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Introduction: Disparities in supporting carers of people with dementia exist in carer populations. The WHO developed an evidence-based iSupport for Dementia programme to address the disparities. However, evidence on how to embed the iSupport programme in routine health and aged care services to optimise support for carers remains largely unknown., Methods and Analysis: This study will apply a hybrid type II effectiveness-implementation trial to evaluate the embedment of two iSupport innovations: 'usual iSupport' and 'tailored iSupport' in health and aged care services in Australia and China. The RE-AIM framework informed the study design. Three aged care organisations in Australia, two public hospitals and a community health centre in China will participate in the trial by delivering the two iSupport innovations to 158 carers of people with dementia with 79 carers in each intervention group using a randomised controlled trial design. The effectiveness of the two iSupport innovations will be determined by measuring the quality of life and self-efficacy of carers, and the quality of life of people with dementia, unplanned hospital admissions, emergency department presentations and admissions to permanent nursing homes and perceived quality of care of people with dementia at baseline, 3 months and 6 months. The effectiveness of strategies used to embed the iSupport innovations in routine care services will be evaluated using qualitative data collected from focus groups or interviews with carers, staff and management involved in the study and records from the participating organisations., Ethics and Dissemination: Ethics approval was obtained from Flinders University (project number: 5819), Xi'an Jiaotong University (project number: 2023-1629) and Zunyi Medical University (project number: KLL-2023-245). We will obtain informed written or oral consent from participants in the trial. We will publish the results in peer-reviewed journals to disseminate the study and generate impact on policy and practice changes., Trial Registration Number: ACTRN12623000323628; The Australian New Zealand Clinical Trials Registry (ANZCTR); registered on 27 March 2023., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Opioid-related harms and opioid use disorder (OUD) are health priorities requiring urgent policy responses. There have been many calls for improved OUD care in primary care, as well as increasing involvement of primary care providers in countries like Canada and Australia, which have been experiencing high rates of opioid-related harms., Methods: Using Starfield's 4Cs conceptualization of primary care functions, we examined how and why primary care systems may be suited towards, or pose challenges to providing OUD care, and identified health system opportunities to address these challenges. We conducted 14 semi-structured interviews with 16 key informants with experience in opioid use policy in Canada and Australia., Results: Primary care was identified to be an ideal setting for OUD care delivery due to its potential as the first point of contact in the health system; the opportunity to offer other health services to people with OUD; and the ability to coordinate care with other health providers (e.g. specialists, social workers) and thus also provide care continuity. However, challenges include a lack of resources and support for chronic disease management more broadly in primary care, and the prevailing model of OUD treatment, where addictions care is not seen as part of comprehensive primary care. Additionally, the highly regulated OUD policy landscape is also a barrier, manifesting as a 'regulatory cascade' in which restrictive oversight of OUD treatment passes from regulators to health providers to patients, normalizing the overly restrictive nature and inaccessibility of OUD care., Conclusions: While primary care is an essential arena for providing OUD care, existing sociocultural, political, health professional, and health system factors have led to the current model of care that limits primary care involvement. Addressing this may involve structurally embedding OUD care into primary care and strengthening primary care in general., (© 2024. The Author(s).)

Objective: To assess Chinese-Australian carers' needs and preferences through co-design strategies with stakeholders to embed an evidence-based iSupport for Dementia program into routine community aged care services in Chinese ethno-specific aged care organisations., Methods: A cross-sectional survey was conducted from July to August 2022 in three Chinese ethno-specific aged care organisations in Australia. We applied a univariate analysis to test variables associated with carers' needs and preferences when embedding the iSupport for Dementia program into routine practice among community aged care services., Results: A total of 101 carers completed the survey. Most carers in our study preferred the iSupport program to be provided in their first language, have a program facilitator to lead the program and would like to interact with peers in the program. Most carers indicated that they are willing to pay for the iSupport program using the budget allocated to their home care package. Younger carers (younger than 65 years), and adult children's carers are more likely to use the web-based iSupport manual and invite their family members to the program compared to those older than 65 years. Other demographic characteristics had no significant association with their needs and preferences., Conclusions: Chinese-Australian carers' perceived needs and preferences in this study will inform the implementation of a culturally tailored iSupport program to be embedded in community aged care services provided by Chinese ethno-specific aged care organisations. Findings will also inform culturally and linguistically congruent iSupport programs for carers from other culturally and linguistically diverse communities in Australia., (© 2024 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

Background: There has been increasing concern over opioid-related harms across the world. In Australia in 2018, codeine-containing products were up-scheduled from over-the-counter access at pharmacies, to requiring a prescription. The drug regulator's decision to up-schedule was contentious and widely debated, due to the potentially large impact on consumers and healthcare professionals. This study aimed to analyse influences on the codeine up-scheduling policy., Methods: This retrospective policy analysis used the Advocacy Coalition Framework (ACF) to understand how policy actors with shared beliefs formed adversarial coalitions to shape policy. Data were drawn from documents (regulator policy documents, public submissions, news reports, organisational media releases and position statements) and semi-structured interviews with 15 key policy actors. Codes were generated relating to policy processes and actor beliefs; broad themes included the role of health professionals, perceptions of opioids, impact on consumers, and the role of government in healthcare., Results: Two coalitions in this policy subsystem were identified: (1) supportive [with respect to the up-scheduling], and (2) opposing. The key evident beliefs of the supportive coalition were that the harms of codeine outweighed the benefits, and that government regulation was the best pathway for protecting consumers. The opposing coalition believed that the benefits of codeine accessible through pharmacists outweighed any harms, and consumers should manage their health without any more intervention than necessary. The policy decision reflected the influence of the supportive coalition, and this analysis highlighted the importance of their public health framing of the issue, the acceptability of their experts and supporting evidence, and the perceived legitimacy of the up-scheduling process., Conclusion: Understanding these coalitions, their beliefs, and how they are translated through existing policy processes and institutions provides insight for those interested in influencing future health policy. Specific lessons include the importance of strategic frames and advocacy, and engagement with formal policy processes., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)