but were inconsistent at increasing overall contraceptive uptake or preventing subsequent pregnancies.

Implications: Primary care nurses and midwives may be able to improve access to contraception and abortion using various approaches. We found only limited evidence for interventions improving reproductive health knowledge and uptake of LARCs due to heterogeneity of study interventions and outcome measures. Reported interventions also tended to only address a narrow scope of access. Further research is needed to explore the various components of access and should include consistent outcome measures.

118. The utility of case based discussion assessments in medical training: a systematic scoping review protocol

Wu Hannah^A, Varshney Karan^B, McArthur Lawrie^A, Walters Lucie^C and Stocks Nigel^A

^AUniversity of Adelaide.

^BDeakin University.

^CRural Clinical School.

Background: Case based discussions (CbD), formerly known as chart stimulated recall (CSR), are a form of workplace-based assessment for medical students and postgraduate trainees. In a CbD, a learner presents a clinical case and the supervisor guides a discussion, while using the patient’s medical notes, to explore clinical reasoning and to identify the learner’s needs. The utility of CbD has been evaluated in postgraduate doctors on vocational training programs including general practice. There is a paucity of literature on its utility with novice level medical students entering clinical learning.

Aims/objectives: The objective of this review is to understand the extent and type of evidence in relation to the utility of CbD as a formal, structured assessment when used in undergraduate medical courses through to postgraduate specialty training.

Methods: This review will be undertaken in accordance with the Joanna Briggs Institution methodology for scoping reviews. Two independent reviewers will screen the articles. The inclusion criteria will be (population) medical students and doctors, (concept) the use CbD or CSR based on real patients, which the learner directly consulted, (context) as a structured assessment between a learner and supervisor. Outcomes include, but will not be limited to: educational impact, feasibility, acceptance, cost-effectiveness, reliability, and validity evidence. Extracted data will be organised initially in a draft framework, then an inductive approach to open code and map concepts to categories for reporting.

Findings: A preliminary literature search was conducted to refine the search strategy and research questions. PubMed, Scopus, Embase, Web of Science, CINAHL, ERIC, PsychInfo, and Cochrane databases, were searched using terms ‘case based discussion’ or ‘chart stimulated recall’ in combination with ‘medicine’ or ‘trainee’. The findings will be shared by August 2024.

Implications: This review will identify gaps in evidence for CbD as an assessment method for undergraduate medical students, and inform the design of future studies.

119. Specialist reconciliation within general practices across Australia

Yardi Shruti^A, Waters Amy^A and Rhee Joel^A

^AUniversity of New South Wales.

Background: As health professionals, it is important to strive for health equity and respond to the healthcare needs of the current population. Increasing patients’ capacity to cope with complex multi-morbidity is not just about renewing specialist referrals, it requires us to reframe our current approach and reduce treatment burden where appropriate. This is where the concept of ‘Specialist Reconciliation’ arises from. Specialist Reconciliation is the structured, patient centred intervention that reassesses the role of all specialists with a view of withdrawing those that have no clear benefit, may cause harm or no longer fit with the current goals of care. This term was coined for this study by the research team after thinking about the well-known concept in healthcare of ‘Medication Reconciliation’. The terminology of ‘Specialist Reconciliation’ is novel however the process is already occurring in GP clinics, however in a ‘fragmented’ way.

Aims/objectives: This research aims to investigate how experienced specialist GP are currently managing the ‘Specialist Reconciliation’ process in their daily clinical practice with patients with advanced and chronic conditions.

Methods: The research aims will be addressed through a qualitative study involving 10–15 semi-structured online interviews with experienced specialist GPs. Recruitment will be via post on social media group such as Facebook.

Findings: Data collection is commencing at the time of abstract submission. Preliminary results will be presented at the AAAPC Conference, covering how GPs navigate the ‘Specialist Reconciliation’ process in daily consults including specific examples, prompts, timing, barriers and views on the ideal framework for this process.

Implications: It is hoped that the findings from this project will provide an in-depth understanding of how ‘Specialist Reconciliation’ is currently being implemented within the complex, real-world context of clinical general practice. Also, it is hoped that it will assist with future recommendations on the framework for ‘Specialist Reconciliation’.

120. Impact of multimorbidity on participation in cancer screening among New South Wales residents aged 45 years and over

Zi Ye Amber^A, Barr Margo^A and Rhee Joel^A

^AUniversity of New South Wales.

Background: Colorectal, breast, and cervical cancers have a preclinical screen-detectable ‘sojourn time’. Australia currently implements population-based cancer screening program for these cancers. However, the effectiveness and advantages of these initiatives heavily depend on individuals’ participation. Multimorbidity (the co-occurrence of ≥2 chronic medical conditions) and complex multimorbidity (the co-occurrence of ≥3 chronic conditions affecting ≥3 different body systems) are emerging issues as the population ages and longevity increases. Mounting epidemiological evidence suggests conflicting associations between multimorbidity and cancer screening adherence. We hypothesise an inverted u-shaped association between patients’ chronic disease burden and cancer screening participation.

Aims/objectives: This study aims to analyse the association between multimorbidity, complex multimorbidity, and population-based cancer screening participation in Australia, with further subgroup analyses; and to provide insight about how to enhance innovation in preventive care among populations with competing management needs.

Methods: We are conducting a retrospective record linkage cohort study of residents of New South Wales, Australia, utilising data via SURE platform from: (1) the Sax Institute 45 and Up Study at baseline (2005–2009, n = 267,153), first follow-up (2012–2015) and the second follow-up (2018–2020); and (2) the Medicare claims provided by Services Australia. Our study aims include: (1) measuring cancer screening participation rates between participants with multimorbidity compared to those without; (2) exploring potential confounding factors for participation in cancer screening such as socioeconomic status, education level, and remoteness; and (3) investigating the independent predictive value of complex multimorbidity in comparison with multimorbidity in relation to cancer screening participation.

Findings: Ethics approval and data collection have been completed for this project. Analysis will continue until July, with preliminary results to be presented in the presentation.

Implications: This presentation will yield valuable insights into the relationships among multimorbidity, complex multimorbidity, and cancer screening participation, with a ultimate goal of providing strategic guidance for public health and general practitioners in enhancing screening clinically.

121. Self-reported hearing loss in urban Aboriginal and Torres Strait Islander adults: unmeasured, unknown, and unmanaged

Pender Alice^A, Schluter Philip^B, Spurling Geoffrey^A, Bainbridge Roxanne^A, Wilson Wayne^A, Tyson Claudette^C and Askew Deboarah^A

^AUniversity of Queensland.

^BUniversity of Canterbury Te Whare Wānanga o Waitaha.

^CSouthern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care.

Background: Effective management of hearing loss in adults is fundamental for communication, relationships, employment, and learning. There is a lack of understanding and evidence on the extent of hearing loss in Aboriginal and Torres Strait Islander adults and available management pathways for them.

Aims/Objectives: To estimate self-reported hearing loss rates and investigate the subsequent management of people self-reporting hearing loss in a large, urban Indigenous primary healthcare service.

Methods: This study was conducted in two parts: (1) a retrospective, observational study of Aboriginal and Torres Strait Islander people aged ≥15 years who had annual health checks from July 2018 to September 2021 at an urban Indigenous primary healthcare clinic in Brisbane to determine self-reported hearing loss rates by age and ethnic groups stratified by sex, and (2) a medical record audit of patients who self-reported hearing loss from January to June 2021 to identify current management approaches, and the proportion of patients appropriately managed.

Findings: Of the 1,735 patients (average age 40.7 years, range: 15.0–88.5 years; 52.0% female) 18.8% self-reported hearing loss. Rates did not differ between sexes. Rates increased with age from 10.7% for patients aged 15–24 years to 38.7% for those aged ≥65 years and are comparable with the national average for adults found on 2018–19 National Aboriginal and Torres Strait Islander Health Survey. Measured hearing loss was 2.5 to 5 times higher than self-reported hearing loss in both studies. An audit of 73 patient medical records revealed that 39.7% of patients with self-reported hearing loss were referred to ENT/audiology or received other management.

Implications: This study shows that hearing loss in Aboriginal and Torres Strait Islander adults is under-measured, under-reported, and under-managed. Almost one in five adults self-reported hearing loss, but the majority had no referral for hearing services. Significant changes to clinical management and government-funded referral options are required to improve hearing loss management.

122. Impact of an integrated general practitioner (GP)–paediatrician model of care on referrals and GP care: a randomised trial

Sanci Lena^A, Hiscock Harriet^B, Khano Sonia^B, Moore Cecilia^B, Dalziel Kim^A, Freed Gary^C, Boyle Douglas^A, Le Jane^B, Morris Tammy Myers^D, Germano Stephanie^E, Wheeler Karen^F, Liaw Siaw-Teng^D and Lingam Raghu^D

^AUniversity of Melbourne.

^BMurdoch Children’s Research Institute.

^CUniversity of Michigan.

^DUniversity of New South Wales.

^ENorth Western Melbourne Primary Health Network.

^FCentral and Eastern Sydney Primary Health Network.

Background: Australia’s hospital system has long wait times, up to 12 months, for paediatricians, and pre-schoolers form the largest proportion of all primary care-type emergency department presentations. As general practitioners (GP) refer to paediatricians, there is potential for strengthening primary care to address this issue.

Aim/Objective: To test if a new model of care reduces GP referral of 0–18-year-olds to hospitals.

Methods: We co-designed our intervention with GPs, hospital paediatricians, primary health networks, clinical colleges, and families, piloted in 2018, then conducted a stepped wedge cluster randomised trial in 21 general practices in Victoria and New South Wales, Australia (2019–2023).

Our intervention comprised: weekly then fortnightly GP-paediatrician co-consultations for 6 months each; monthly education and case discussions; and phone/email paediatrician support. Our outcome measures were GP referrals (primary outcome), confidence in paediatric care, and healthcare costs.

Findings: Participating GPs (n = 130) conducted 50,101 paediatric consultations during the Control period (May 2021 to end March 2022) and 96,804 during the Intervention period (July 2021 to end March 2023). During the Intervention, 1984 co-consultations, 530 case discussions and 154 emails/phone calls occurred. GP hospital referrals reduced (Control period: 990 referred (2.30%) vs Intervention period: 1398 referred (1.96%); risk difference (Intervention – Control) −0.34% (95% CI −0.69, 0.00), P = 0.053). Reductions strengthened for high referring GPs (i.e. those referring 5% or more at baseline) – (Control period 3408 (7.31%) vs Intervention period 10,030 (3.03%), risk difference (Intervention – Control), −4.28%, (95% CI −6.59, −1.97), P < 0.001. Health-system costs saved was A$98,082. GPs reported improved knowledge and skills in child health (P < 0.02).

Implications: GPs and the health system seem to benefit from the GP–pPaediatrician capacity building model of care. Future work will test the model in rural areas with telehealth, and sustainability of effects on referrals and self-perceived skills over time post-intervention.

123. Evaluation of shared decision making and natural history communication for self-limiting conditions: analysis of UK primary care consultations

Abukmail Eman^A, Bakhit Mina^A and Hoffmann Tammy^A

^ABond University.

Background: Shared decision-making (SDM) is promoted as an effective strategy for engaging patients in interactive discussions to support patients in making informed decisions that are consistent with their values and preferences. This requires conveying information about the possible options available for managing their illness, including, where relevant, a ‘wait and see’ option. This is a viable option in many situations, particularly for self-limiting illnesses that may resolve on their own without specific treatment, such as acute infections and musculoskeletal conditions. No previous studies investigated the frequency and characteristics of natural history communication (i.e. wait and see) in primary care consultations.

Objective: To analyse communication about the natural history of self-limiting illnesses and the use of SDM in primary care.

Methods: Transcripts from the ‘One in a Million’ UK database about self-limiting conditions were analysed by two raters. Natural history communication was evaluated using expert-developed questions, while SDM was assessed using OPTION-12 scale (max. score 100) and 5 ACEPP tool items (max. score 5).

Results: Natural history was mentioned in 49% of the consultations. Most GPs discussed recovery timeframes, with limited communication about self-management and self-monitoring strategies. The mean total OPTION score for the 55 consultations was 25.2 (SD 7.4), with item 12 scoring highest at 2.1 (SD 1.3), while Items 3 and 10 scored lowest at (0.1 (SD 0.2) and 0.2 (SD 0.3), respectively. The mean total ACEPP score was 1.2 (SD 0.5), with item 4 highest at 0.5 (SD 0.3), and items 3 and 5 scoring lowest at 0 (SD 0.1). Patient decision aids were not used in any consultation.

Conclusion: Natural history communication and SDM practices were limited in the consultations of self-limiting illnesses.

Practice Implications: Equipping clinicians with the necessary SDM skills, including natural history, may improve the quality of communication, thereby enhancing informed decision-making.

124. Exploring individuals’ perceptions and acceptability of a ‘wait and see’ approach for managing self-limiting illnesses: a qualitative study

Abukmail Eman^A, Bakhit Mina^A and Hoffmann Tammy^A

^ABond University.

Background: Primary healthcare is typically the first encounter between patients and health professionals. Some of the conditions frequently seen by general practitioners (GPs) are self-limiting (those that resolve with/without treatment), such as acute viral infections. No active treatment (i.e. ‘wait and see’) is often a viable option for many self-limiting situations. Different phrases are commonly used to communicate the option of observing and providing supportive management, such as ‘do nothing’, ‘watchful waiting’, and ‘wait and see’. No previous studies have explored patients’ understanding of these terms and their perspectives and acceptability of the ‘wait and see’ approach for self-limiting illnesses.

Objective: To explore individuals’ perceptions and acceptability of a ‘wait and see’ approach, and phrases to describe this, for managing self-limiting illnesses.

Methods: Semi-structured interviews with a purposive sample of 30 Australians. Two researchers independently conducted a thematic analysis of interview transcripts, and all authors agreed on final themes.

Results: Four themes emerged: (1) interpretation of what ‘wait and see’ meant varied and encompassed whether individuals had already sought medical care; (2) individuals’ experiences and circumstances influenced the acceptability of a ‘wait and see’ approach; (3) symptom management was perceived as the most reassuring phrase to describe this approach; (4) individuals highly valued clear communication about a ‘wait and see’ approach and wanted a collaborative and action-oriented plan for the waiting period.

Conclusion: Individuals generally accepted a ‘wait and see’ approach, although less so for some illnesses and in some circumstances. They wanted it at least presented as an option when appropriate, with ‘symptom management’ as the preferred terminology. Clear communication and collaborative decision-making were valued.

Practice implications: When ‘wait and see’ is a reasonable option, clinicians should communicate this to patients, support them in decision-making, and provide a plan for the waiting period if the option is chosen.

125. Enhancing culturally competent primary health care to reduce domestic violence and abuse among South Asian communities: HARMONY, a pragmatic cluster-randomised controlled trial

Taft Angela^A, Young Felicity^A, Hegarty Kelsey^B, Yelland Jane^C, Mazza Danielle^D, Boyle Douglas^B, Norman Richard^E, Garcia-Moreno Claudia^F, Nguyen Cattram^C, Li Xia^A, Pokharel Bijaya^A, Allen-Leap Molly^A and Feder Gene^G

^ALa Trobe University.

^BUniversity of Melbourne.

^CMurdoch Children’s Research Institute.

^DMonash University.

^ECurtin University.

^FWorld Health Organization.

^GUniversity of Bristol.

Background: Australian primary care populations include diaspora families from low-middle-income countries. Domestic violence and abuse (DVA) is prevalent globally and harmful to mental health and wellbeing, with immigrant women likely to experience severe DVA and migration trauma. Improving culturally safe primary care requires augmenting the whole clinic system. Harmony is a pragmatic cluster RCT, that aimed to: (a) increase DVA identification and referral among all active female patients ≥18, but especially South Asian women (SA) and (b) improve routine recording of DVA and ethnicity.

Methods: Recruited clinics in areas with South Asian communities were randomised in 2019/20 according to clinics size and SEIFA. Eligible clinics required (a) ≥1 South Asian GPs; (b) MD or Best Practice software and; (c) agreement to data extraction, using specially formulated algorithms for South Asian patient and DVA identification.

Intervention: Clinics received culturally competent DVA training, co-facilitated by a GP educator and bilingual DVA advocate. Following training, the DVA advocate supported intervention clinics and DVA affected women for 12 months. Both arms trained to record ethnicity and DVA data. Primary outcomes analysed using adjusted Poisson regression by intention-to-treat.

Findings: 19/24 clinics recruited, randomised, and completed (45,438 women). 52% clinic staff were South Asian. 47% female patients were reproductive age 26–45 years, and 17.6% were South Asian. At baseline, fewer South Asian women (0.38%) than non-South Asian (0.63%) experiencing DVA were identified. No referrals were identified. Following the intervention, there were increases in identification (Int 0.98%, Comp 0.88% – IRR 1.17, CI 0.60–2.28) but Intervention referrals were 5.6% vs Comparison 3.0% and half were South Asian. Feedback highlighted the advocate role for referrals. Full results will be presented.

Implications: Culturally competent DVA GP care for diaspora communities needs to be improved in systemic but simple ways.

126. Endometriosis and chronic pelvic pain diagnosis and management in Australian primary care settings: perspectives of general practitioners, stakeholders and patients

Crawford Sharinne^A, Kost Alissia^A, Moradi Maryam^A, Chakraborty Sangita^A, Rowe Catriona^A and Mazza Danielle^A

^AMonash University.

Background: In Australia, 14% of women are diagnosed with endometriosis by 44–49 years old, with a delay to diagnosis of approximately 8 years. General practitioners (GPs) are often the first point of contact in the healthcare system for patients and are the ‘gatekeepers’ to hospital services.

Aims/Objectives: To explore the perspectives of GPs, stakeholders and patients regarding endometriosis and chronic pelvic pain (CPP) diagnosis and management in primary care settings.

Methods: This qualitative study involved individual interviews with GPs and stakeholders, and focus group discussions with women with endometriosis or CPP. Inductive thematic analysis was undertaken.

Findings: Ten GPs, eight stakeholders, and 17 patients from across Australia participated. All participant groups highlighted: the significant impact of endometriosis and CPP on patients’ health and quality-of-life; limited access to and affordability of healthcare services; challenges in reaching a diagnosis; benefits of multidisciplinary care; and the importance of the doctor-patient relationship. They perceived gaps in health professionals’ knowledge and skills regarding endometriosis and CPP, and a lack of community awareness about what is normal menstruation. GPs questioned if they could make a clinical diagnosis for endometriosis and CPP, expressing a desire for further guidance about these complex conditions. Stakeholders and patients highlighted how current management approaches do not meet patient needs.

Implications: GPs need further guidance to support diagnosis and management. Additional support for patients is required, particularly in improving healthcare access and affordability. We recommend the development of evidence-based tools for use by GPs and patients, to improve endometriosis and CPP healthcare in general practice settings.

127. Association between mental health outcomes of patients with work-related injury and their compensation claim status: exploratory findings from the IMPRovE trial

Costa Vera^A, Nolidin Karen^A, Collie Alex^A, Chakraborty Samantha^A, Kenardy Justin^B, Brijnath Bianca^C, Mortimer Duncan^A, Enticott Joanne^A and Mazza Danielle^A

^AMonash University.

^BUniversity of Queensland.

^CNational Ageing Research Institute.

Background: The workers’ compensation claims process may exacerbate adverse mental health symptoms for claimants.

Aim: We sought to describe associations between mental health outcomes for claimants and their contemporaneous claim status.

Methods: A total of 153 general practice patients with work-related mental health injury across Australia participated in ‘The Implementing work-related Mental-health guidelines in general PRacticE’ (IMPRovE) trial. Patient claim status, working status, and health outcomes (DASS-21 and SF-36) were assessed using 3-monthly self-report surveys, and examined over time using mixed-effects linear regression. Analyses were adjusted for intervention status, compensation claim, working status, time-point, state, clinic size, location (urban vs regional/rural), age and gender.

Findings: Patients with a claim under review had poorer mental health compared to patients with an accepted claim for stress (5.73; 95% Confidence Interval 1.69–9.77), anxiety (4.99; 1.49–8.50), depression (5.82; 1.48–10.16), overall mental health (5.80; 2.47–9.12), and compared to patients with a rejected claim for stress (6.14; 0.51–11.78), and depressive symptoms (5.88; 1.12–10.63). Patients without a submitted claim had better mental health than patients with a claim under review for stress (6.63; 3.70–9.55), anxiety (5.75; 2.71–8.78), depression symptoms (5.73; 2.37–9.09), and overall mental health (6.14; 2.87–9.42); however, they did not differ from patients with an accepted or rejected claim.

Implications: Mental health was poorer throughout the claims process. Further work is required to establish causality and to determine if more support during the claims process by general practitioners and compensation regulators might help to minimise psychological harm.

128. Two-year follow-up of a clustered randomised controlled trial of a multicomponent general practice intervention for people at risk of poor health outcomes

Reed Richard^A, Roeger Leigh^A and Kaambwa Billingsley^A

^AFlinders University.

Background: This study reports 2-year follow-up results of a multicomponent intervention designed to improve continuity of general practitioner (GP) care, access to longer GP appointments and timely general practice follow-up after a hospital event for patients at risk of poor health outcomes.

Aim: A 2-year follow-up of health service use and cost-effectiveness was evaluated.

Methods: A clustered randomised controlled trial (Flinders QUEST) was conducted during 2018–19. The trial recruited 20 general practices (10 intervention and 10 control) and 1044 patients from three cohorts: children; adults (aged 18–64 years with two or more chronic diseases); and older adults (aged ≥65 years). Health service outcomes included hospital use, specialist services and pharmaceuticals. Effectiveness was based on quality-adjusted life years (QALYs) calculated from EuroQoL utility scores.

Findings: Over the 2 years (from the start of the intervention period), there were no statistically significant intervention effects for health service use. In the total sample, the mean total cost per patient was greater for the intervention than control group, but the number of QALYs gained in the intervention group was higher. The estimated incremental cost-effectiveness ratio (ICER) was A$18,211 per QALY gained, which was lower than a pre-specified A$50,000 per QALY gained threshold. The intervention’s cost-effectiveness was shown to differ by cohort. For the adult cohort, the intervention was associated with higher costs and lower QALYs gained (vs the total cohort) and was not cost-effective. For the older adults cohort, the intervention was associated with lower costs (A$540 per patient), due primarily to lower hospital costs, and was more effective than usual care.

Implications: The positive cost-effectiveness results warrant replication in a further study targeted to older people with an intervention period of at least 2 years.

129. A pragmatic trial of integrated health-social hubs for migrant and refugee women and their infants in Australia-First 2000 Days Care Connect (FDCC)

Hodgkins Michael^A, Ostojic Katarina^B, Kumar Roshika^C, Lyle Kim^D, Lawson Kenny^E, Eapen Valsa^F, Rimes Tania^G, Hu Nan^A and Woolfenden Sue^H

^AUniversity of New South Wales.

^BUniversity of Sydney.

^CIngham Institute.

^DChild, Youth and Family Health Services, Northern Sydney Local Health District.

^EWestern Sydney University.

^FUnit of Child Psychiatry, South Western Sydney Local Health District.

^GChild, Youth and Family Services, South Eastern Sydney Local Health District.

^HSydney Institute for Women, Children, and their Families, Sydney Local Health District.

Background: One quarter of pre-school aged children from migrant and refugee families living in New South Wales are at risk of developmental vulnerability. These children are more likely to struggle at school and have poorer health outcomes. Only one-third of children complete their 12-month growth and development checks with Child and Family Health Nursing (CFHN) services. Migrant and refugee families can experience additional barriers in attending services. A NSW Health service review and the NSW Health First 2000 Days Framework (2019) have noted needed service improvements: transition from maternity to CFH services, increasing attendance and length of time families engage with CFH services. Evidence is emerging on the benefits of Integrated Health and Social Care hubs (Hubs) to improve access to services for priority populations. Hubs are place-based interventions with health-social service integration and navigation support.

Aim: To evaluate the impact of Hubs on attendance at CFHN services including completion of development checks until 12 months of age; and supporting maternal wellbeing and psychosocial needs in two Sydney Hubs sites (Miller, Rockdale).

Methods: A quasi-experimental trial of Hubs compared to routine care. Pregnant migrant women were recruited and allocated to Hubs (n = 120) or routine care (n = 120), with allocation based on residential proximity to the Hubs, until their child was 12 months.

Findings: The Hub group had significantly higher rates of ongoing CFH attendance (e.g. 6-month follow-up: risk ratio 2.04 95% CI: 1.45–2.88) and three times higher rates of completion of checks compared to control group. Other findings include an increased use of maternal psychosocial screening and higher rates of exclusive breastfeeding in intervention mothers.

Implications: This is the first trial to evaluate Hubs in Australia, showing that migrant women and their children engaged in the program had higher rates of accessing CFHN service. Hubs may be a key strategy in addressing disparities in CFHN service access for migrant women and children.

130. CONn Syndrome Evaluation in Primary care (CONSEP): protocol for a cluster randomised controlled trial

Russell Grant^A, Jia Linghan^A, Saha Sajal Kumar^A, Edwards Jessica^B, Jensen Grace^C, May Gwini Stella^A, Melder Angela^A, Chen Gang^A, Stocks Nigel^B, Nelson Mark^C, Sikaris Ken^D and Yang Jun^A

^AMonash University.

^BUniversity of Adelaide.

^CUniversity of Tasmania.

^DUniversity of Melbourne.

Background: Primary aldosteronism (PA), the commonest treatable cause of secondary hypertension, affects up to 1 in 7 primary care patients living with hypertension. Hypertension in patients living with PA is poorly controlled by standard antihypertensive drugs and patients with PA are at 2–4-fold greater risk of heart disease and stroke. While detectable by a simple blood test, (the aldosterone to renin ratio (ARR)), PA is often overlooked.

Aim: The CONSEP trial will develop and evaluate the impact of an electronic clinical decision support (eCDS) intervention on the diagnosis of PA in primary care patients living with hypertension.

Methods: We will conduct a pragmatic, parallel-group, cluster-randomised controlled trial in 28 accredited general practices recruited from Practice Based Research Networks in Victoria, South Australia and Tasmania. Intervention and control practices will receive education on PA screening. Intervention practices will use an eCDS tool to assist in incorporating PA screening into the management of people living with hypertension. Screen-positive patients will be further evaluated in tertiary endocrine services. Primary outcomes will be changes in the proportion of eligible patients (a) screened for PA using the ARR (first 12 months) and (b) diagnosed with PA (first 24 months). Secondary outcomes include blood pressure control and antihypertensive use (at 12 and 24 months) Implementation feasibility and cost-effectiveness will be assessed. Data will include e-audits of clinical records, practice and provider surveys and provider interviews.

Findings: This 4-year trial will report outcomes in 2027.

Implications: The outcomes of the CONSEP trial could have a substantial impact on the investigation, diagnosis and treatment of PA in primary care. CONSEP will establish the efficacy and cost-effectiveness of the intervention for increasing PA screening and diagnosis. If proven effective, the intervention will inform future strategies to better control hypertension, improve lives and reduce health expenditure.

131. Nudging patients with chronic disease to take their medications – applying behavioural economics to general practice

Tee Kevin^A, Anderson Katrina^A and Barnes Katelyn^A

^AAustralian National University.

Background: Encouraging patients with chronic disease to continue taking their medications can be difficult as the costs are immediate (financial, time, effort, side effects) but the benefits are only realised after long-term sustained use. Behavioural Economics is a relatively new field of study that posits people do not always make rational decisions. Various techniques have been developed to nudge people into taking actions to improve their health.

Aim: To identify behavioural economics techniques that could be used in general practice to encourage patients to adhere to taking medications for chronic diseases and the feasibility of employing such techniques in general practice consultations.

Methods: We will undertake 15–20 semi-structured individual interviews with general practitioners (GPs) in the Canberra and South-East NSW Region. Convenience and purposive sampling techniques will be used, with recruitment through local GP groups and the research team’s professional networks. Snowball sampling whereby participants share study information may also be used. Interviews will be transcribed verbatim and will ask about current techniques GPs use to encourage medication adherence for patients with established chronic disease. Up to five behavioural economics techniques identified in the literature, and not currently used by the participants, will be discussed to determine feasibility of use in general practice consultations. Techniques that are already used and those that could feasibly be used to encourage medication adherence for patients with chronic disease will be documented and disseminated amongst participants.

Results: Preliminary results will be expected in July and available for the conference. We anticipate GPs already use behavioural economics techniques but may not be aware of the theoretical underpinnings.

Implications: Findings can enhance GP care of patients with chronic disease and could be incorporated into General Practice education at the medical student, registrar and fellow levels.

132. HealthPathways supporting endometriosis diagnosis and management: a content analysis

Percival-Cobb Kira^A, Crawford Sharinne^A, Mazza Danielle^A and Kost Alissia^A

^AMonash University.

Background: Approximately 14% of Australian women of reproductive age have confirmed or suspected endometriosis. Endometriosis is a chronic condition associated with pelvic pain, particularly during the menstrual cycle, sexual intercourse, urination and bowel movements. Australian women wait approximately 8 years to receive an endometriosis diagnosis. Women with endometriosis often present to their general practitioner (GP) with complex symptoms, posing both diagnostic and management challenges. Some GPs report not knowing where to refer women with endometriosis. Clinical pathways (CPWs) are evidence-based tools formulated from medical data, physician experience, and clinical guidelines to provide a standardised multidisciplinary model of healthcare. CPWs can address the challenges experienced by GPs by guiding them through the diagnostic, management and referral process. HealthPathways is a website that provides CPWs for GPs in Australia. There are 33 locally specific HealthPathways websites that provide information for a range of health conditions. To begin alleviating the diagnostic delays for women with endometriosis, we first need to understand the resources available; currently no research has examined the information available for endometriosis in HealthPathways.

Aim: To investigate which HealthPathways websites provide information regarding endometriosis in Australia; and to assess the diagnostic, management and referral information provided.

Methods: A content analysis is being conducted to determine how many of the 33 HealthPathways sites provide a CPW on endometriosis. The diagnostic, management and referral content of each CPW will be examined and presented.

Findings: We anticipate our research will highlight how HealthPathways supports the diagnosis and management of endometriosis in primary care, including variation in the information provided across the 33 HealthPathways.

Implications: We expect the results of our research will increase GP awareness of HealthPathways, thereby encouraging GP usage of HealthPathways for endometriosis. An overarching aim of this research is to support the timely diagnosis and management of endometriosis for Australian women.