Allyson Mutch

The Building Partnerships Program: An Approach to Community-Based Learning for Medical Students in Australia

Abstract The Building Partnerships Program at the University of Queensland, Australia seeks to address the dual challenge of preparing doctors who are responsive to the community while providing a meaningful context for social sciences learning. Through partnerships with a diverse range of community agencies, the program offers students opportunities to gain non-clinical perspectives on health and illness through structured learning activities including: family visits; community agency visits and attachments; and interview training. Students learn first-hand about psychosocial influences on health and how people manage health problems on a day-to-day basis. They also gain insights into the work of community agencies and how they as future doctors might work in partnership with them to enhance patient care. We outline the main components of the program, identify challenges and successes from student and community agency perspectives, and consider areas that invite further development.

HIV Testing in Men who have Sex with Men: A Follow-up Review of the Qualitative Literature since 2010

The landscape of HIV testing has changed significantly in recent years following the rise in importance of the ‘treatment as prevention’ strategy and advancements in new HIV testing and prevention technologies. This review provides a synthesis of qualitative research findings published since 2010 on preferences and practices of men who have sex with men (MSM) surrounding HIV testing in high-income settings. MSM are one of the hardest groups to reach with standard or conventional HIV testing approaches. To develop innovative testing strategies for this particular group, a good understanding of their concerns, barriers and facilitators of accessing HIV testing is needed. This updated review provides valuable information for improving existing programs and designing new testing services for MSM.ResumenEl panorama de las pruebas para VIH ha cambiado significativamente en los últimos años por la creciente importancia del “tratamiento preventivo” como estrategia y los avances tanto en nuevas pruebas como en tecnologías preventivas. Esta revisión es una síntesis de hallazgos en estudios cualitativos publicados desde 2010 acerca de las preferencias y prácticas de hombres homosexuales (HH), en relación con pruebas de VIH en clases sociales de altos ingresos. Los hombres homosexuales son uno de los grupos más difíciles de abordar con pruebas de VIH standard o convencionales. Es necesario entender las preocupaciones, barreras y facilitadores de este grupo en particular para desarrollar estrategias alternativas de testeo. Esta revisión actualizada aportara valiosa información para mejorar programas actuales y diseñar nuevos servicios de pruebas de VIH para HH.

Who knows they have a treatment plan

Background: Guidelines for the effective care of chronic and complex conditions increasingly recommend developing treatment plans in collaboration with patients as one strategy in a coordinated approach to management. We examined the socio-demographic characteristics associated with the development of treatment plans for patients with asthma, diabetes or a cardiovascular condition to establish what proportion of patients with these conditions recalled being consulted in the plans preparation. Method: Serial, cross-sectional population based surveys using computer assisted telephone interviews (CATI) with 2,296 randomly selected adult participants with asthma, diabetes or a cardiovascular condition living in Queensland in 2006 and 2,203 adults with these conditions in 2008. Results: The proportion of patients with asthma, diabetes or a cardiovascular condition aware of having a treatment plan for their chronic condition increased almost two-fold between 2006 and 2008. Approximately half the respondents did not recall being asked for their input into the plan. Patients with a cardiovascular condition, older patients, and early school leavers were less likely to recall having a treatment plan. There were some variations when each condition was examined separately. Conclusion: Overall, the use of treatment plans and engagement of patients in their development remains low, particularly in those subgroups of the community who are most likely to benefit.

Incorporating patient preferences in the management of multiple long-term conditions: is this a role for clinical practice guidelines?

Background Clinical practice guidelines provide an evidence-based approach to managing single chronic conditions, but their applicability to multiple conditions has been actively debated. Incorporating patient-preference recommendations and involving consumers in guideline development may enhance their applicability, but further understanding is needed. Objectives To assess guidelines that include recommendations for comorbid conditions to determine the extent to which they incorporate patient-preference recommendations; use consumer-engagement processes during development, and, if so, whether these processes produce more patient-preference recommendations; and meet standard quality criteria, particularly in relation to stakeholder involvement. Design A review of Australian guidelines published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Document analysis of guidelines examined the presence of patient-preference recommendations and the consumer-engagement processes used. The Appraisal of Guidelines for Research and Evaluation instrument was used to assess guideline quality. Results Thirteen guidelines were reviewed. Twelve included at least one core patient-preference recommendation. Ten used consumer-engagement processes, including participation in development groups (seven guidelines) and reviewing drafts (ten guidelines). More extensive consumer engagement was generally linked to greater incorporation of patient-preference recommendations. Overall quality of guidelines was mixed, particularly in relation to stakeholder involvement. Conclusions Guidelines do incorporate some patient-preference recommendations, but more explicit acknowledgement is required. Consumer-engagement processes used during guideline development have the potential to assist in identifying patient preferences, but further research is needed. Clarification of the consumer role and investment in consumer training may strengthen these processes.

Increasing HIV testing among hard-to-reach groups: examination of RAPID, a community-based testing service in Queensland, Australia

BackgroundThe success of ‘treatment as prevention’ (TasP) to control HIV relies on the uptake of testing across priority population groups. Innovative strategies including; rapid HIV testing (RHT) in community and outreach settings, engaging peer service providers, and not requiring disclosure of sexual history have been designed to increase access. This paper reports on the implementation of ‘RAPID’, a community-based testing program in Queensland, Australia that employs these strategies to increase access to testing.MethodsService data, including client registration forms and a satisfaction survey from all clients attending RAPID between August 2014 and July 2015 were analysed.ResultsIn 2014/2015 1,199 people attended RAPID to receive a free HIV test. The majority were urban-based gay men. 17.1% were first-time testers and 20.1% of participants were not eligible to access Medicare, Australia’s universal health care scheme.ConclusionsRAPID’s evidence-based strategies appear to facilitate access to HIV testing, particularly among those who have never tested before; however the implications for the ongoing treatment and care of people ineligible for Medicare, who test positive to HIV warrants careful consideration.

Supporting parents following pregnancy loss: a cross-sectional study of telephone peer supporters.

BackgroundThe death of a baby before or soon after birth can place an enormous psychological toll on parents. Parent support groups have grown in response to bereaved parents’ unmet needs for support. Peer support is the hallmark of these organisations but little is known about the experiences of volunteers who provide support. This study examines the perceptions and experiences of parent support group volunteers who deliver a 24-h telephone support service for the Australian Stillbirth and Newborn Death Support (Sands) organisation in order to inform the ongoing development and sustainability of effective peer support. This parent-led organisation has delivered support to those affected by miscarriage, stillbirth and newborn death for more than 30 years.MethodsTwenty-four Parent Supporters completed an online questionnaire. A mix of open- and closed questions asked about aspects of the Parent Supporter role. Quantitative data was summarised using descriptive statistics. Free-text responses to open-ended items were categorised and used to extend and illustrate the quantitative findings.ResultsOur findings reveal a group of highly dedicated and experienced volunteers who had taken 473 calls in the preceding 12 months. Calls were diverse but most were from bereaved mothers seeking ‘to talk with someone who understands’ in the early weeks and months after stillbirth or miscarriage. Most Parent Supporters indicated they felt well-prepared, confident, and satisfied in their role. Challenges include balancing the demands of the role and ongoing training and support.ConclusionsPeer volunteers contribute to addressing a significant need for support following pregnancy loss. Delivering and sustaining high quality parent-led support depends on volunteer recruitment and retention and this, in turn, requires organisational responses.

Increasing access to consumer health organisations among patients with chronic disease - a randomised trial of a print-based intervention

AIM To assess whether a print-based intervention led to increased contact with consumer health organisations (CHOs) by general practice patients with chronic disease. BACKGROUND CHOs can enhance peoples capacity to manage chronic illness by providing information, education and psychosocial support. However, these organisations appear to be grossly under-utilised by patients and clinicians. METHODS A total of 276 patients completed a computer-assisted telephone interview before randomisation to an intervention (n = 141) or control (n = 135) group. The intervention consisted of mailed printed materials designed to encourage contact with a CHO relevant to the patients main diagnosed chronic condition. Follow-up interviews were conducted 4 and 12 months later. FINDINGS Patients with conditions other than diabetes who received the intervention were twice as likely as those in the control group to contact a consumer health organisation during the 12-month study period: 41% versus 21% (P < 0.001). No such effect was found for diabetes patients, probably because of pre-existing high levels of contact with diabetes organisations. The intervention package received strong patient endorsement. Low-intensity interventions may be effective in improving access to CHOs for patients with chronic disease.

A journey towards sustainable feedback

Abstract Meeting students’ expectations associated with the provision of feedback is a perennial challenge for tertiary education. Efforts to provide comprehensive, timely feedback within our own first year undergraduate public health courses have not always met students’ expectations. In response, we sought to develop peer feedback activities to support the development of ‘self-evaluative strategies’ that would acknowledge the centrality of students in the feedback process. We describe these activities, their staged development and the qualitative and quantitative data gathered from students and the teaching teams to evaluate this. Our first steps towards embedding peer feedback with first year students indicated they are willing to engage in the process and appreciated the opportunity to provide and receive feedback, but the quality and extent of the peer feedback was largely superficial. Students’ reflections on the feedback received were also shallow. Supporting students to develop self-evaluative skills cannot be achieved in the short term, but must be embedded in courses and consistently reinforced, with greater emphasis placed on the development of a dialogue around feedback that connects students with peers and educators.

Proposed changes to Medicare: undermining equity and outcomes in Australian primary health care?

Australian and New Zealand Journal of Public Health 1

Exploring intimate partner violence in Polynesia: a scoping review

Intimate partner violence (IPV) is a major, global public health concern with significant impacts, particularly for women, worldwide. There is an immediate need to develop comprehensive understandings of the complex drivers of this multifaceted issue in diverse cultural and social contexts. This scoping review used a systematic approach to gather a broad scope of peer-reviewed, publisher-controlled, and gray literature investigating IPV in Polynesia, a region of the Pacific experiencing high rates of IPV. A total of 181 articles were identified through a comprehensive search that included five cross-disciplinary databases; government, intergovernmental, and nongovernment websites; and consultation with community organizations. Thirty-three articles met the inclusion criteria related to IPV in a Polynesian country or community abroad and were included in this review. Narrative synthesis, which included summarizing and sorting key findings into common themes, was conducted to provide an overview of what is currently known about IPV in Polynesia and Polynesian communities living aboard. Key themes, which arose from the data analysis included: high prevalence of IPV, attitudes supporting IPV, urbanization and migration, traditional protective factors, and formal leadership and laws. The paucity of rigorous literature highlights an immediate need for IPV prevention research and intervention within Polynesian communities. This review includes a discussion of the limitations of this small body of literature and makes recommendations for future research, policy, and program development to include intersectionality in order to deepen understandings and enhance inclusive and meaningful intervention and policy implementation.