Teresa Burgess

I don't think general practice should be the front line: experiences of general practitioners working with refugees in South Australia

IntroductionMany refugees arrive in Australia with complex health needs. In South Australia (SA), providing initial health care to refugees is the responsibility of General Practitioners (GPs) in private practice. Their capacity to perform this work effectively for current newly arrived refugees is uncertain. The aim of this study was to document the challenges faced by GPs in private practice in SA when providing initial care to refugees and to discuss the implications of this for policy relating to optimising health care services for refugees.MethodsSemi-structured interviews with twelve GPs in private practice and three Medical Directors of Divisions of General Practice. Using a template analysis approach the interviews were coded and analysed thematically.ResultsMultiple challenges providing care to refugees were found including those related to: (1) refugee health issues; (2) the GP-refugee interaction; and (3) the structure of general practice. The Divisions also reported challenges assisting GPs to provide effective care related to a lack of funding and awareness of which GPs required support. Although respondents suggested a number of ways that GPs could be assisted to provide better initial care to refugees, strong support was voiced for the initial care of refugees to be provided via a specialist refugee health service.ConclusionGPs in this study were under-resourced, at both an individual GP level as well as a structural level, to provide effective initial care for refugees. In SA, there are likely to be a number of challenges attempting to increase the capacity of GPs in private practice to provide initial care. An alternative model is for refugees with multiple and complex health care needs as well as those with significant resettlement challenges to receive initial health care via the existing specialist refugee health service in Adelaide.

Unmet needs of people with end-stage chronic obstructive pulmonary disease: recommendations for change in Australia

Chronic obstructive pulmonary disease (COPD) is an increasing cause of mortality. However, people with COPD are unlikely to receive care that meets the needs of themselves or their carers at the end of life.

Could recidivism in prisoners be linked to traumatic grief? A review of the evidence

Traumatic grief arises as a result of interpersonal trauma experienced as a betrayal of attachment. The distinct set of symptoms associated with it were first recognized in the 1990s. Losses associated with traumatic grief can be either death or non-death related. A variety of studies have demonstrated that many prisoners have suffered from losses and trauma throughout their lives, and in many instances they have never received any support or interventions to address resultant problems. This paper examines whether there could be a relationship between many of the maladaptive behaviours demonstrated by the prisoners (including substance use), mental illness and traumatic grief. Of particular importance is the exploration of whether the high rates of recidivism seen in many developed countries (and which in Australia have been reported as high as 77%) may be related to traumatic grief. This paper explores new concepts that may be relevant to the development of strategies to reduce recidivism.

Ensuring quality of care through implementation of a competency‐based musculoskeletal education framework

Introduction As the Bone and Joint Decade 2000–2010 draws to a close, it is timely to review its impact on musculoskeletal medical education, which was clearly identified by the World Health Organization as a key factor contributing to less than optimal musculoskeletal care (1). The increasing burden of musculoskeletal disorders (including chronic bone and arthritic conditions) and the uncertain quality of care provided (2,3) has meant that there is a growing imperative to ensure that optimal, evidence-based, and cost-effective treatment is being provided to people with musculoskeletal disorders by medical practitioners (4). In 2004, the Bone and Joint Decade established the International Education Task Force and Undergraduate Curriculum Development Group to develop strategies to address the issue of insufficient and/or inadequate medical education, particularly in the areas of basic and clinical science (5,6). They released global core recommendations for a musculoskeletal undergraduate medical curriculum, which were designed to enable the development of a locally applicable musculoskeletal curriculum that was able to meet national guidelines and be reflective of local needs, priorities, and opportunities (5). Despite the release of the global core recommendations for a musculoskeletal undergraduate medical curriculum, in 2007 Woolfe and Akesson identified that the poor quality of medical education and a lack of coordination between the different disciplines and professional specialties working in musculoskeletal health care have meant that people do not receive the best practice treatment (6). Furthermore, in 2007 Day et al demonstrated significant deficiencies in the knowledge of chronic arthritic conditions in graduating medical students (2). Deficiencies in undergraduate education in musculoskeletal science have also been identified by medical students and graduates in studies conducted in a number of countries (2,7–10), and there is an obvious requirement for clinically relevant, evidence-based curriculum design that integrates traditional scientific and clinical disciplines. The Australian Musculoskeletal Education Collaboration (AMSEC) project began in Australia in 2005, with the aim of developing nationally agreed musculoskeletal core competencies (based on the Bone and Joint Decade curriculum recommendations) for implementation in all Australian medical schools. Initiated by the Australian Orthopaedic Association and funded by the Australian government, this project has succeeded in bringing together all key musculoskeletal specialist and representative organizations in a national, multidisciplinary education collaboration (including orthopedics, rheumatology, general practice, rehabilitation medicine, sports medicine, endocrinology, neurology, geriatrics, radiology, pediatrics, nursing, and interested allied health professions). While the Bone and Joint Decade recommendations formed the base from which the Australian competencies were developed, it was also vital that specific Australian standards and requirements were considered. The AMSEC competencies were therefore also related directly to the Australian Medical Council standards and principles and The National Patient Safety Framework (11,12). The purpose of this article is to outline the relevance of a competency-based approach to musculoskeletal education and to describe the development of theAMSECmusculoskeletal core competencies. Furthermore, we demonstrate the significance of the AMSEC competencies and the competency education process for optimal education in musculoskeletal medicine relative to chronic rheumatic disease.

Developing and evaluating the GriefLink web site: processes, protocols, dilemmas and lessons learned

Despite a profusion of recommendations regarding the quality of web sites and guidelines related to ethical issues surrounding health-related sites, there is little guidance for the design and evaluation of sites relating to loss and grief. This article, which addresses these deficiencies, results from a community consultation process of designing and evaluating a web site—GriefLink—for bereaved consumers and for the professionals who help them. It presents the literature review that informed the project, the recommendations for design and content, the lessons learned through the process itself, and the difficulties of evaluating the benefits of a grief-related web site. Some ethical and legal dilemmas in developing grief-related web sites are discussed and issues of design, content, process, evaluation, and general features are addressed, which may also be applied to other communication forms for loss and grief matters, such as the print media.

Twelve tips for supporting student learning in multidisciplinary clinical placements

Healthcare profession students participate in a range of clinical placements within multidisciplinary health care settings. Often these placements offer students opportunities to participate in activities with staff and/or students from other healthcare disciplines. Although health service staff generally recognise the importance of clinical placements for student learning, they sometimes feel overwhelmed by workload and resource constraints. As a consequence, the potential of the clinical team to contribute to student learning may not be fully realised. A key element of successful clinical placement programs across all healthcare disciplines is a coordinated approach to the development and management of complex university/health service partnerships. Explicit mechanisms to support clinical team members in their teaching roles can also contribute to develop and sustain staff capacity for student supervision, as appropriate recognition of clinical staff contributes to student learning. Twelve tips are offered for consideration by universities, health services and clinical staff when planning and implementing student clinical placements in multidisciplinary healthcare settings.

Parental and societal support for adolescent immunization through school based immunization programs

OBJECTIVES Adolescent immunizations such as human papillomavirus vaccine have been implemented through school based immunization programs (SBIPs) in Australia. We assessed community attitudes toward immunization of adolescents though SBIPs. METHODS A cross-sectional population survey of rural and metropolitan households in South Australia in 2011. Univariate and multiple regression analyses identified predictors of support for a SBIP. RESULTS Participation rate was 57.3% with 1926 adults interviewed. Overall, 75.9% regarded school as the best place to offer adolescent immunizations, with 16.4% preferring the family physician. Parents of high school students were most supportive (88.4%) of a SBIP with 87.9% of their adolescents reported as having participated in the program. Adults 18-34 years (79.4%) were more likely to support a SBIP compared to older adults (68.7% of >55 years) [adjusted OR=2.39, p=0.002] and men were more supportive (80.3%) than women (71.7%) [adjusted OR=1.54, p=0.003]. Reasons for participation in the SBIP included convenience (39.9%), public funding for the service (32.4%), and confidence in immunization recommendations (21.0%). CONCLUSIONS Public support for the SBIP was very high particularly amongst parents whose adolescent/s had participated in the program.

Electronic medical records may be inadequate for improving population health status through general practice: cervical smears as a case study.

Objective:To determine whether routine electronic records are an accurate source of population health data in general practice through reviewing cervical smears rates in four South Australian practices.

Student non‐completion of an undergraduate degree: wrong program selection or part of a career plan?

Institution wide comparisons of students who leave university before completing their degree and students who complete their studies, have identified ‘wrong course selection’ and a lack of vocational focus as common reasons for non‐completion. It is not fully understood, though, whether these trends are constant across different disciplines and programs and whether all relevant contributing factors, in particular career intentions, have been considered. This study was undertaken to explore reasons for student non‐completion in more detail in one program. Students enrolled in an undergraduate health sciences degree completed a questionnaire at enrolment and another 12 months later, regarding their reasons for enrolment, career intentions and expectations for/experiences of learning. Students who did not re‐enrol after the first year were invited to complete a separate exit questionnaire regarding their reasons for not re‐enrolling. Many students who did not re‐enrol after the first year of study transferred to another degree that was more aligned with their career intentions. In this context rather than a ‘wrong’ selection, non‐completion of the initial undergraduate degree formed part of a career plan.

Ethical challenges in school-based immunization programs for adolescents: a qualitative study

OBJECTIVES We investigated ethical issues in school-based immunization programs for adolescents and how they are addressed. METHODS We used qualitative methods and an ethnographic approach to observe 9 secondary schools on immunization days in South Australia in 2011; concurrently, we conducted 9 focus groups with female secondary school students, 6 semistructured interviews with parents, and 10 interviews with nurses and teachers. We explored ethical challenges from the perspective of these groups. RESULTS We identified ethical challenges for the delivery of adolescent immunization in a school-based setting in 3 main areas: informed consent, restrictions on privacy, and harm to students in the form of fear and anxiety. CONCLUSIONS We found areas in which the design and delivery of school-based immunization programs can be improved. Information about immunization should be provided in ways that are appropriate to young people and their parents, and privacy protections should be enhanced when possible. Involving young people in the design and delivery of programs would assist with making these improvements.