Libby Kalucy

Advancing Health Promotion in Australian General Practice

Health promotion activities, while having the potential to prevent disease and decrease the burden of ill health, often play a minor role in the health care offered by general practitioners. There are several identified barriers to the involvement of Australian general practitioners in health promotion. These include structural barriers and barriers within the practice setting, individual practitioner and patient factors, and difficulties in evaluating the outcomes of health promotion activities. This article explores the barriers to the engagement of Australian general practice with health promotion and reviews several recent initiatives that have the potential to increase the health promotion activities of general practitioners. These initiatives act at the level of the individual practitioner, the practice, and in the community. Despite the lack of a coordinated national approach, these strategies form an important development in general practice.

Pathways to research impact in primary healthcare: What do Australian primary healthcare researchers believe works best to facilitate the use of their research findings?

BackgroundPrimary healthcare researchers are under increasing pressure to demonstrate measurable and lasting improvement in clinical practice and healthcare policy as a result of their work. It is therefore important to understand the effectiveness of the research dissemination strategies used. The aim of this paper is to describe the pathways for research impact that have been achieved across several government-funded primary healthcare projects, and the effectiveness of these methods as perceived by their Chief Investigators.MethodsThe project used an online survey to collect information about government-funded primary healthcare research projects. Chief Investigators were asked how they disseminated their findings and how this achieved impact in policy and practice. They were also asked to express their beliefs regarding the most effective means of achieving research impact and describe how this occurred.ResultsChief Investigators of 17 projects indicated that a number of dissemination strategies were used but that professional networks were the most effective means of promoting uptake of their research findings. Utilisation of research findings for clinical practice was most likely to occur in organisations or among individual practitioners who were most closely associated with the research team, or when research findings were included in educational programmes involving clinical practice. Uptake of both policy- and practice-related research was deemed most successful if intermediary organisations such as formal professional networks were engaged in the research. Successful primary healthcare researchers had developed critical relationships with intermediary organisations within primary healthcare before the initiation of the research and had also involved them in the design. The scale of research impact was influenced by the current policy environment, the type and significance of the results, and the endorsement (or lack thereof) of professional bodies.ConclusionsChief Investigators believed that networks were the most effective means of research dissemination. Researchers who were embedded in professional, clinical or policy-focussed intermediary organisations, or had developed partnerships with clinical services, which had a vested interest in the research findings, were more able to describe a direct impact of their research. This suggests that development of these relationships and engagement of these stakeholders by primary healthcare researchers is a vital step for optimal research utilisation in the primary healthcare setting.

Partnership approaches, regional structures and primary health care reform

Partnershipsareessentialforreformoftheprimaryhealthcare system in Australia according to discussion papers produced in 2008 by the reform initiatives. Building on the foundation of patient–provider relationships, partnerships are needed between health care providers, between governments and between health and other sectors. Partnerships will feature in the regional structures that are being proposed to develop, resource and network private, public and state-based primary heath care services. This paper considers the potential for Divisions of General Practice to undertake the role of these regional structures. Whileprimary healthcareinAustraliadeliversagreatdeal of value, reform is needed to address considerable inequities in care and outcome, as well as many current and future pressures. Years of tinkering at the edges of the system have resulted in an increasing proliferation of narrowly targeted programsandfundingarrangements,andgrowingcomplexity

Editorial Issue 4 2010: Access and more

Access to needed care is fundamental to a good primary health care system. This issue of the AJPH highlights some important access topics. The availability of primary care physicians is addressed by Roeger et al. using an innovative method in the rapidly developing field of geographic information systems (GIS). Other papers cover more specific issues of access: access of Indigenous patients to primary oral health service provision in rural and remote WA (Kruger et al.), and of children and adolescents in out-of-home care to comprehensive health assessments in general practice (Webster et al.). Descriptive research is an essential precursor to developing appropriate interventions to improve access or care delivery. This issue features several papers which investigate the perceptions of primary care professionals about barriers to addressing specific topics. As well as Webster et al.’s paper, Ball et al. use such methods to examine nutrition in general practice, Allan to investigate drug and alcohol services and mental health services in rural and remote Australia, and in a different setting, Doyle and Ristevski investigate the perspectives of teachers and health workers on promoting ear health within primary schools. Finally, Henderson et al. examine Australian consumers’ perceptions of food safety. As is appropriate for a journal which integrates theory and practice in primary health, another theme in these papers is the use of specific models or frameworks. To guide their research methodology Bamberg et al. use implementation science in developing research and evaluation capacity in community health, and Hallinan uses program logic to examine the Pap nurse in general practice program. Bird et al. assess the effects of an integrated care facilitation model, on the ever topical issue of reducing use of hospital resources by patients with chronic conditions. As Lawn states in her paper on chronic disease self management, ‘organisational change aimed at service improvement continues to be a challenging process for many health services, managers and teams’. As demand grows and both patients and the workforce age, it is more important than ever that primary health care professionals work with researchers and evaluators to reflect on and publish their experiences of implementing changes, for the benefit of themselves and their sector.