Rationale & Objectives Primary aldosteronism (PA) is underdiagnosed in people living with hypertension, despite its considerable prevalence, association with poorer cardiovascular and kidney outcomes, and availability of effective treatment. The factors underlying such underdiagnosis and undertreatment remain uncertain. This study aimed to identify key factors influencing screening, diagnosis and treatment of PA from the clinician’s perspective. Study Design Exploratory qualitative study. Setting and Participants Thirty-eight clinicians were recruited from across Australia, including cardiologists (n = 8), endocrinologists (n = 10), general practitioners (n = 10) and nephrologists (n = 10). Purposive sampling achieved diversity in practice location, setting, and clinical experience. In-depth semistructured interviews were conducted between May and November 2024. Analytical Approach Interview transcripts were analyzed using both deductive content analysis aligned with the Consolidated Framework for Implementation Research and inductive reflexive thematic analysis. Results Four themes were developed to explain factors affecting clinician screening, diagnosis, and treatment decisions: (1) Clinician experience, knowledge, and perceptions; (2) PA screening and diagnosis complexity and burden; (3) accessibility of services and information; and (4) health system, government, and organizational factors. Common barriers across clinician groups included that PA is often considered in a narrow patient cohort, with older and comorbid populations not considered candidates for screening; that the perceived complexity and burden associated with PA diagnosis inhibits initiation of the diagnostic process; that limited access to services is a barrier to screening or workup of PA; and that lack of streamlined and local diagnostic services contributes to fragmented care and diagnostic delay. Key facilitators included access to specialized diagnostic units and cross-disciplinary and collegial decision making in patient management. Limitations Generalizability may be limited due to Australian context. Conclusions These findings highlight key factors that influence clinicians’ decision making in PA detection and management, providing important guidance to the design of future clinician-targeted interventions to improve PA diagnosis and treatment. Plain-Language Summary Primary aldosteronism (PA) is the most common hormonal cause of hypertension; however, it is vastly underdiagnosed and often suboptimally managed. The basis for this is poorly understood. To explore this, nephrologists, endocrinologists, cardiologists, and general practitioners were interviewed to understand their decision making in PA management. Major barriers included: often only narrow profiles of patients were considered candidates for PA screening; the diagnostic process was perceived as burdensome and therefore often not initiated; and that limited diagnostic service access dictated clinical management and contributed to diagnostic delay. Conversely, specialized diagnostic units and professional networks promoted optimal patient management. These findings highlight key factors that can be leveraged in the design of future clinician-targeted interventions to improve PA care.

INTRODUCTION:The Primary Care Assessment Tool (PCAT) is designed to assess a patient's experience with primary care across various core and ancillary domains, including First contact - Utilization, First contact - Access, Ongoing Care, Coordination, Comprehensiveness (services provided), Family-centeredness, Community Orientation, and Cultural Competence. This study examined the psychometric properties of the Adult Primary Care Assessment Tool Short Form (PCAT-S) in the Australian general practice setting. METHOD:Data included 715 participants from the EQuIP-GP study, a cluster randomized controlled trial (RCT) conducted with adults aged 18-65 years with a chronic illness or aged over 65 years, from 34 general practices across Australia. For each subscale we assessed internal consistency using Cronbach's alpha. Factor structure of the PCAT-S instrument was assessed through confirmatory and exploratory factor analysis, using three samples with different methods for handling 'don't know/can't remember' responses. RESULTS:The findings were mixed. Specifically, the subscales related to First Contact - Utilization, Ongoing Care and Comprehensiveness, demonstrated satisfactory internal consistency. However, the remaining subscales showed weak internal consistency. Confirmatory factor analysis indicated potential model misspecification, while exploratory factor analysis generally supported the hypothesized factor structure, albeit with some observed deviations. CONCLUSIONS:The findings indicate the PCAT-S shows promise as an instrument to evaluate primary care experiences in Australia. However, the observed variability in internal consistency, along with issues identified in confirmatory and exploratory factor analyses, highlight the need for further validation and refinement in this population. Further research is required to address the identified limitations and enhance the tool's applicability within the Australian general practice context.

OBJECTIVE:Appropriate intervals for repeat (surveillance) colonoscopy are important for early colorectal cancer detection and treatment, timely patient access, and minimising patient risks. This study aimed to assess the concordance of endoscopist-recommended surveillance colonoscopy intervals with those recommended by the 2018 Australian Cancer Council surveillance colonoscopy guidelines. METHODS:Three metropolitan and three rural public hospitals in Victoria, Australia, each retrospectively audited at least 35 consecutive colonoscopy cases where the outcome recommendation was for future surveillance. The audit covered colonoscopies conducted between April 2020 and June 2021. Nurses at each hospital audited colonoscopy reports, histopathology results and other relevant patient documentation. Audit data were used to calculate the guideline-interval, which was compared with the endoscopist-recommended return interval to determine concordance. RESULTS:Of 465 consecutive colonoscopy cases audited, 248 were recommended for future surveillance colonoscopy and had complete data. A total of 25.4% (63/248) had an endoscopist-recommended interval that was consistent with the guidelines. Among discordant cases, 74.6% (n = 138) of recommendations were early; 20.5% (n = 38) were not indicated and 4.9% (n = 9) were late according to the guidelines. Excluding cases that should not return for surveillance (n = 38), concordance by guideline-recommended interval categories was 66.7% (8/12) for cases with an interval of ≤12 months, 31.0% (13/42) for 3 years, 58.3% (42/72) for 5 years and 0.0% (0/84) for 10 years. CONCLUSIONS:Guideline concordance was suboptimal at participating hospitals. Most discordant surveillance interval recommendations made were earlier than the guidelines recommend. An active, tailored approach to implementation is required given the lack of uptake several years after guideline introduction.

Background Primary care research capacity is hindered by fragmented systems, limited protected clinician time, and poorly developed pathways for translating evidence into practice. The Translating Research Outcomes into the Primary Health Interface (TROPHI) initiative was established in outer Eastern Melbourne, Australia, to address these challenges by strengthening regional research capacity, fostering collaboration between primary care and academic sectors, and supporting research translation. TROPHI was funded by Windermere Foundation. Aim To evaluate the implementation and early impact of TROPHI, focusing on its ability to build interdisciplinary networks, enhance research capacity, and facilitate primary care research. Design & setting Our hybrid evaluation was set in outer Eastern Melbourne, Australia Method Our evaluation was informed by Cooke’s framework for research capacity development and the Consolidated Framework for Implementation Research (CFIR). We analysed study documents and conducted semi-structured interviews with 29 TROPHI staff, award recipients, partners, consumers, and funders. Results TROPHI established a regional interdisciplinary network and created accessible entry points into research for clinicians through mentorship, bursaries, fellowships, and seed funding. Participants reported increased research skills, confidence, and engagement, alongside early examples of translation into practice. Over three years, TROPHI leveraged an initial AUD$1M philanthropic investment into more than AUD$3M in competitive grants. Implementation was supported by established organisational partnerships but required substantial contributions from staff at lead organisations. Conclusion TROPHI strengthened primary care research capacity by fostering partnerships and supporting clinicians, generating regional momentum. It represents a promising model for regional capacity building. Sustained impact will require ongoing investment, broader workforce engagement, and stronger integration with systems.

OBJECTIVES:This study aimed to investigate the impact of 'who' delivers a health message (general practitioner or community representative), and the 'visual stimulus' (animation or talking head) used on influencing attitudes toward safe behaviours in the context of the COVID-19 pandemic, across six vulnerable population subgroups STUDY DESIGN: A 'helix' randomised controlled trial with 2x2 factorial design. METHODS:Participants (40 per subgroup) were randomly allocated within their subgroup to an intervention sequence. They completed a factorial, counter-balanced allocation of four intervention combinations across four safe behaviour contexts. Exposure to each intervention was followed by online survey questions investigating intention to undertake, and encourage family and friends to undertake, the context-specific behaviour using a 5-point Likert-style scale RESULTS: A total of 358 participants responded to requests to participate in the study, of whom 298 (83%) fully completed and 58 (16%) partially completed surveys. Participants were more likely to report higher intention to perform COVID-safe behaviours when exposed to animation compared to talking head visual stimuli (Coef = -0·12, 95% CI = -0·22 to -0·01, p = 0·03; β = -0.12, 95% CI -0.22 to -0.01, p = .03, animation > talking head) There was no main effect of 'who' provided the message; however, several interaction effects were noted across population subgroups for each intervention. CONCLUSION:The approach best suited for different vulnerable subgroups varies across each, indicating a one-size-fits-all approach should not be used and is inequitable. However, the additional costs and time-delays that would be encountered in preparing subgroup-specific materials also warrant consideration.

BACKGROUND:Extracorporeal membrane oxygenation (ECMO) is a complex, costly, and uncommon life-saving treatment for critically ill patients with severe cardiac and/or respiratory failure in intensive care units, though its use has increased in recent years. Survivors frequently experience long-term physical, cognitive, and psychological challenges and require support from a wide range of healthcare providers and facilities, many of whom may have limited experience with ECMO. Timely and comprehensive discharge communication is essential to ensure continuity and quality of care across settings. OBJECTIVES:The aims of this study were to assess the proportion of patients treated with ECMO who had a documented primary care physician or clinic on file and to evaluate the inclusion of clinical information in their hospital discharge summaries. METHODS:This multi-centre retrospective observational study included adults treated with ECMO and discharged alive from four tertiary hospitals between January 1, 2021, and December 31, 2022. Patients who died in hospital or were transferred to another acute facility were excluded. Data were collected through medical records' review and linkage with the EXCEL Registry. RESULTS:Of the 150 participants who met eligibility criteria (mean age: 48 years, 72.7% male), 126 (84%) had a documented primary care physician or clinic. Among the 148 (98.7%) medical discharge summaries, the primary diagnosis was recorded for all participants, ECMO use was recorded for 147 (99.3%) participants, discharge destination for 142 (95.9%), hospital follow-up plans for 136 (91.9%), and ECMO indications for 135 (91.2%). Discharge medications were recorded in 131 (88.5%) cases, and a hospital contact person was provided in 95 (64.2%) cases. In contrast, intensive care unit-specific and ECMO-specific recommendations were reported in only 23 (15.5%) and 8 (5.4%) summaries, respectively. CONCLUSIONS:These findings highlight the need to improve discharge communication to better support primary care physicians in delivering coordinated care following hospital discharge.

BACKGROUND:Older adults from culturally and linguistically diverse backgrounds often face communication barriers in general practice, which compromise care quality and patient safety. Limited English Proficiency is a key determinant of these barriers, yet little is known about how older, LEP patients experience communication from general practice. AIM:To identify the experiences and preferences for communication from Australian general practice by older Greek patients with limited English proficiency. DESIGN & SETTING:An exploratory, qualitative, descriptive research design was used. The study took place in a Greek community club in South-East Melbourne. METHOD:Ten older Greek persons with limited English proficiency and two informal carers were interviewed in a mix of both English and Greek. Interviews lasted 20-45 minutes, were audio-recorded, transcribed verbatim, and translated to English. Data were analysed using reflexive thematic analysis. RESULTS:Participants described diverse experiences, three themes emerged: 1) The 'good doctor' and 'good clinic': being a person or place that provides them with a range of communication modalities tailored to their needs, is comfortable and accessible, and provides essential health services on-site; 2) Communication experiences with healthcare professionals, including the communication methods used and the reasons for their use; and 3) The diverse range of preferences for communication, particularly in relation to technology, which were often due to their age and English proficiency. CONCLUSION:The preferences and needs for communication from general practice clinics amongst this group was influenced by age and language related factors. It is important to consider these factors when designing, and implementing communication systems in general practice.

OBJECTIVES:Despite evidence and guidelines supporting rehabilitation, people with dementia experience limited access due to health professionals' attitudes, knowledge gaps, and systemic barriers. The INCLUDE package is an interdisciplinary online training programme and Community of Practice (CoP) designed to address these barriers. The aim of this study was to evaluate the impact of the INCLUDE package on health professionals' knowledge, attitudes, confidence, advocacy, and practice change in dementia rehabilitation. METHODS:A pre-post longitudinal study involved two groups of health professionals across Australia. Group 1 (n = 103) completed the online training and an 8-month CoP; Group 2 (n = 373) completed training only. Surveys administered at pre-training (T1), post-training (T2), and 10-month follow-up (T3; Group 1 only) assessed knowledge, attitudes and confidence towards dementia and dementia rehabilitation. Multilevel mixed-effects regression models were used to examine changes over time. Content analysis was used to explore advocacy, practice changes, barriers, and sustainability. RESULTS:476 health professionals participated. The largest groups were physiotherapists (n = 121, 26.7%), occupational therapists (n = 120, 26.5%) and nurses (n = 37,13.6%). The Dementia Attitudes Scale (coefficient 10.4, 95% CI 9.4-11.4), Dementia Rehabilitation Questionnaire (3.8, 95% CI 3.0-4.5), and Confidence in Delivering Dementia Rehabilitation Scale (3.2, 95% CI 2.8-3.5) improved from T1 to T2. In Group 1, improvements in attitudes towards dementia and confidence in rehabilitation were sustained at T3, but knowledge and attitudes towards dementia rehabilitation declined from T2 to T3. Participants advocated for dementia rehabilitation and made changes in their workplace including revising rehabilitation access criteria, advertising dementia rehabilitation to referrers, and developing interdisciplinary programs. CONCLUSIONS:The INCLUDE package improved health professionals' attitudes, knowledge and confidence in dementia rehabilitation. Although participants made changes in their workplace, barriers still existed. Organisational and system-level changes are also required to improve access to dementia rehabilitation. TRIAL REGISTRATION:This study is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12623001029684.

OBJECTIVE:To examine changes in rates of primary care patients seeing multiple prescribers and characteristics of patients who ceased seeing multiple prescribers for monitored medicines after voluntary implementation of the Victorian prescription drug monitoring program (PDMP). STUDY DESIGN:Controlled interrupted time series analysis of primary care electronic medical records. SETTING:A total of 562 general practices across three Victorian healthcare networks (Monash Health, Peninsula Health, Eastern Health). PATIENTS:People prescribed at least one PDMP-monitored medicine (e.g., opioids, benzodiazepines) and/or non-monitored psychotropic medicines (e.g., antidepressants, antipsychotics) between 1 January 2017 and 30 June 2023. INTERVENTION:Voluntary (1 April 2019) and mandatory (1 April 2020) implementation of the Victorian PDMP. MAIN OUTCOME MEASURES:Changes in the monthly rate of people seeing multiple prescribers (defined as four or more prescribers) following PDMP implementation for monitored medicines, with non-monitored medicines used as a control; characteristics of people who ceased seeing multiple prescribers for monitored medicines following PDMP implementation. RESULTS:Following voluntary PDMP implementation (1 April 2019), there was a significant reduction in the differential step and trend changes in the rates of seeing multiple prescribers between people prescribed monitored and non-monitored medicines (differential step change: β, -3.55 [95% confidence interval (CI), -5.08 to -2.03]; differential trend change: β, -0.29 [95% CI, -0.46 to -0.12]). Following mandatory PDMP implementation (1 April 2020), there was no significant step change difference. However, there was an increase in the differential trend change in the rate of seeing multiple prescribers between those prescribed monitored and non-monitored medicines (differential trend change: β, 0.21 [95% CI, 0.05-0.37]; p = 0.009). Logistic regression revealed that older age (95% CI, 1.39-1.75), male gender (95% CI, 1.09-1.25), metropolitan residence (95% CI, 1.04 and 1.23) and substance use disorder diagnosis (95% CI, 1.07-1.28) were associated with significantly higher odds of seeing multiple prescribers before PDMP implementation. CONCLUSIONS:Implementation of the PDMP was associated with meaningful reductions in people accessing monitored medicines from four or more prescribers.

Primary aldosteronism (PA) is a common and treatable cause of hypertension, affecting up to 15% of patients in primary care, yet it remains substantially underdiagnosed. Recent international guidelines recommend routine screening for PA in all individuals with hypertension, highlighting the need for effective implementation strategies in general practice. We aim to determine whether an electronic clinical decision support (eCDS) tool integrated into general practice software improves PA screening and diagnosis. CONSEP (CONn Syndrome screening and Evaluation in Primary care) is a pragmatic cluster randomised controlled trial conducted in general practices across three Australian states. Practices will be block-randomised by size and location (state) in a 1:1 ratio to intervention (eCDS) or control. Patients eligible for analysis will be adults with hypertension attending participating practices. De-identified data will be extracted from clinical software at baseline, 12 months, and 24 months. Analyses will follow intention-to-treat principles using regression models accounting for clustering at the practice level. Primary outcomes are the proportion of patients screened for PA within 12 months and the proportion diagnosed with PA within 24 months. Secondary outcomes include blood pressure control, antihypertensive medication burden, cost-effectiveness, and a process evaluation assessing acceptability, feasibility, and sustainability. By embedding guideline-based screening into routine workflows, this trial addresses a major evidence-practice gap in hypertension care. If effective, the intervention could improve hypertension management, increase detection of PA, and reduce long-term cardiovascular risk in primary care.

BACKGROUND:Health-related quality of life is central to healthy ageing, yet gender differences among older adults and their underlying determinants are not well understood. We examined gender differences in quality of life in a large cohort of older Australians and the extent to which biopsychosocial factors mediate these differences. METHODS:We analysed baseline cross-sectional data from the Statins in Reducing Events in the Elderly trial, a randomised controlled trial of community-dwelling Australians aged ≥70 years without cardiovascular disease, major physical disability, or dementia. Quality of life was measured across eight domains of the 36-Item Short Form and summarised using the SF-6D index. Gender differences were examined using age-adjusted linear regression, with mediation assessed by the percentage reduction in the association between gender and quality of life after adjusting for individual biopsychosocial factors. RESULTS:Among 9971 participants (52% women; mean age 74.7 ± 4.5 years), women scored lower than men in Physical Functioning, Vitality, Mental Health, and Bodily Pain (all p < 0.001), but higher in General Health (p < 0.001). The SF-6D index was lower in women (mean difference - 0.03, p < 0.001). Pain severity, depressive symptoms, and histories of osteoarthritis and depression mediated the greatest amount of the gender difference in scores (between 42% and 92%). CONCLUSIONS:Older women reported better general health but poorer quality of life than men in most domains. These gender differences were largely attributable to pain and depressive symptoms, both of which are common and modifiable. Targeted management of these symptoms may improve quality of life and reduce gender disparities in later life.

Evidence shows that patient outcomes following musculoskeletal injury have been associated with the timing of care. Despite the increasing number of injured workers presenting with low back pain (LBP) in primary care, little is known about the factors that are associated with the timing of initial healthcare provider visits. This study investigated factors that are associated with the timing of initial workers’ compensation (WC)-funded care provider visits for LBP claims. We used a retrospective cohort design. A standardised multi-jurisdiction database of LBP claims with injury dates from July 2011 to June 2015 was analysed. Determinants of the time to initial general practitioner (GPs) and or musculoskeletal (MSK) therapists were investigated using an accelerated failure time model, with a time ratio (TR) > 1 indicating a longer time to initial healthcare provider visit. 9088 LBP claims were included. The median time to first healthcare provider visit was 3 days (interquartile range (IQR) 1–9). Compared to General practitioners (GPs) (median 3 days, IQR 1–8), the timing of initial consultation was longer if the first healthcare providers were MSK therapists (median 5 days, IQR 2–14) (p < 0.001). Female workers had a shorter time to first healthcare provider visit [TR = 0.87; 95

BACKGROUND:Early physical therapy for workers reporting low back pain (LBP) may reduce disability and improve return to work. This study aimed to explore the relationship between the timing of physical therapy commencement and the duration of work disability after the onset of compensable LBP. METHODS:We conducted a retrospective cohort analysis of workers with workers' compensation claims for LBP in two Australian states. We investigated the association between the timing of physical therapy commencement and work disability duration using an accelerated failure time model. Median duration of work disability in paid calendar weeks was the principal outcome. RESULTS:We examined 9160 accepted workers' compensation claims for LBP. Patients who had not seen a physical therapist had the shortest duration of disability (median, 4.1 weeks). In those who had seen a physical therapist, the median duration of work disability was associated with the timing of commencement of physical therapy, from 8.0 weeks for care within 7 days of the injury to 34.7 weeks when care was commenced greater than 30 days after the onset of injury. Our adjusted model demonstrated that, compared to physical therapy within 7 days of injury onset, commencement of physical therapy between 8 and 14 days, 15 and 30 days, and greater than 30 days was associated with a 37.0% (Time ratios (TR) 1.37; 95% CI (1.23, 1.52)), 119% (TR 2.19; 95% CI (1.96, 2.44)) and 315% (TR 4.51; 95% CI (4.06, 5.02)) increased likelihood of longer disability duration, respectively. CONCLUSIONS:In workers with work-related LBP undertaking physical therapy, early commencement of physical therapy was associated with a significantly shorter duration of disability. Although we cannot establish causality, our findings highlight the potential benefits of initiatives that promote timely initiation of treatment in reducing extended work disability for injured workers undergoing physical therapy for LBP.