Deakin Rural Health

Current Research

A Post-Hospital Discharge Pharmacist Medication Management Service for High Risk Patients Using Telehealth

Medication reviews conducted by hospital pharmacists after patients’ discharge from hospital have shown to be beneficial to patients, especially for those at risk of medication related problems.  These reviews are generally conducted in the patients’ home or over the telephone. This study aims to assess whether using videoconferencing to conduct the medication review is a suitable alternative. Using videoconferencing means that the service can be offered to people who live remotely, which is not the case for reviews in patients’ homes.  Participants’ will be evaluating the pharmacy service as well as the technology. The pharmacist will record the changes made to medications and the potential effect this may have had on the participant if the changes had not been made. 

Aim of the study:
This study aims to assess whether using videoconferencing to conduct the medication review following hospital discharge is a suitable alternative to attendance at an outpatient clinic.

ACcessing Contraception for Emergency Supply Study (ACCESS)

Community pharmacy is the main source of emergency contraception (EC) access in Australia. But previous research suggests that unnecessary barriers exist and that the potential for improved quality of care exists. This research seeks to understand barriers and enablers to EC access from the perspective of women who have used EC, and pharmacists. Findings will be used to develop and test an intervention to improve access in community pharmacy.

Aim of the study:
To explore barriers and enablers to emergency contraceptive access by females, and develop and pilot test an intervention to improve access.

Applied Suicide Intervention Skills Training

Suicide prevention remains a key directive at the national level as outlined in the National Review of Mental Health Programmes and Services (2014). The review has outlined a recommendation to reduce suicides and suicide attempts by 50% in the next 10 years. ASIST as a suicide prevention strategy is time and cost intensive, with the maximum number of participants for a two day course is 24. A key area of investigation is to determine whether participants have intervened with a person at risk after completing the training course. 

This proposal will engage with past participants of the Applied Suicide Intervention Skills Training (ASIST) courses delivered in the south west region of Victoria and evaluate the ASIST as a suicide prevention intervention within level three of the Kirkpatrick evaluation framework.  

Aim of the study:
The primary aim of this project will be to determine how frequently participants intervened with a person at risk pre and post ASIST training

Determining best practice for the management of teenage pregnancy in rural and regional health services

Teenage pregnancy is associated with high rates of maternal and neonatal death and medical complications. Australia has the 6th highest rate of teenage pregnancy in the developed countries, with the highest rates in non-urban areas. There is a lack of evidence for the best practice management of teenage pregnancy.

Aim of the study:
The overall aim of our project is to develop a best practice model of care for the management of teenage pregnancies in rural and regional centres. This will be achieved through fulfilling the following objectives: 

  1. Scope best practice models of care
  2. Gain an understanding of the barriers and facilitators to teenagers engagement with healthcare providers during their pregnancy
  3. Describe the characteristics of teenagers birthing at rural and regional health services and the outcomes of their maternity care
  4. Development of an evidence-based best practice guideline for the management of teenage pregnancy
Developing a best-practice, pre-operative exercise therapy 'prehabilitation' model for patients with prostate, colon and breast cancer, in the Grampians region of Victoria

The postoperative period brings significant loss of physical function in cancer patients undergoing surgery. Exercise rehabilitation attempts to recover cardiorespiratory fitness (CRF) postoperatively. However, preoperative exercise training ('prehabilitation’) is a largely untested method to optimise preoperative CRF gains. We will review local practice and analyse current research before undertaking an experimental cancer prehabilitation study with patients in the Grampians region of Victoria.

Research hypotheses:                              
1.  Prehabilitation will be a feasible method of exercise therapy in prostate, breast and colorectal cancer patients undergoing surgery.
2.  Patents receiving the prehabilitation intervention will have more favourably postoperative cardiorespiratory fitness (CRF), Quality of Life (QoL) and cancer related fatigue compared with Active Controls.
3.  Patients receiving the prehabilitation intervention will have greater post- operative health and recovery outcomes compared with Active Controls.

Does a targeted, online, interactive teaching module improve medical students' medical imaging knowledge acquisition and clinical application?

Despite positive research towards e-learning and blended teaching in medical imaging curricula, the inclusion of 2D and 3D image-interaction combined with deliberate practice within the classroom to assist medical imaging teaching has not been researched before in post-graduate, clinically based, medical students. It is hypothesised that the combination of hands on image-interaction and deliberate practice will enhance medical students’ knowledge acquisition, clinical decision making and critical interpretation of findings.

Aim of the study:
To determine whether a targeted, online, interactive teaching module improves medical students’ medical imaging knowledge and application.

Economic evaluation of the Partnered Pharmacy Medication Charting program

Medication errors are a major source of adverse events in hospitals, which has negative impacts on both patient health, costs of treatment and length of stay. The initial Alfred hospital RCT of the Partnered Pharmacist Medication Charting (PPMC) model of care - whereby patient medications are charted by a pharmacist in ED upon admission with physician collaboration and sign-off - resulted in considerable reductions to the rate of medication errors. The same PPMC model is now being trialled in seven metropolitan and regional hospitals to determine the likely feasibility of scaling this up across Victoria, impact on length of stay, and the cost-effectiveness of the model overall compared with usual care.

Aim of the study:
To evaluate the partnered pharmacy charting model in seven Victorian hospitals (with Deakin University to conduct economic evaluation and to evaluate the model roll-out from an implementation perspective).

Evaluating outcomes of a large regional health service mandatory leadership training program

Effective leadership in healthcare settings is important for the delivery of safe, high quality healthcare. Leaders in healthcare are operating in complex environments and are managing multiple stakeholders, multidisciplinary teams, budgetary constraints, and increasing demands for care quality and safety. Implementing successful leadership development programs has therefore become necessary to meet important healthcare goals. Ballarat Health Services (BHS) is initiating a large-scale leadership development program to strengthen the capacity of all senior leaders within the organization to better facilitate the delivery of these critical goals.

Aim of the study:
The broad aim of this research is to examine the effectiveness of the BHS leadership development program in improving job performance, leadership behaviours, and important healthcare service outcomes by using a structured best practice evaluation model and process

Evaluation of a distributed and collaborative approach for the delivery of simulation training in rural areas: The perspective of nurse educators

This project will analyse data previously collected investigating the effectiveness of registered nurses and registered midwives in rural areas in delivering simulation based training to local community healthcare workers. This was evaluated using semi-structured interviews, which require us to code and prepare a manuscript. This project has already had a previous paper published on the protocol of the model used, with the results from this paper looking at its effectiveness.

Aim of the study:
To develop and evaluate a simulation model which was aimed at educators in rural areas to target areas in the local community which may have shortfalls in education

How do people with and without dementia use anticoagulants?

Atrial fibrillation (AF) and dementia or mild cognitive impairment (MCI) are frequently comorbid conditions in older adults. Anticoagulant therapy is a mainstay of AF treatment and has a significant impact in reducing the incidence of stroke. The advent of Direct Oral Anticoagulants (DOACs) over the past few years has expanded use of anticoagulation. However, dementia or MCI impacts the management of comorbid chronic disease, and both the prevalence of use and benefits of OAC use in this subgroup of patients are uncertain.  The objective of this review was to examine national prescribing data to determine trends in OAC use among patients with dementia, and to undertake a systematic review to identify published data comparing the prevalence and outcomes of OAC use in people with and without dementia or MCI.

Aim of the study:
To explore trends in the use of warfarin and NOAC anticoagulants in Australian people with dementia.

Impact of the Dementia Care in Hospitals Program (DCHP) on staff job satisfaction, confidence and comfort in caring for patients with cognitive impairment

This study examined the Dementia Care in Hospitals Program (DCHP) and reported on its implementation across four Australian hospitals. Both clinical and non-clinical staff received training to improve their knowledge on communicating with patients with cognitive impairment. A staff satisfaction survey was administered both before and after staff received this training. This survey measured staff job satisfaction, the level of confidence and comfort in supporting patients with cognitive impairment, organisational support received and how well equipped the hospital environment was to meet the needs of patients with CI. 

Aim of the study:
The Dementia Care in Hospitals Program (DCHP) is a hospital-wide education program which was developed to improve the awareness of, communication with, and care for, patients with memory and thinking difficulties including cognitive impairment (CI), dementia and delirium in the acute setting.  This study aims to evaluate the impact of the DCHP on staff satisfaction, confidence and comfort in dealing with patients with CI

Improving Health Care Delivery and Medicines Use

Rates of diabetes in the middle east are among the highest in the world and risk an impending public health crisis. This program grant will establish a research group comprising University of Sharjah academics and Australian experts to conduct research that helps to address this.

Aim of the study:
To conduct a program of research in primary care that informs the development of new models for screening and prevention of CVD and diabetes

Let's have a yarn about chronic disease: a collaborative multi-disciplinary participatory action research approach to addressing Aboriginal health in South West Victoria

This project builds upon a partnership between Dhauwurd Wurrung Elderly and Community Health Service (DWECHS) and Deakin Rural Health (DRH) for the purpose of establishing community-driven methods to increase the uptake of structured care planning and chronic condition management for Aboriginal people in South West Victoria (Gunditjmara country). Building local research and clinical capacity are central objectives of this project.

Aim of the study:
Develop community-driven strategies to improve the management of chronic disease in Gunditjmara country and subsequently, improve health outcomes.

Longitudinal tracking of Deakin SOM graduates

All SOM graduates have been contacted to participate in this survey, tracking their geographical work location to PGY 8. This information is then compared with their selection data and academic information to determine if there are any patterns associated with becoming a rural doctor.

Aim of the study:
To determine who they are, how they go and where they go. Longitudinal tracking project for SOM graduates

Meeting national targets and indicators to reduce mortality from chronic illness in general practice

This will be a longitudinal study in general practice of changes to  practice performance in the area of cardiovascular disease risk screening before, during, and after the implementation of a patient-centred quality improvement initiative. While monitoring the performance, we will also undertake qualitative evaluation to understand the processes and intervention components that promote patient-centeredness and sustainability of performance. Unique features of this intervention will be its co-design approach to intervention, a focus on sustainable health service interventions, and in-depth service mapping at baseline to explore current screening processes.

Aim of the study:
To develop and investigate the feasibility, sustainability and impact of a quality improvement initiative in primary care, in collaboration with patients and practitioners, using key population health performance indicators. Additional aims will be to determine the overall impact on cardiovascular health outcomes and equity of impact for key vulnerable groups.

Organisation antecedents of sustained healthcare interventions

Drivers to promote initial implementation of evidence-based healthcare interventions are well explored but theory and evidence for predictors of sustained implementation is scarce; what exists focuses on attributes of individual health professionals. Our understanding of organisational drivers of sustainability is derived from research in other industries, and may not translate to healthcare. A systematic literature review and examination of primary care organisations demonstrating sustained improvement will be conducted to develop theory and taxonomy around organisation attributes that sustain high quality preventative care. Findings will inform external funding applications to test the sustainability assessment tool for health settings.

Aim of the study:
To explore and clarify organisational attributes affecting the sustained delivery of complex health interventions in primary care (specifically relating to cardiovascular disease risk).

Patient Measure of Safety in Primary Care: pilot study of an intervention to improve safety in rural Victoria

The aim of this pilot study is to test the feasibility of the PC PMOS as a tool to improve patient safety in the western region’s primary care. Patients from 6 practices will complete the PC PMOS, and practices will then use this feedback to develop and implement specific safety interventions over a 6 month period. The enablers, barriers, acceptability, practicability, and success of the intervention will be investigated to determine the feasibility of implementing the PC PMOS in real world primary care practice.

Aim of the study:
The aim of this pilot study is to test the feasibility of the PC PMOS as a tool to improve patient safety in the western region’s primary care.

Peer work experience in south west Victoria

Peer work force has been a relatively new addition to the mental health work force in Victoria, although the concept has been around for some time. There is little if any standardised format and or carer pathway for peer workers presently in Australia. This protect seeks to explore the experiences of the peer workers, the clinicians, the families and the customers in South West Health care.

Aim of the study:
What is the experiences of peer workers in the public Mental Health service, from the consumers, clinician’s, families and peer workers point of view?   

Pharmacy Diabetes Screening Trial

The Pharmacy Diabetes Screening Trial is a pragmatic cluster-randomized controlled trial to be conducted in 363 community pharmacies across Australia, randomly allocated by geographical clusters to one of three groups, each with 121 pharmacies and 10,304 screening participants. The three groups are: Group A - risk assessment using a validated tool (AUSDRISK™); Group B - AUSDRISK™ assessment followed by point-of-care HbA1c (glycated haemoglobin) testing; and Group C - AUSDRISK™ assessment followed by point-of-care blood glucose testing. It is hypothesised that the addition of either an HbA1c or blood glucose test to the AUSDRISK™ assessment alone will result in improved uptake of referrals for diagnostic testing for higher risk individuals, a reduction in unnecessary referrals, and consequently a statistically significant and cost-effective increase in the proportion of newly diagnosed cases of type 2 diabetes.

Aim of the study:
The aim of the Pharmacy Diabetes Screening Trial is to compare the clinical effectiveness and cost-effectiveness of three screening models for type 2 diabetes in a previously undiagnosed population.

Primary Care Patient Measure of Safety (PC PMOS) Validation Study

The PC PMOS has shown good face validity but has not undergone further reliability and validity testing to produce a robust tool intended to improve safety in practice. Therefore, the aim of this study was to establish the validity and reliability of the PC PMOS in primary care. The objectives were to explore the factor structure and internal reliability of the scale, the extent to which the scale discriminates between primary care practices (discriminant validity), and the extent to which it converges with staff measures of patient safety (convergent validity).

Aim of the study:
To validate the Primary Care Patient Measure of Safety (PC PMOS) tool

Process evaluation protocol for a complex intervention to improve nurse-led hypertension management (the m-Power study)

A mixed-methods approach will be used for the process evaluation and the Consolidated Framework for Implementation Research will guide it. Four fidelity domains will be examined (design, training, delivery, and receipt).  The nurse care coordinators (NCCs) training will be evaluated using Kirkpatrick’s model for training evaluation and the reaction, learning and behaviour levels assessed. To understand the development of the EDSS, the intervention developers will be interviewed. The intervention doctors and NCCs will be interviewed to elicit their views on the intervention effectiveness. The NCCs will also be interviewed to understand the implementation barriers and facilitators for the intervention. Patient focus groups will be conducted to assess their perspective on the intervention. The quality of the intervention delivery will be examined using process indicators (number of SMSs sent, counselling sessions conducted etc.) and exit surveys with patients. Template Analysis will inform qualitative data analysis.

Aim of the study:
The m-Power Heart Project (m-Power study) used three strategies known individually to reduce hypertension (task shifting, mHealth and electronic decision support systems (EDSS)) and is evaluating their combined effectiveness using a cluster randomized controlled design in community health centres (CHCs) within Visakhapatnam, India. We aim to evaluate the process of developing and implementing the m-Power study.

Project Primip - Implementing an intervention to promote normal labour and birth

This study evaluates the impact of an evidence-based labour care bundle on the caesarean section rate in primiparous women birthing at a large regional health service.

Aim of the study:
The aim of this research was to improve the management of labour in primiparous women, through the introduction of an evidence-based Labour Care Bundle

Screening for Gambling Disorders in rural communities in Victoria a pilot study

Assessment and screening for Gambling Disorder (GD) among clients of mental health services is available in major centres around Australia along with best practice CBT based therapies to support people seeking to overcome problems with gambling.  Such services are not generally available in rural and remote communities, so this initial pilot study is unique in screening for and assessing prevalence of GD in participating populations in rural South Western Victoria. The pilot additionally provides early intervention and referral to best practice treatment for those clients being identified as having moderate to severe gambling problems.

Aim of the study:
1.  Prevalence of GD among clients of the primary mental health team in South Western Victoria.
2.  Number of clients who are assessed as having a gambling problem who subsequently access specialist services.
3.  Difference in the number and severity of patients who access the PMHT services from different sites.

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