Deakin Rural Health

Current Research

Access and Outcomes to Cardiovascular Disease Services in Rural and Remote Australia

In a cardiac emergency every minute counts and for the prevention of a secondary event every healthy year after is important.  This project will use the Cardiac ARIA index  to develop an understanding of the geographic dimensions of cardiovascular disease (CVD) outcomes using novel methods led by experts in geography, epidemiology and health. Understanding how access to cardiac services influences CVD outcomes is critical in ensuring equitable and cost effective services in Australia.

Data on mortality, hospitalisations, and emergency presentations from South Australia (SA) and the Northern Territory (NT) will be used to determine if cardiac services are providing the community with the best outcomes during and after a cardiac event.

This study aims to:

  1. Validate the objective utility of the Cardiac ARIA index by determining the association between the index score and cardiac morbidity and mortality rates within the population of SA and NT.
  2. Determine if this relationship is modified by the demographic characteristics of a population location. The results of this study will determine hot spots in SA/NT where there is a mismatch between need and access.

For further details about this project please contact Dr Vincent Versace.

APHCRI Centre of Research Excellence for building quality, governance, performance and sustainability in primary health care through the Clinical Microsystem Approach

The Department was awarded an Australian Primary Health Care Research Institute (APHCRI)-funded Centre of Research Excellence (CRE) in 2011 for building quality, governance, performance and sustainability in primary health care through the Clinical Microsystem Approach. This Centre of Research Excellence in Primary Health Care Microsystems (CRE) would investigate improved models in regional governance and e-health, effective multidisciplinary teamwork and primary care performance and accountability across two research streams.

Stream 1: based in the University of Queensland, investigated quality, governance and sustainability in maternity share-care.

Stream 2: located in the Department’s Warrnambool office, was to examine safety and quality of primary healthcare. There is an estimated 1.5% of patients are expected to experience an adverse event, and over 11% to experience an adverse event from prescribed medication/prescription errors. More than half of these are considered preventable. In the GGT, this Stream 2 would address the need for Australian general practices to improve patient safety as they cope with the increasing complexity of chronic disease management, multimorbidity and polypharmacy.

The research teams comprised expertise in general practice, nursing, allied health and other specialties with an aim to identify best practice quality and safety procedures and how these could be best implemented in a general practice setting.

A manual suitable for a Collaborative on Patient Safety was completed in partnership with the Improvement Foundation, which manages the Australian Primary Care Collaboratives program. The manual has been endorsed by the Australian Government Chief Medical Officer, who has written the foreword. Considerable knowledge exchange between the Department of Health, the Improvement Foundation and the researchers has taken place as well as deep involvement of national and international experts.

A Patient Measure of Safety (PMOS) questionnaire that was designed in the United Kingdom (UK) to measure a patient’s perception of factors relating to (clinical) safety and used in UK hospitals has been adapted by CRE to measure patient safety in Australian general practices.

This work will continue in the CRE 2015 Extension: Towards Building Better Primary Health Care which builds on developments from the CRE for Primary Health Care Microsystems through three separate projects.

The Centre of Research Excellence in Primary Health Care Microsystems was a collaboration between the GGT UDRH and the Universities of Queensland and New South Wales, and worked closely with the Australian Commission on Safety and Quality in Health Care, Australian General Practice of Accreditation Limited, Improvement Foundation Australia, Australian Practice Managers Association, Australian Practice Nurses Association, the Chronic Illness Alliance and the Royal Australian College of General Practitioners.

APHRCI Centre of Research Excellence 2015 Extension: Towards Building Better Primary Health Care

The APHCRI Centre of Research Excellence (CRE) 2015 Extension, Towards Building Better Primary Health Care, builds on work from the CRE for Primary Health Care Microsystems.
It consists of three separate projects; (1) developing a model to test the Primary Care Patient Measure of Safety questionnaire; (2) developing a collaborative manual for multimorbidity, and (3) undertaking a pilot of a telephone intervention for women who have had gestational diabetes.

1) The Primary Care Patient Measure of Safety (PC PMOS) tool was developed during the reporting period in collaboration with international partners Dr Sally Giles and Dr Jane O’Hara from the Greater Manchester Patient Safety Translational Research Centre and the Bradford Institute for Health Research. This tool is a 50 item questionnaire for patients to complete and provide feedback on a range of factors that contribute to potential safety incidents in the primary care setting. It is the first tool of its kind in Australia, and was developed using patient experience data from participants in the GGT region.
A paper reporting on PC PMOS has been accepted by BMJ Quality and Safety and a model to validate PC PMOS in Australian general practices has been developed and ethics approval granted.

2) Multimorbidity is one of the biggest challenges now facing primary care as it can lead to fragmented care and polypharmacy, with a disproportionate increase in medication interactions and medication errors. A collaborative-care model has been developed in which practice nurses act as the case managers and work with patients to ensure that clinical decisions include patient priorities and goals. This model also incorporates a guide to assist GPs to reduce any inappropriate medications being prescribed.
A draft manual with training guides has been created and a pilot to test the model in a single practice has been developed and run, following ethics approval.

3) TeleMAGDA is an adaptation of the Victorian Life! lifestyle-modification program using telephone coaching rather than group participation. Negotiations have commenced with BUPA Health Dialog for an NHMRC partnership grant application (November 2015).

Melbourne Diabetes Prevention Study (MDPS); A Randomised Control Trial of its Efficacy, Effectiveness and Cost Effectiveness

The dramatic increase in the prevalence of type 2 diabetes mellitus poses a major health problem worldwide. Diabetes is the second highest contributor to the Australian burden of disease and presents an enormous economic responsibility; hence the urgent need to implement a widespread and coordinated approach to its prevention. The diabetes prevention program developed by the Melbourne Diabetes Prevention Study team is a structured program involving individual and group education sessions related to diet, exercise and mental health. The program is a version of the ‘Life! helping you to prevent diabetes, heart disease and cardiovascular disease’ program that currently runs in Victoria, coordinated by Diabetes Australia-Victoria. The MDPS is studying high risk populations in southern and eastern metropolitan areas of Melbourne over a 12 month period using a randomised control study.

The MDPS aims to:

1. Evaluate the efficacy and effectiveness of the MDPS diabetes prevention program by monitoring clinical and behavioural outcomes before and after the intervention (particularly reduction in diabetes risk, weight and central obesity and changes in quality of life) and by comparing participants in the program with another cohort receiving usual care at the same time.

2. Undertake an economic assessment of the MDPS diabetes prevention program by (a) evaluating whether it is 'value-for-money' through Cost Utility Analysis (CUA) and economic modelling of longer term impacts; and (b) evaluating technical efficiency issues through Cost-Effectiveness Analysis (CEA), combining resource usage data and clinical/behavioural outcomes.

3. Assess a broad range of factors to supplement the technical analysis.

4. Evaluate 'usual care' in the management of individuals at high risk of progression to type 2 diabetes.

Progress
Recruitment of participants for a pilot study began from a number of general practices in the Knox Division of General Practice in September 2009 with assistance from Greater Eastern Primary Health. The pilot study was completed in June 2011.   Recruitment for the main study commenced in September 2011, with recruitment streams comprising community events, GP clinics, pharmacies and Life! provider organisations for people aged between 50 and 75 in Melbourne’s eastern suburbs who are at high risk of developing type 2 diabetes.   Recruitment continued throughout 2012 with a large focus on pharmacy recruitment. During this time, over 2500 individuals were screened for Diabetes risk and over 340 consented for participation in the study.  In 2012, Deakin University became a provider of the Life! program to more effectively deliver the intervention. In order to do so, an additional 3 staff members attended training to become accredited Life! facilitators.  Recruitment concluded in February 2013, with the final baseline test being conducted in April 2013.

Mothers After Gestational Diabetes in Australia (MAGDA) study: Preventing Diabetes in Pregnancy from Progressing to Type 2 Diabetes: Macrolevel System Change in South Australia and Victoria

The Mothers After Gestational Diabetes in Australia (MAGDA) study is a National Health and Medical Research Council (NHMRC) Partnerships for Better Health project. Funded by NHMRC, SA Health, Victorian Department of Health and Human Services, and Diabetes Australia - Victoria, this is a unique project where stakeholders work together to build an improved policy for prevention of diabetes in this high risk group of women.

The primary project partners are:
NHMRC, Deakin University (Lead Agency), Flinders University, Melbourne University, Department of Health Victoria, SA Health, Diabetes Australia Victoria, Networking Health Victoria and Charles Darwin University.

Operating over a 5-year period (2011 – 2015), the project comprises of 4 studies:

Study 1: Gestational Diabetes Mellitus (GDM) screening, recall register and recall system.
Investigating the registration of pregnant women with GDM on the National Gestational Diabetes Register (NGDR) and the linkage of pathology laboratory data to measure the effectiveness of a reminder system to affect patient recall and testing. Study 1 partners include: Melbourne University’s GRHANITE™ Health Informatics Unit, Diabetes Australia National Gestational Diabetes Register, Melbourne Pathology, Healthscope, Dorevitch, SA Pathology and the Victorian and South Australian perinatal data collection units: Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) and SA Pregnancy Outcome Unit.

Study 2: Randomised controlled trial of post-natal Diabetes Prevention Program for women with a history of GDM.
Currently in its final stages, the trial recruited 574 women with GDM, collected data post-natal at 3 time points over 12 months (blood samples, anthropometric measurements and comprehensive questionnaires) and educated participants by means of facilitated group lifestyle change programs. A program was developed specific to this population group (MAGDA DPP). Data collection ended at the end of May 2015 and results are expected to be published in late 2015.

Study 3: Economic assessments of screening, GDM registers and recall system, and MAGDA DPP.
Cost-Utility Analysis (CUA) and economic modelling of longer-term impacts to evaluate efficiency and ‘value for money’ as well as technical efficiency issues through Cost-Effectiveness Analysis (CEA), the combination of resource usage data and the recruitment/participation and clinical/behavioural outcomes.

Study 4: Moving from research and policy to operational health services.

From the outset the goal has been to influence both policy and practice through the sharing of evidence, learnings and experience across academia, government and health services providers.

Dr Sharleen O’Reilly leads the NHMRC TRIP Fellowship, GooD4Mum Collaborative Project, which aims to improve the diabetes prevention care provided to women with a history of gestational diabetes in participating Victorian general practices over a 12 month period.  The MAGDA study outcomes are expected to be published in late 2015 / early 2016.

Pharmacy and Medicines-use Research

Rural pharmacists play a vital role in rural communities. GGT UDRH is committed to conducting research that identifies evidence-treatment gaps for medication management, and optimises the role of pharmacists in chronic disease screening, prevention and management.  Key ongoing projects are examining discharge management for acute coronary syndrome, screening in pharmacies, health literacy in community pharmacy, and medicines management collaborations for complex patients.

Current research activities are funded primarily through a Heart Foundation Focus Grant (Absolute risk screening in pharmacy) and a Heart Foundation Postdoctoral award for Dr Kevin Mc Namara.

The aim of the 'Absolute risk screening in pharmacy' project is to determine if quality accredited community pharmacies can deliver cardiovascular disease (CVD) risk assessments to patients that adhere to national guidelines and integrate with the screening activities of general practice. Currently only a small minority of such patients appear to receive such screening in general practice.

Standard Frontline Worker Ice Training Package

The Standard Frontline Worker 'Ice' Training Package was developed by Flinders University’s National Centre for Education and Training on Addiction (NCETA) as part of the Victorian Government’s Ice Action Plan.

DRH will be involved in the project by assisting in identifying clinicians within the region who work with people who are affected by ‘Ice’.  The training package has been designed to meet the needs of a wide range of frontline workers including those from the health and welfare, education, criminal justice and transport sectors. It provides information and resources for frontline workers to enhance their existing skills and knowledge and guide workers’ practice when assisting clients and their families.

The training package includes information about 'Ice' and its use and harms, how it affects people and communities, ways of supporting people who use 'Ice', and organisational responses.   The training resource can be accessed from the NCETA site 

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