Reflecting on 2021 for the Australian Journal of Primary Health

The past year has also seen significant changes in academic publishing. There has been an emphasis on rapid dissemination of research findings during the pandemic, increasing the prominence of pre-publication manuscripts and reinforcing the need for timely peer review. There has been a significant increase in the volume of manuscripts submitted, including to the AJPH.

At the same time, it is more difficult than ever to find peer reviewers for submitted articles. There has been a significant increase in the pressures on people’s time, through their paid jobs, but also because of juggling caring responsibilities during multiple lockdowns. Many people have been redeployed to support health systems and organisations to respond to the COVID-19 pandemic. The Australian Government’s decision to not provide any financial support to universities during the pandemic has led to thousands of jobs being lost across the sector over the past year, with more losses likely to come. Precarious employment has become even more entrenched and fewer people are in jobs that include service to the profession as part of their roles. This leads to fewer people being able to undertake reviews at the time we need high-quality peer review most.
— Read on www.publish.csiro.au/py/Fulltext/PYv27n6_ED

It’s been a pleasure being an Associate Editor for AJPH, and it was good to have this opportunity to reflect on the pst year with Virginia Lewis and Jenny Macmillan as I’m stepping down.

Do general practice management and/or team care arrangements reduce avoidable hospitalisations in Central and Eastern Sydney, Australia?

New paper published in BMC Health Services Research with colleagues from CPHCE, SESLHD, SLHD and CESPHN:

There was no evidence to suggest that the use of [General Practice Management Plans] and/or [Team Care Arrangements] has prevented hospitalisations in the Central and Eastern Sydney region.

Source: Do general practice management and/or team care arrangements reduce avoidable hospitalisations in Central and Eastern Sydney, Australia?

 

On the risks of general practice by smartphone, and who’s excluded by (and through) mHealth initiatives

Answers to some questions about GP at Hand come from a recent independent evaluation.2

The evaluation confirms that GP at Hand caters principally to a healthy, affluent, young, and working population: 98.5% of patients are aged 20-64,3 two thirds live in affluent areas, and only 0.1% are cared for by the service’s “chronic care team.”

Registered patients found GP at Hand convenient and used the service more often than they did their previous practice, also reducing their previous high use of other urgent NHS services. However, a quarter of GP at Hand’s newly registered patients move back to a conventional NHS practice, many within two weeks.

— Read on www.bmj.com/content/366/bmj.l4713

Quality in general practice

…PIP QI [Practice Incentive Payment Quality Improvement] is a top-down quality improvement strategy. Funding is based on data extraction for 10 quantitative measures that are shared with the local Primary Health Networks (PHNs). The practice then must engage in a quality improvement project, with vague descriptors of qualifying activities. The secretive nature of negotiations about the content of PIP QI has excluded the medical profession and the people we are trying to treat. The 10 measures are relatively crude, including percentage of patients who smoke, patients with diabetes with recent glycated haemoglobin recording, and patient weight recordings.

These limited measures are far too narrow to assess a complex system such as general practice. Rather than driving quality improvement, the focus becomes one of coding for the purposes of data extraction.

Source: We need to talk about quality in general practice

Interesting post from members of the GPs Down Under Facebook group.

Primary health care provider–focused interventions for improving outcomes for people with type 2 diabetes

In brief

The greatest opportunities to enhance diabetes care in the Australian primary health care setting seem to be:

  1. delivering culturally tailored programs involving community health workers (a strong interest of mine)
  2. incorporating diabetes decision support into practice software.

About the paper

Colleagues at the Centre for Primary Health Care and Equity and I did a rapid review on what works to improve outcomes for people with Type 2 diabetes in primary health care , which is available now.

We identified (1) computerised decision support, (2) feedback and benchmarking on diabetes care quality, (3) culturally tailored programs (usually delivered by community health workers), and (4) enhanced practice nurse involvement in diabetes care as interventions that had a positive impact across several outcome measures. These outcomes included:

  • clinical outcomes (blood pressure, and body mass index, or weight)
  • biochemical outcomes (glycosylated haemoglobin [HbA1c], lipid profile, or renal function)
  • psychological outcomes (anxiety, depression, diabetes-related distress, perceived seriousness and vulnerability, self-efficacy, or self-care)
  • health-related quality of life measures from participant self-report.

The evidence about the use of decision aids (e.g. when to commence statins) was equivocal in terms of their impact on HbA1c, lipid profile and renal function. One high quality integrated care study on a virtual clinic, which brought together nurses, diabetologists and GPs, showed improvements in blood pressure but not renal function. No single intervention improved all the outcome measures that were considered.

References

Faruqi, N. et al. (2019) ‘Primary health care provider–focused interventions for improving outcomes for people with type 2 diabetes: a rapid review’, Public Health Research and Practice, 29(4), p. e29121903. doi: 10.17061/phrp29121903.