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Background: To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation. Methods: Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria. Results: Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants' knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes. Conclusions: Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability. Limited studies have sought to implement and evaluate novel workforce approaches to reducing differential diabetes-related outcomes in the Aboriginal and Torres Strait Islander peoples populations. This review described the characteristics of the chronic disease management training programs and their effectiveness for Aboriginal Health Workers and Practitioners. Most included studies reported satisfaction with the training content, whereas some reported improved knowledge, confidence, and clinical and non-clinical skills of the participants. However, few studies reported knowledge transfer into clinical practice and client-related outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To identify features of mental health services that affect the uptake of services among parents of children with chronic medical conditions, to inform the design of pathways into mental health care. Methods: A discrete choice experiment in which participants made choices between hypothetical mental health services described in terms of service features: cost, wait time, provider knowledge of chronic medical conditions, recommendations, opening hours, and travel time. Participants were parents of children attending The Royal Children's Hospital outpatient clinics for the management of a chronic medical condition who completed the online survey between August 2020 and January 2021. The uptake of mental health services with differing features was predicted based on regression models examining the relationship between choice and service features, and accounting for participant characteristics and unobserved heterogeneity. Results: The sample comprised 112 parents, of whom 52% reported unmet needs. The most influential service features were wait times, cost, recommendation from medical specialists, and mental health provider knowledge of chronic medical conditions. Predicted uptake of a realistic service showed inequalities across income, parental education, and single parent status. A service comprising preferred features was predicted to eliminate these inequalities. Conclusions: Reducing cost and wait time for mental health services could reduce unmet need among children with chronic medical conditions. Specific approaches to tackle the high levels of unmet needs in this group include equipping medical specialists to recommend mental health providers and training mental health providers on the impacts of chronic medical conditions on children. Offering preferred services could increase uptake and reduce inequalities in mental health care. What is known about the topic? Children with chronic medical conditions have high rates of unmet need for mental healthcare. Qualitative research has indicated features of mental health services that may be important to consider in service design to address these unmet needs. What does this paper add? A detailed understanding of parents' preferences for features of mental health services for children with chronic medical conditions, including their importance and prediction of uptake under different scenarios. What are the implications for practitioners? Parents preferred services with recommendation from specialists, mental health providers who understand the impact of chronic conditions, lower cost, and shorter wait time. Offering preferred mental health services is predicted to significantly reduce unmet needs and reduce inequalities in care. [ABSTRACT FROM AUTHOR]

Objective. To examine the effectiveness of telephone-based coaching services for the management of patients with chronic diseases. Methods. A rapid scoping review of the published peer reviewed literature, using Medline, Embase, CINAHL, PsychNet and Scopus. We included studies involving people aged 18 years or over with one or more of the following chronic conditions: type 2 diabetes, congestive cardiac failure, coronary artery disease, chronic obstructive pulmonary disease and hypertension. Patients were identified as having multi-morbidity if they had an index chronic condition plus one or more other chronic condition. To be included in this review, the telephone coaching had to involve two-way conversations by telephone or video phone between a patient and a provider. Behaviour change, goal setting and empowerment are essential features of coaching. Results. The review found 1756 papers, which was reduced to 30 after screening and relevance checks. Most coaching services were planned, as opposed to reactive, and targeted patients with complex needs who had one or more chronic disease. Several studies reported improvements in health behaviour, self-efficacy, health status and satisfaction with the service. More than one-third of the papers targeted vulnerable people and telephone coaching was found to be effective for these people. Conclusions. Telephone coaching for people with chronic conditions can improve health behaviour, self-efficacy and health status. This is especially true for vulnerable populations who had difficulty accessing health services. There is less evidence for improvements in quality of life and patient satisfaction with the service. The evidence for improvements in health service use was limited. This rapid scoping review found that telephone-based coaching can enhance the management of chronic disease, especially for vulnerable groups. Further work is needed to identify what models of telephone coaching are most effective according to patients' level of risk and co-morbidity. What is known about the topic? With the increasing prevalence of chronic diseases more demands are being made of limited health services and resources. Telephone health coaching for people with or at risk of chronic diseases is seen as a means of supporting people to manage their health and reducing the burden on the healthcare system. What does this paper add? Telephone coaching interventions were effective for vulnerable people with chronic disease(s). Often the vulnerable populations had worse control of their chronic condition at baseline and demonstrated the greatest improvement compared with those with better control at baseline. Planned (i.e. weekly or monthly telephone calls to support the patients with chronic disease) and unscripted telephone coaching interventions appear to be most effective for improving self-management skills in people from vulnerable groups: the planned telephone coaching services had the advantage of regular contact and helping people develop their skills over time, whereas the unscripted aspect allowed the coach to tailor support to the patient's individual needs What are the implications for practitioners? Telephone coaching is an effective means of supporting people with chronic diseases to manage their own health. Further work is needed to embed telephone coaching within existing services. Good linkages with the patient's general practitioner are important. This might be a regular report, updates via the patient e-health record, or provision for contact if a problem is identified or linking to the patient e-health record. [ABSTRACT FROM AUTHOR]

Supporting patients to have healthy dietary behaviours contributes significantly to preventing and managing lifestyle-related chronic diseases. 'Nutrition care' refers to any practice provided by a health professional to support a patient to improve their dietary behaviours and subsequent health outcomes. Approximately 3% of consultations by Australian general practitioners (GPs) involve the provision of nutrition care. The aim of the present paper was to forecast the potential implications of a higher frequency of nutrition care by GPs. Evidence on the effect of improved dietary behaviours on chronic disease outcomes, number of Australian adults estimated to have poor dietary behaviours and effectiveness of GPs providing nutrition care were taken into consideration. Using hypertension as a case example, for GPs to provide nutrition care to all hypertensive adults who would benefit from improved dietary behaviours, GPs would need to provide nutrition care in a target rate of 4.85% of consultations or 4.5 million different patients each year. The target aligns with the existing priorities for supporting chronic-disease prevention and management in Australia by increasing the rate that brief lifestyle interventions are provided by primary health professionals. This conservative target presents a considerable challenge for GPs, support staff, researchers and policy makers, but can be used to inform future interventions to support nutrition care by GPs. [ABSTRACT FROM AUTHOR]

Chronic ill health has recently emerged as the most important health issue on a global scale. Rural communities are disproportionally affected by chronic ill health. Many health systems are centred on the management of acute conditions and are often poorly equipped to deal with chronic ill health. Cardiovascular disease (CVD) is one of the most prominent chronic ill health conditions and the principal cause of mortality worldwide. In this paper, CVD is used as an example to demonstrate the disparity between rural and urban experience of chronic ill health, access to medical care and clinical outcomes. Advances have been made to address chronic ill health through improving self-management strategies, health literacy and access to medical services. However, given the higher incidence of chronic health conditions and poorer clinical outcomes in rural communities, it is imperative that integrated health care emphasises greater collaboration between services. It is also vital that rural GPs are better supported to work with their patients, and that they use consumer-directed approaches to empower patients to direct and coordinate their own care. [ABSTRACT FROM AUTHOR]

Primary healthcare services in Australia need to respond to the needs of an ageing population and the rising prevalence of chronic and complex conditions in that population. This paper reports on the results of a comprehensive Australian and international literature review on nurse-led and nurse-involved primary healthcare interventions with a particular focus on those serving people with chronic and complex conditions and hard to reach populations. The key question this review addresses is: what role can nurses play in primary healthcare to manage people with chronic and complex conditions? International evidence demonstrates that nurses working in primary care provide effective care, have high patient satisfaction and patients are more likely to comply with nurse instructions than general practitioner instructions. Nurses can provide care equivalent to doctors within their scope of practice but have longer consultations. Lifestyle interventions provided by nurses have been shown to be effective for cardiac care, diabetes care, smoking cessation and obesity. The nursing workforce can provide appropriate, cost-effective and high-quality primary healthcare within their scope of practice. [ABSTRACT FROM AUTHOR]

The Australian government's commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model's feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients' stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded. [ABSTRACT FROM AUTHOR]

Considerable interest in reform for primary health care and health more generally has emerged recently. There are concerns that primary and community services are fragmented, inequitable and inefficient, particularly for people with chronic and complex conditions. The evidence suggests there will be a significant increase in demand for these services and that stronger primary health care systems lead to better health outcomes. This paper makes a number of suggestions about the development of funding, payment, governance and organisational arrangements that could be part of a National Primary Health Care Strategy for Australia. [ABSTRACT FROM AUTHOR]

The Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health was established in late 2003 through a major National Health and Medical Research Council (NHMRC) grant involving collaboration between the Aboriginal Health Council of South Australia (AHCSA), Flinders University, and Aboriginal Health Services. Our foundation research communities are the Aboriginal communities served by these Aboriginal Health Services in the Spencer Gulf/Eyre Peninsula region. In recent years a number of collaborative research programs involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work is the basis of the initial CCRE activities. Key objectives of the CCRE are to improve the health status of Indigenous people through conducting relevant and meaningful Aboriginal controlled health research, providing/formal training for Indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. The inclusion, empowerment and engagement of Indigenous people in the process of managing community health represent tangible strategies for achieving more equitable health outcomes for Aboriginal people. This paper outlines the CCRE operational rationale and presents early activities and outcomes across the three strategic areas of CCRE operations: research, education and training, and translation. Some critical reflections are offered on the progress and experience of the CCRE thus far. A common obstacle this CCRE has encountered is that the limited (especially staff) resources available to the Aboriginal Health Services with which we are collaborating make it difficult for them to engage with and progress the projects we are pursuing. [ABSTRACT FROM AUTHOR]

Background. The Australian Government Medicare Enhanced Primary Care (EPC) initiative for chronic disease management (CDM) supports integrated allied health (AH) and general medical practitioner (GP) care. There are limited examples of how to operationalise this initiative in private practice, and minimal evidence of expected service utilisation or acceptability to patients. This paper reports on a 2007 Australian integrated GP/private sector AH pilot program, based on Medicare EPC guidelines for Type II diabetes. Objectives. Describe how the pilot program was put in place (operationalised). Report on service utilisation and patient perspectives of the pilot program. Methods. Pilot program: patients with Type II diabetes were referred to credentialed diabetes educators (CDEs), dietitians or podiatrists by their GP, via a Medicare-approved team care arrangement (TCA). Dietitians and CDEs operated on a sessional basis from GPs' rooms, and podiatrists operated from their own clinics. All AH providers accepted the Medicare Plus rebate only, and provided guidelines-based care (focussed on patient education, disease ownership and self-management). Service utilisation was measured by the number and type of AH attendances per patient. Patient perspectives of the pilot program, and what they perceived they had gained from participation in it, were measured by semi-structured telephone interviews. Results. An average of 2.3 AH consultations were consumed by 588 patients, of whom 59 were interviewed. Interviewed patients appreciated the ready and timely access to AH services at no additional cost, the integration of GP/AH care, and being actively involved in managing their disease. Approximately 60% of patients had never previously consulted an AH provider regarding diabetes. Interviewees perceived that collocated, integrated GP-AH care heightened their disease awareness, improved their knowledge of their disease and encouraged them to better self-manage. Most interviewees indicated that they did not require further AH assistance in the short term (having gained what assistance they needed), and ~60% interviewees indicated they would pay a gap fee for similar AH services in the future. Conclusion. Integrated AH/GP guidelines-based care provided in GP clinics appears to be cost efficient. It has the potential to improve patient access to AH care, promote the role of integrated care in the management of Type II diabetes, and improve patient education and self-management. [ABSTRACT FROM AUTHOR]

This study assessed Australian clinical practice guidelines for life-limiting index conditions for the extent to which they acknowledged comorbidities and framed management recommendations within the context of older age and reduced life expectancy. A comprehensive search identified current, evidence-based Australian guidelines for chronic life-limiting conditions directed at general practitioners. Guideline content was analysed qualitatively before comorbidity acknowledgements were quantified using a 17-item checklist. Full guidelines were quality appraised using AGREE-II. Ten documents covering chronic obstructive pulmonary disease, heart failure, cancer pain, dementia and palliative care in aged care were identified. Most guidelines addressed one 'comorbid' condition and prompted clinicians to consider patient quality of life and personal preferences. Fewer addressed burden of treatment and half suggested modifying treatments to account for limited life expectancy, age or time horizon to benefit. Half warned of potential adverse drug interactions. Guidelines were of moderate to very high quality. Guidelines naturally prioritised their index condition, directing attention to only the most common comorbidities. However, there may be scope to include more condition-agnostic guidance on multimorbidity management. This might be modelled on the 'guiding principles' approach now emerging internationally from organisations such as the American Geriatrics Society in response to increasing multimorbidity prevalence and evidence limitations. [ABSTRACT FROM AUTHOR]

Objective. To examine what new health information is identified at a patient's most recent 75þHA compared with their standard GP consultations in the prior 24 months. Methods. Parameters measured included newly identified chronic conditions, new management for previously diagnosed chronic conditions, medication management, referrals, vaccinations, and positive test results for the monitoring of previously diagnosed chronic conditions. A retrospective patient record study collecting data from two GP clinics in metropolitan and regional Victoria was undertaken. A total of 195 75þHA recipients were included. Results. No significant difference was found in the number of new chronic conditions recorded at patients' most recent 75þHA compared with standard GP consultations in the prior 24 months. However, significant differences in the types of conditions were noted, with 75þHAs significantly more likely to record elevated lipids (P, 0.001), vitamin D deficiencies (P = 0.004), eye/vision-related (P = 0.011), diabetes (P = 0.019), and hearing conditions (P = 0.045) compared with standard GP consultations. Significantly more referrals (P, 0.001) and new management for previously diagnosed conditions (P=0.009) occurred at 75þHAthan at standard GP consultations. Patients who were receiving their first 75þHAwere significantly more likely to receive vaccinations than those receiving a subsequent 75þHA(P=0.022). Conclusion. 75þHAs fulfil a role in addressing chronic health problems otherwise overlooked during standard GP consultations. [ABSTRACT FROM AUTHOR]

As the burden of chronic and complex disease grows, there is an emphasis on programs that enhance the quality of care within primary care. The Connecting Care in the Community (CCC) program is an example of the implementation of care integration. This qualitative study sought to explore the experiences general practice staff face in managing clients with chronic and complex care issues, and their perceptions of the contribution of the CCC program to this care. Seventeen general practice staff from 11 practices throughout the Illawarra/Shoalhaven region participated in semistructured interviews. Five main themes emerged: (1) awareness of the CCC program; (2) varying program exposure and value placed on the program; (3) practice 'busyness' and role confusion; (4) communication and information sharing; and (5) the need for staff education and knowledge of local resources. If policymakers and healthcare organisations can gain a better understanding of the experiences of general practice staff, they will be able to design and implement programs that best meet the needs of the providers that they are attempting to integrate. [ABSTRACT FROM AUTHOR]

Objective. To critically examine utilisation of the 13 allied health services provided through Medicare Chronic Disease Management program and related general practitioner (GP) care planning initiatives. Methods. Statistics generated from national billing data from July 2005 to June 2009 were extracted from Medicare data and compared by profession, State or Territory and population. Results. Most services grew over 4 years although nationally consistent service levels were not found for any allied health provider profession. On referral from GPs, podiatry, physiotherapy and dietetics provided most services (82%) in 2008-09. Professions had unique patterns of referral instanced by age range and sex of clientele. Wide variation was apparent in per capita utilisation of allied health services by State or Territory; some with far less than average national use and others with high use. Annual number of GP Management Plans or Team Care Arrangements was low (mean: 22 per GP in 2008-09), indicating low use of care planning. Conclusion. Inequality of accessibility for patients was apparent. Five years into the program, a review of Medicare Allied Health CDM policy is warranted. Implications. Research and evaluation is needed to identify whether the program is meeting the needs of GPs, allied health providers and chronic disease patients. INSET: What is known about the topic?. [ABSTRACT FROM AUTHOR]

The article reports on satisfaction with referral relationships between general practice and allied health professionals in primary health care in Australia. It report the development and use of the Measure of Multidisciplinary Linkages (MoML) questionnaire, to evaluate the relationships between GPs and AHPs participating in the Team-link project, an intervention study that aimed to facilitate multidisciplinary teamwork between general practitioners (GPs) and AHPs outside the practice.

Objective. To compare the demographic, socioeconomic, and medical characteristics of patients who had a General Practitioner Management Plan (GPMP) with those for patients without GPMP. Methods. Cohort study of patients with chronic diseases during the time period 1 July 2006 to 30 June 2008 using the Australian Department of Veterans' Affairs (DVA) claims database. Results. Of the 88 128 veterans with chronic diseases included in the study, 23 015 (26%) veterans had a GPMP and 11 089 (13%) had a Team Care Arrangement (TCA). Those with a GPMP had a higher number of comorbidities (P < 0.001), and a higher use of services such as health assessment and medicine review (P < 0.001) than did those without GPMP. Diabetes was associated with a significantly increased use of GPMP compared with all other chronic diseases except heart failure. Conclusions. GPMPs are used in a minority of patients with chronic diseases. Use is highest in people with diabetes. [ABSTRACT FROM AUTHOR]