ISPRN has two streams of research delivery. The first is a ground-up approach, which involves ISPRN members generating research project ideas and engaging the role of a chief investigator with support from ISPRN academics.
The second is a top-down approach which involves external researchers approaching ISPRN regarding their current research idea. ISPRN members are able to nominate if they want to become involved in the project and come onboard the project as a partner.,They are able to develop research capacity skills while being acknowledged for their contribution to the project.
Summaries of ISPRN research projects are listed below.
Do health literacy levels affect the use of complementary and alternative medicine (CAM) use in rural Australian communities?
Dr Dora von Conrady, Professor Andrew Bonney, Clinical A/Prof Bastian Seidel, A/Prof Judy Mullan, Mr Jason Nunes
Researchers have recently completed a study project that investigated whether health literacy affects the use of complementary and alternate medicine (CAM) in urban, regional and rural Australian general practice.
Health literacy refers to the degree to which individuals understand basic health information to make appropriate health decisions.
Complementary and alternate medicine refers to a set of health care practices that are not part of conventional medicine.
A questionnaire was developed and piloted in a Tasmania. This questionnaire was refined and distributed among patients of eight general practices. The questionnaire was completed by 377 participants.
The questionnaire asked participants about visits to complementary practitioners; (chiropractors, homeopaths, acupuncturists, herbalists and spiritual healers). It also questioned patients on treatments received from medical doctors; the use of herbal and dietary supplements; and the use of self-help practices.
Participants were asked to indicate which treatments were used and how often. They were asked the main reason for use of the treatment and how helpful they found it.
The results of the study showed that participants who could read and understand health information well were less likely to use CAM (odds ratio 0.46, 95% CI 0.3-0.7, P<0.001).
The researchers commented that patient education remains a cornerstone of the medical consultation and may result in more thoughtful use of CAM.
This project was funded by Grand Pacific Health.
Rural GP referral process for Isotretinoin treatment in moderate to severe acne
Dr Munther Zureigat, Professor Andrew Bonney, A/Prof Judy Mullan, Dr Jo-Ann See, Dr Jenna Rayner, Ms Athena Hammond, Ms Karen Fildes, Mr Luke Dalla
Acne Vulgaris is one of the most common dermatological presentations in General practice. Acne scarring is a known major consequence of late referrals for Isotretinoin treatment - a drug that can only be prescribed by dermatologists for patients with moderate to severe acne. Isotretinoin has been shown to be very effective in preventing scarring if started at the optimal time.
Acne scarring has long-term psychological impact on patients (mainly adolescents) and is strongly related to poor body image, depression and possibly suicide.
The aim of this project was to investigate GP experiences around the barriers and facilitators of referral to dermatologists for isotretinoin treatment.
Twenty GPs participated in a telephone interview on the topic. Six GPs practiced in metropolitan areas in and around Wollongong (30%), seven were from regional areas in the Shoalhaven area (35%), and seven were from rural areas (mostly from Milton-Ulladulla) (35%).
Multiple factors were mentioned by participants in determining when to escalate to specialist dermatologist care, in particular, the patients’ level of distress was mentioned by the majority of those interviewed.
Major barriers to referrals included long waiting times, cost of seeing a specialist and travel. Multiple participants brought up the need to have more urgent appointments for severe acne or very distressed patients. GPs should be encouraged to discuss acne with their patients and provide patients with educational resources.
This project concluded that investing in GP education about treating acne, early recognition of acne scarring and referrals to dermatology care has the potential to improve the outcomes of acne treatment.
This project was funded by Grand Pacific Health.
Electronic Medical Data Benchmarking Project
Dr Stephen Barnett, Dr Adam Hodgkins, Mr Abhijeet Ghosh, Mr Chris Harrison, Dr Joan Henderson, Ms Bridget Dijkmans-Hadley
The aim of this project is to collect de-identified data from electronic records of a sample of ISPRN practices as a ‘benchmarking’ study, comparing the data from these practices with the Bettering Evaluation and Care of Health (BEACH) national data set. The results will inform the design and interpretation of future studies, particularly in regard to the generalisability of findings.
Demonstrating the value of raw clinical Electronic Medical Data for primary care research: a benchmarking study on chronic disease prevalence in primary care
Dr Stephen Barnett, Dr Adam Hodgkins, Mr Abhijeet Ghosh, Dr Khin Win, Mr Chris Harrison, Ms Joan Henderson, Dr Allan Pollack, Dr Khin Than Win, Dr Pippa Burns, Prof Liz Halcomb, Dr Lucie Stanford, Mr Jack Bird
The second phase of this project (first stage above) will utilise Electronic Medical Data from six general practices to benchmark data with the national BEACH data for chronic disease prevalence using proxy markers for condition.
Six practices from the Illawarra and Southern Practice Research Network (ISPRN) agreed to participate in the study. Data was obtained by running an SQL query on medical records stored in Best Practice Software. Data from a number of fields were extracted, including patient age, sex, smoking status, residential postcode as well as medical indicators for diabetes mellitus.
A sample of 30,007 patients, with a median age of 47 years was obtained. A total of 1,953 patients (6.5%) were estimated to have diabetes (either type 1 or type 2).
As part of this study the researchers developed an incremental assessment model, which can be used by primary care planners and other researchers to provide an accurate estimate of diabetes from general practice clinical electronic records.
In summary, this study demonstrates the value of ‘uncleaned’ data from primary care electronic medical records. With the addition of proxies for diabetes, the disease prevalence rates appear highly accurate.
These findings could be built on by developing proxy ‘maps’ for a range of chronic diseases. In addition, there is the potential to use this approach to develop an accurate diabetes ‘cohort’ for longitudinal observational or even intervention studies.
This project was funded by Grand Pacific Health.
The inter-disciplinary development of a Patient Decision Aid (PDA) for major depression reflecting a bio-psycho-social treatment model
Ms Elizabeth Lyons, Prof Andrew Bonney, Dr Leila Matar, Mr Brian Corless, Dr Fiona Williams, Ms Edith Melgarejo
This project aims to develop a Patient Decision Aid (PDA) for primary care patients who are diagnosed with major depression. The collaborative, interdisciplinary development process will follow guidelines published by the International Patient Decision Aids Standards Collaboration and the Ottawa Decision Support Framework and is informed by literature reviews for each of its components and has also been reviewed by the ISPRN advisory working group. The decision aid was extensively evaluated by general practitioners and community members.
GP attitudes towards Continuing Professional Development
Dr George Albert, Prof Andrew Bonney, Dr Andrew Moreton, Dr Stephen Barnett, Clinical A/Prof Bastian Seidel, Dr Andrew Moreton
The aim of this project is to investigate the attitudes of GPs to their continuing professional development. Insight will be obtained by purposefully recruiting GPs in different locations to be involved in qualitative interviews. It is anticipated that results of this study will be of value in promoting professional self-development for GPs and, hopefully, greater work satisfaction for GPs and improved outcomes for patients.
Wellbeing in student and established medical practitioners: formative research
Prof Andrew Bonney, Dr Andrew Dalley, Prof Lindsay Oades, Dr Min Ko Ko Thaung, Ms Bridget Dijkmans-Hadley, Ms Alyssa Horgan, Dr Louise Wright, Dr Fiona Williams and Mr Jason Nunes
A career in medicine can be very stressful and stressors can commence as early as medical school. This research aimed to measure the wellbeing and career intentions among Phase 1 and Phase 3 medical students at UOW.
The results indicated that factors such as the ability to balance work and family life was very important for both cohorts, when considering a specialty. Reassuringly the students reported overall high levels of wellbeing with similar scores between cohorts. These findings were in contrast to previous research suggesting increased rates of poor psychological health in medical students.
The researchers involved in this study were: This project was run by in-kind support by it’s investigators.
Satisfaction with and importance of information within hospital discharge summaries
Dr Carl Mahfouz, Prof Andrew Bonney, A/Prof Judy Mullan, Ms Bridget Dijkmans-Hadley, Dr Warren Rich
The aim of this study was to develop a discharge summary assessment tool to explore the attitudes of General Practitioners (GPs) to hospital discharge summaries and to pilot the tool to measure the satisfaction of GPs with components of the discharge summaries in comparison with the importance of those components to patient care.
A literature review were used to develop the tool. Each item was presented in a 5-point likert-style format; ranging from very unimportant to very important and very unsatisfied to very satisfied for each set respectively. An open response section collected respondents’ additional written comments.
GPs rated core clinical and management data as the most important features of discharge summaries. The top three elements ranked important or very important were: reason for admission to hospital; list of diagnoses on discharge and reasons for medication change.
GPs were most frequently unsatisfied with the changes in medication component. Other top-ranked unsatisfied/very unsatisfied items were prioritisation of pathology results and efficiency of the format of the discharge summary.
This project was funded by Illawarra Shoalhaven Medicare Local.
Feasibility study for a randomised controlled trial of shared-continuity for Type 2 Diabetes Management in primary care
Prof Andrew Bonney, Prof Sandra Jones, Dr Lyn Phillipson, Dr Chris Magee
The primary care system in Australia is under significant pressure to effectively manage the burgeoning caseload of chronic disease management. This caseload is projected to contribute to workforce shortages in the primary care setting in the short-, medium- and long-term. General practice registrars (GPRs) will increasingly need high level skills in chronic disease management as our population continues to age. However, both Australian and international data demonstrate that GPRs see relatively fewer older patients and patients with chronic diseases than established GPs, reducing training opportunities in chronic disease management.
This study aims to investigate older patient attitudes to General Practice Registrars and Practice Nurses providing care for the management of their Type 2 Diabetes Mellitus. Patients were randomised to either participate in usual care or the intervention component.
Patients were allocated to either the usual care arm that continued with the same care that they received at their general practice or were allocated to the intervention component where they were seen by a practice nurse and GP registrar, with their usual doctor checking in on the consultation at the end of their appointment.
All participants completed a baseline survey and a survey at the end of the study with regards to their attitudes towards General Practice Registrars and Practice Nurses providing care for the management of their Type 2 Diabetes Mellitus.
The study highlights the increased need for chronic disease management training for GP Registrars (GPRs). This pilot provides evidence that it is feasible to undertake an adequately powered randomised controlled trial of shared continuity in GP training practices for chronic disease management training. The intervention, as adapted in each practice, was acceptable to the majority of participants and indicated positive educational outcomes for GPRs. Despite the limitations of a pilot study, there was no measured negative impact on patients’ clinical parameters.
“No afterhours…no nursing homes”
Clinical A/Prof Russell Pearson, Dr Eniko Ujvary, Prof Andrew Bonney, A/Prof Judy Mullan, Ms Bridget Dijkmans-Hadley
The aim of this project was to discover what GPs behaviours/attitudes were towards providing care in residential aged care facilities (RACF) and what they perceive to be barriers and enablers to patient care in this setting.
The views of a purposive sample of 26 GPs and GP Registrars working in rural and regional NSW were captured through focus group discussions and one-on-one interviews.
Analysis of the qualitative data revealed that GP attitudes towards RACF visiting fell into five key themes: pleasure, duty, remuneration, hesitation and frustration.
The data also revealed that the overriding emotion GPs felt about RACF visitation was frustration with the avoidable delays and inefficiencies associated with the work.
Despite the pleasure GPs derived from their work in RACFs and their sense of obligation to be involved, their hesitation and frustration was compounded by the work’s perceived poor remuneration. The researchers commented on the need for further research to help improve GP engagement in RACF visits.
This project was funded by CCCGPT and the Graduate School of Medicine. (GSM)
Why are GPs asked to remove Implanon contraceptive implants early?
Dr Meike Flore, Dr Lily Chen, Prof Andrew Bonney, Dr Adam Hodgkins, Ms Bridget Dijkmans-Hadley, Dr Kate Manderson, Ms Gail Lloyd, Ms Gina Evans, Ms Haley Frew
This aim of the study is to discover the reasons why women ask for early removal of Implanon (progesterone only contraceptive) implants (that is, prior to its 3 year expiration dates). The findings may inform advice given to women prior to insertion of Implanon and/or lead to discussion around alternative forms of contraception.
Interviews were undertaken with 19 women aged between 18 to 50 years of age regarding their experiences with Implanon™. Bleeding side-effects were the main cause for early removal of the contraceptive device. Interestingly, mood swings and weight gain were also common factors for early removal.
Patients felt they hadn’t been as well informed about their side effects. The study found that women would be less likely to remove their Implanon™ early if they were made aware of potential side effects.
This project was funded by Grand Pacific Health.
The attitude of patients over 65yrs to ceasing long-term sleeping tablets
Dr Fiona Williams, Prof Andrew Bonney, Dr Carl Mahfouz, Clinical A/Prof Russell Pearson, Clinical A/Prof Bastian Seidel
The aim of this project was to assess elderly patient’s use and knowledge of sleeping tablets and their attitude to stopping them.
Seventeen patients aged over 65yrs from four Australian General Practices took part in telephone interviews.
Many patients in the study had been taking sleeping tablets for some time despite limited benefit.
The majority of patients showed a willingness to cease medication however did not see a need to as they were not aware of side effects or addictive nature of sleeping tablets.
The researchers commented that GPs need to recognize the importance of spending time with patients presenting for repeat prescriptions of sleeping tablets. They stated that GPs need to discuss the cause of sleep disturbance, potential side effects of the medication and alternative options for insomnia. Discussing these strategies may reduce the use of this potentially harmful medication in the elderly.
This project was funded by CCCGPT.
Factors affecting medical students’ sense of belonging in a longitudinal integrated clerkship
Dr George Albert, Prof Andrew Bonney, Prof Nicky Hudson, Dr Patricia Knight-Billington
The aim of this study was to investigate the experience of students undertaking a longitudinal integrated clerkship from the perspective of belonging in order to identify areas of improvement. Findings indicate that there is a complex interaction of factors relating in a positive or negative experience such as academic leadership, external (general practice) environment and intrinsic (student) factors.
Development and validation of an insulin proficiency assessment tool for insulin self management in adults with type 2 diabetes mellitus
Ms Dianna Fornasier, Ms Bridget Dijkmans-Hadley, Ms Alyssa Horgan, A/Prof Judy Mullan, Prof Peter Caputi, Mr Jason Nunes, Ms Cheryl Nanikvell, Mr Simon Scott- Findlay, Ms Helen Hulme-Jones, Ms Bronwyn Henderson, Ms Angela Clark, Ms Christine Campbell
Research has identified gaps in insulin self management outcomes, particularly for patients with type 2 diabetes mellitus (T2DM) over the age of 65. The research team developed a 26 item tool to be used in assessing a T2DM patients’ knowledge and self-management of their T2DM and administration of insulin.
The tool demonstrated high accuracy in identifying patients who have inadequate knowledge of hypoglycaemia and hyperglycaemia management. The research also found that there were gaps in patients’ knowledge around insulin self-management.
This project was funded by the Department of Health and Ageing.
What is the effect on weight of regularly weighing 20-70 year old general practice attendees: a pilot study
Dr Duncan Mackinnon, Prof Andrew Bonney, Mr Darren Mayne
The aim of this pilot study was to establish the feasibility of whether weighing patients at every consultation, followed by usual care, has an impact on healthy weight maintenance of 20-70 year old general practice attendees. Lessons from this study, and preliminary data, will be used to support a proposed larger scale study in the future.
The results indicate that obese patients lost 3.3kg more than underweight or normal weight patients and lost 2.8kg more than overweight patients. This study demonstrated a weight loss of 0.8kg overall and a significant 2.5kg weight loss in obese patients. This small intervention could have nationwide benefits with minimal costs for national health services.
Dr Mackinnon presented an academic poster on his research project at the Primary Health Care Research Information Service Conference in July 2014, where he was presented with the award for Best Poster.
Chaperone use in Australian general practice: current practice and attitudes of general practitioners and patients
Dr Lucie Stanford, Prof Andrew Bonney, Dr Rowena Ivers, A/Prof Judy Mullan
A cross-sectional survey completed by 732 adult patients, between August-November 2012, was used to investigate Australian patients attitudes toward chaperone use for intimate physical examinations in a GP setting. The study findings suggested that both male and female patient participants (aged between 18-95 years) were significantly more likely to want a chaperone present when their usual GP was conducting an intimate physical examination (e.g. genital or ano-rectal examinations), as compared to when a GP they did not know well was conducting the examination (p<0.05).
In addition, the study found that even though 45.3% of the study participants had no preference with regard to whether or not the chaperone was outside or inside of the curtain during the examination, as many as 41.3% responded that they wanted the chaperone to remain outside the curtain and just over an eight (11.3%) preferred that the chaperone remain inside the curtain.
This project was funded by the Department of Health and Ageing.
Cross-sectional survey of older patients’ views regarding multidisciplinary care for chronic conditions in general practice
Prof Andrew Bonney, Dr Chris Magee, Clinical A/Prof Russell Pearson
This project aims to establish preliminary data on the views of older patients in the Illawarra/Shoalhaven towards community-based team care for chronic conditions. The project also seeks to assess the utility of a cross-sectional survey methodology for this topic and investigate the psychometric properties of an instrument adapted for this purpose. If successful, a further aim is to secure external, competitive funding for a multi-centre, mixed methods research project addressing this topic. Findings indicate older patients support important features of health care reform in general practice, including co-location of health professionals in general practices, multidisciplinary chronic disease management teams and advanced roles for practice nurses. Results also demonstrate the importance to older patients of interpersonal continuity of care with their GP.
Effective collaborations and research partnerships have been a key strength of ISPRN.
Our list of research projects (below) demonstrates a wide range of collaborations with individual researchers from various University of Wollongong faculties and schools. ISPRN also has major research partnerships with various institutions around Australia and internationally including: the University of Newcastle, the Illawarra Health and Medical Research Institute (IHMRI), University of New England, University of Notre Dame, University of Queensland, Deakin University and the University of Montreal.
Illawarra Health and Medical Research Institute (IHMRI) collaborative projects
Southern IML Pathology Research Cohort Study
The SIMLR Cohort Study is a partnership between Southern IML Pathology and the Illawarra Health and Medical Research Institute (IHMRI). The project utilises Southern IML Pathology’s large, longitudinal, community-derived database to analyse and identify health risk indicators and where those risks are clustered geographically.
Improving continuity of care for patients diagnosed with head and neck (oral and oro-phayrngeal) cancers at a regional cancer centre. Can a multidisciplinary care team reduce agency loss between care settings and providers? Find out more information about IHMRI.
Other Collaborative Projects
Older patients and their involvement in the decisions concerning their health care.
Prof Andrew Bonney, A/Prof Judy Mullan, Ms Athena Hammond
The research team will undertake a comprehensive qualitative study based in general practice. The research team will interview 40 older patients with multiple conditions, who receive health care from numerous health care providers. Some of the practitioners providing this health care will also be interviewed to understand what their experiences have been around patient participation in health care decision making and to seek their views on improving this process. This project is funded by the Illawarra Retirement Trust.
The effect of targeted social marketing resources on older patient attitudes towards GP registrars
Prof Andrew Bonney, Dr Lyn Phillipson, Ms Julie Hall, Ms Elizabeth Smyth, Dr Pippa Burns
This study used targeted information resources to better inform older patients and then assess older patients’ attitudes and behaviours regarding GP registrars.
Ten general practices displayed brochures and posters about GP registrars for a six month period. Nine general practices did not display any resources during this time to act as a comparison.
Patients who were exposed to the brochures and posters demonstrated a significant improvement in trusting their GP registrar. They were also more comfortable in having a GP registrar treat them for a complex or chronic condition.
Qualicopc-Australia: The Australian Arm of an International Comparative Study of Primary Health Care Systems
University of Wollongong, University of Western Sydney, The Australian National University
The QUALICOPC study (Quality and Costs of Primary Care) aims to evaluate primary care systems internationally (in 34 countries) against criteria of quality, equity and costs.
Improving continuity of care for patients diagnosed with head and neck (oral and oro-phayrngeal) cancers at a regional cancer centre. Can a multidisciplinary care team reduce agency loss between care settings and providers?
Ms Jennifer Haughton, Ms Jessica Boehm, Prof Andrew Bonney, Dr Bruce Ashford, Prof Liz Halcomb, Dr Marianna Milosavljevic, Dr Karen Walton, Dr Karen Charlton, Ms Vhari Dickson
This research project is a collaboration between IHMRI and the Illawarra Shoalhaven Local Health District (ISLHD).The aim of this project is to conduct a pilot study that maps the treatment journey of a cohort of patients newly diagnosed with oral or oro-pharyngeal malignancy and identify the factors that enhance or detract from their continuity of care with the aim of informing improved processes in patient care.
The brave new world of older patients: preparing general practice training for an ageing population
Prof Andrew Bonney, Prof Sandra Jones, Dr Lyn Phillipson, Mr Lance Barrie
The aim of this project is to develop resources utilising a social marketing framework to improve older patient interactions with general practice registrars.
We are all time poor
Hamirudin A Haslinda, Charlton K, Walton K, Bonney A, Albert G, Hodgkins A, Potter J, Milosavljevic M, Dalley A.
This study aimed to identify barriers and opportunities to implementing nutrition screening of older people in general practice. It was identified that time restraints were the main barrier to performing nutrition screening in general practice.
Feasibility of implementing routine nutritional screening for older adults in Australian general practices: a mixed-methods study
A Hamirudin, K Charlton, K Walton, A Bonney, J Potter, M Milosavljevic, A Hodgkins, G Albert, A Ghosh, A Daley
This study aimed to demonstrate the feasibility of introducing a validated nutrition screening tool and resource kit for use with older patients attending general practice. A statistically significant improvement in nutritional screening knowledge of general practice staff was found at the end of the three month test period. The tool was identified as being a quick and easy tool that can categorise older patients according to their nutritional risk.
Trends in uptake of the 75+ health assessment in Australia: a decade of evaluation
Ms Aliza Haslinda Hamirudin, Mr Abhijeet Ghosh, A/Prof Karen E. Charlton, Prof Andrew D. Bonney
This study aimed to identify the uptake of the 75+ health assessment within regional areas of NSW and compare this against state and national trends over an 11 year period. The study indicated trends over time in uptake of the health assessment.
Is there an association between health literacy level and quality of chronic disease management in primary care?
A/Prof Judy Mullan, Prof Andrew Bonney, Dr Christopher Magee, Dr Kath Weston, Dr George Albert, Dr Sue Abadier, Dr Bahgat Gerges in collaboration with the University of Montreal, Quebec, Canada
Poor health literacy can lead to poor health outcomes and over-use of healthcare services. How doctors caring for patients with chronic conditions identify those with poor health literacy skills and provide them with effective medical information is unknown. Investigating this issue can help us develop management strategies for doctors caring for these ‘high risk’ patients. This pilot study will assess the feasibility of screening for health literacy in chronic disease patients and explore associations between health literacy screening results and patients’ health outcomes.