https://ogma.newcastle.edu.au/vital/access/ /manager/Index en-au 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:24647 Wed 30 Nov 2016 15:16:28 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:53526 Wed 28 Feb 2024 15:51:35 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36546 Wed 24 Nov 2021 15:50:27 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:55201 90% of patients annually) and five practices with low rates of monitoring HbA1c levels (< 80% of patients annually) from HNELHD, NSW provided the sampling frame. A total of nine GPs were interviewed. The transcripts from the interviews were reviewed and analysed to identify emergent patterns and themes. Results: Overall, GPs were supportive of DAP. They considered that DAP resulted in significant changes in their knowledge, skills, and approach and improved the quality of diabetes care. Taking a more holistic approach to care, including assessing patients with diabetes for co-morbidities and risk factors that may impact on their future health was also noted. DAP was noted to increase the confidence levels of GPs, which enabled active involvement in the provision of diabetes care rather than referring patients for tertiary specialist care. However, some indicated the program could be time consuming and greater flexibility was needed. Conclusions: GPs reported DAP to benefit their knowledge, skills and approach for managing diabetes. Future research will need to investigate how to improve the intensity and flexibility of the program based on the workload of GPs to ensure long-term acceptability of the program.]]> Wed 24 Apr 2024 13:05:58 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:54884 Wed 20 Mar 2024 13:20:05 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:38722 Wed 19 Jan 2022 09:36:08 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:48902 Wed 19 Apr 2023 16:30:23 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:31511 Wed 15 Dec 2021 16:09:40 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:38671 n = 17) achieved the targeted number of 20 or more patients. Conclusions: Recruitment in general practice settings can be successfully achieved through multiple recruitment strategies, effective communication and rapport building, ensuring research topic and design suit general practice needs, and using familiar communication strategies to engage patients. Trial registration: The trial was prospectively registered on 29 April 2015 with the Australian New Zealand Clinical Trial Registry www.anzctr.org.au (trial ID: ACTRN12615000401550).]]> Wed 15 Dec 2021 14:32:30 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:52422 Wed 11 Oct 2023 12:05:53 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:16751 Wed 11 Apr 2018 16:36:30 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:30383 Wed 11 Apr 2018 15:20:36 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:13779 Wed 11 Apr 2018 14:39:54 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21093 Wed 11 Apr 2018 14:16:18 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21145 Wed 11 Apr 2018 14:09:04 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14772 2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare? Discussion: Strengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem. We need practice-based evidence to fill this gap. By recognising generalist practice as a ‘complex intervention’ (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem. Summary: Answers to the complex problem of multi-morbidity won’t come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity.]]> Wed 11 Apr 2018 13:41:48 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:2662 Wed 11 Apr 2018 13:18:15 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:13536 Wed 11 Apr 2018 12:39:48 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:24290 Wed 11 Apr 2018 12:36:53 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:15465 Wed 11 Apr 2018 12:18:57 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:18878 Wed 11 Apr 2018 11:58:12 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:22522 Wed 11 Apr 2018 09:19:17 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:25449 Wed 10 Nov 2021 15:05:26 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32455 Wed 10 Jun 2020 14:37:51 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36862 Wed 07 Apr 2021 20:17:27 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:49019 Wed 03 May 2023 12:31:33 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37180 Wed 01 Mar 2023 11:52:01 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:52874 Tue 31 Oct 2023 10:37:22 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:50425 Tue 25 Jul 2023 18:48:29 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20161 Tue 24 Aug 2021 14:24:28 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:18324 Tue 23 Jun 2015 18:57:17 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37786 Tue 22 Jun 2021 15:48:03 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:41967 Tue 16 Aug 2022 14:45:31 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:55295 Tue 14 May 2024 12:35:35 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:47053 Tue 13 Dec 2022 15:25:32 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:35472  90% and MW 60%), self-rated health and rates of acute problems (red alerts) requiring prompt intervention were similar in both groups. Typical presentations were different in the two groups with IPCC presenting with age-related multimorbidity problems and MW with a cluster of pain, depression, and drug and alcohol problems in the context of psychosocial and environmental problems with many more instances of not coping (pink alerts). PaJR was well received with very low dropout rates in either group. This approach identified problems, generally amenable to intervention, but many psychosocial problems, particularly in MW, were challenging to solve within existing health service structures and resources. In conclusion supporting complex health journeys through conversations using lay care guides and an adaptive systems approach is feasible in at least two very different settings and patient groups.]]> Tue 13 Aug 2019 12:27:16 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:54139 Tue 06 Feb 2024 11:49:40 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:34917 Tue 03 Sep 2019 18:18:26 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:34248 Thu 30 Mar 2023 18:42:18 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:45230 Thu 27 Oct 2022 12:26:23 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:45336 Thu 27 Oct 2022 10:50:18 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32457 Thu 27 Jan 2022 15:59:25 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:528 Thu 25 Jul 2013 09:10:32 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:38606 2 or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician-led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF). Results: Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group; 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group; and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means -3.86, 95% CI -6.81 to -0.90, P=.01; week 18: difference in means -4.05, 95% CI -6.81 to -1.28, P<.001; week 36: difference in means -4.99, 95% CI -8.04 to -1.94, P<.001; and week 62: difference in means -4.62, 95% CI -7.62 to -1.62, P<.001). Conclusions: A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small sample size, and replication on a larger sample with longer follow-up will strengthen the results.]]> Thu 18 Nov 2021 09:43:15 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:33156 Thu 17 Mar 2022 14:34:24 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20835 Diabetes Research and Clinical Practice, Diabetes Care, Diabetic Medicine, Population Health Management, Rural and Remote Health, Australian Journal of Primary Health, PLoS Medicine, Medical Journal of Australia, BMC Health Services Research, BMC Public Health, BMC Family Practice) and Commonwealth and state government health websites was undertaken to acquire Australian studies of diabetes workforce models published 2005–13. Various diabetes workforce models were examined, including ‘one-stop shops’, pharmacy care, Aboriginal services and telephone-delivered interventions. The quality of evidence was evaluated against several criteria, including relevance and replication, strength of evidence, effect size, transferability and representativeness, and value for money. Results: Of the 14 studies found, four were randomised controlled trials and one was a systematic review (i.e. Level II and I (best) evidence). Only three provided a replicable protocol or detailed intervention delivery. Eleven lacked a theoretical framework. Twelve reported significant improvements in clinical (patient) outcomes, commonly HbA1c, cholesterol and blood pressure; only four reported changes in short- and long-term outcomes (e.g. quality of life). Most studies used a small or targeted population. Only two studies assessed both benefits and costs of their intervention compared with usual care and cost effectiveness. Conclusions: More rigorous studies of diabetes workforce models are needed to determine whether these interventions improve patient outcomes and, if they do, represent value for money. What is known about the topic?: Although health systems with strong primary care orientations have been associated with enhanced access, equity and population health, the primary care workforce is facing several challenges. These include a mal-distribution of resources (supply side) and health outcomes (demand side), inconsistent support for teamwork care models, and a lack of enhanced clinical inter-professional education and/or training opportunities. These challenges are exacerbated by an ageing health workforce and general population, as well as a population that has increased prevalence of chronic conditions and multi-morbidity. Although several policy directions have been advocated to address these challenges, there is a lack of high-quality evidence about which primary care workforce models are best (and which models represent better value for money than current practice) and what the health effects are for patients. What does this paper add?: This study demonstrated several strengths and weaknesses of Australian diabetes models of care studies. In particular, only five of the 14 studies assessed were designed in a way that enabled them to achieve a Level II or I rating (and hence the ‘best’ level of evidence), based on the NHMRC’s (2000, 2001) frameworks for assessing scientific evidence. The majority of studies risked the introduction of bias and thus may have incorrect conclusions. Only a few studies described clearly what the intervention and the comparator were and thus could be easily replicated. Only two studies included cost-effectiveness studies of their interventions compared with usual care. What are the implications for practitioners?: Although there has been an increase in the number of primary care workforce models implemented in Australia, there is a need for more rigorous research to assess whether these interventions are effective in producing improved health outcomes and represent better value for money than current practice. Researchers and policymakers need to make decisions based on high-quality evidence; it is not obvious what effect the evidence is having on primary care workforce reform.]]> Thu 16 Jul 2020 10:20:24 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:31957 Thu 12 Apr 2018 13:44:00 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36843 Thu 04 Nov 2021 10:39:30 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:7885 Sat 24 Mar 2018 08:41:36 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:8262 Sat 24 Mar 2018 08:40:36 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:7783 Sat 24 Mar 2018 08:39:19 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:7023 Sat 24 Mar 2018 08:37:55 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:8016 Sat 24 Mar 2018 08:36:50 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:9953 Sat 24 Mar 2018 08:14:27 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:11094 Sat 24 Mar 2018 08:13:24 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20771 vs as-needed 1·05, 0·92–1·20). We recorded no difference between treatment groups for time to recovery (adjusted p=0·79). Adherence to regular tablets (median tablets consumed per participant per day of maximum 6; 4·0 [IQR 1·6–5·7] in the regular group, 3·9 [1·5–5·6] in the as-needed group, and 4·0 [1·5–5·7] in the placebo group), and number of participants reporting adverse events (99 [18·5%] in the regular group, 99 [18·7%] in the as-needed group, and 98 [18·5%] in the placebo group) were similar between groups. Interpretation: Our findings suggest that regular or as-needed dosing with paracetamol does not affect recovery time compared with placebo in low-back pain, and question the universal endorsement of paracetamol in this patient group.]]> Sat 24 Mar 2018 08:00:22 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20056 Sat 24 Mar 2018 08:00:13 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20480 Sat 24 Mar 2018 07:59:08 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:19963 Sat 24 Mar 2018 07:58:34 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20906 Sat 24 Mar 2018 07:57:54 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:19132 Sat 24 Mar 2018 07:55:53 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:19114 Sat 24 Mar 2018 07:55:52 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:19181 Sat 24 Mar 2018 07:52:17 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:19389 Sat 24 Mar 2018 07:52:05 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:5672 Sat 24 Mar 2018 07:47:33 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:4974 Sat 24 Mar 2018 07:46:55 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:27835 Sat 24 Mar 2018 07:41:17 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:27393 Sat 24 Mar 2018 07:34:09 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:26053 Sat 24 Mar 2018 07:31:35 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:30671 95% in both groups. GPs and their patients both found the GPCOG to be an acceptable cognitive assessment tool. The dementia cases missed via case-finding were younger (p = 0.024) and less cognitively impaired (p = 0.020) than those detected. Conclusion: There is a very limited benefit of screening for dementia, as most people with dementia could be detected using a case-finding approach, and considerable potential for social and economic harm because of the low PPV associated with screening.]]> Sat 24 Mar 2018 07:29:36 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:26028 Sat 24 Mar 2018 07:26:29 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:30684 P value 0.19). This brief training package failed to increase overall opioid cessation. The inconsistency of these actual prescribing results with “hypothetical” prescribing behavior suggests that reducing opioid prescribing in chronic noncancer pain requires more than changing knowledge and attitudes.]]> Sat 24 Mar 2018 07:23:47 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:27575 Sat 24 Mar 2018 07:23:41 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:22242 Sat 24 Mar 2018 07:17:31 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:23062 Sat 24 Mar 2018 07:12:27 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:23757 Sat 24 Mar 2018 07:11:09 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:23993 Sat 24 Mar 2018 07:10:24 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:54971 Mon 25 Mar 2024 15:20:41 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:34258 Mon 25 Feb 2019 11:39:27 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:44899 Mon 24 Oct 2022 16:10:27 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32297 Mon 23 Sep 2019 13:03:07 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:49552 Mon 22 May 2023 09:13:19 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36661 Mon 22 Jun 2020 16:39:42 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:18636 Mon 20 Jul 2015 16:45:12 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:51790 Mon 18 Sep 2023 15:19:19 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:46209 Mon 14 Nov 2022 11:43:52 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36852 Mon 13 Jul 2020 10:41:17 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:27290 Fri 25 Sep 2020 12:37:05 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:55388 Fri 24 May 2024 10:34:16 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:31131 Fri 22 Apr 2022 10:19:23 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36288 Fri 20 Mar 2020 12:31:30 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:53086 Fri 17 Nov 2023 11:34:27 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:39695 Fri 17 Jun 2022 16:21:04 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:49424 Fri 12 May 2023 15:09:21 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:49361 Fri 12 May 2023 12:35:08 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14295 Fri 10 Mar 2023 19:27:41 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:13846 Fri 10 Mar 2023 19:20:41 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:33003 Fri 10 Mar 2023 19:15:55 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:53592 Fri 08 Dec 2023 15:45:50 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:49829 Fri 02 Jun 2023 12:27:03 AEST ]]>