http://localhost:8080/xmlui/handle/123456789/4591 423-544 (Agustus, 2022) Sat, 11 Apr 2026 16:04:18 GMT 2026-04-11T16:04:18Z http://localhost:8080/xmlui/handle/123456789/4611 Title: Sustainable and effective methods to increase long-acting reversible contraception uptake from the ACCORd general practice trial Authors: Taft, Angela; Watson, Cathy J.; McCarthy, Edwina; dkk. Abstract: Objective: Most Australian women access contraception through general practitioners (GPs) but choose oral methods rather than long-acting reversible contraceptives (LARCS). The Australian Contraceptive ChOice pRoject (ACCORd) successfully tested a complex intervention for LARC uptake. We aimed to explore the critical elements of this intervention to increase LARC uptake. Design: ACCORd was a cluster randomised control trial conducted in 57 GP clinics in Melbourne, Australia. To explore intervention impact, fidelity checks (n=21 GPs) and interviews with 37 GPs and 40 patients were undertaken 12 months after initial consultations. Data were inductively coded, thematically analysed and mapped to Normalization Process Theory constructs. Results: Doctors understood the importance of effectiveness-based contraceptive counselling (EBCC). GPs demonstrated cognitive engagement in the promotion of LARC and some appreciated the rapid referral pathways. GPs and women valued the effectiveness approach. GPs held varying views about having a rapid referral pathway, with many already having established pathways in place. Some GPs viewed intrauterine device insertion costs or insertion training as barriers to ongoing practice. Most GPs and women saw the ACCORD model as effective and sustainable. Conclusions: GP training in EBCC and the use of rapid referral pathways were critical features of an effective sustainable model for successful uptake of LARCs in primary care. Implications for public health: Improving Australian women’s access to and use of LARCs is sustainable with EBCC training and support for general practitioners. Mon, 01 Aug 2022 00:00:00 GMT http://localhost:8080/xmlui/handle/123456789/4611 2022-08-01T00:00:00Z http://localhost:8080/xmlui/handle/123456789/4610 Title: Factors related to under-treatment of secondary cardiovascular risk, including primary healthcare: Australian National Health Survey linked data analysis Authors: Butler, Danielle C.; Paige, Ellie; Welsh, Jennifer; Law, Hsei Di; Moon, Lynelle; Banks, Emily; Korda, Rosemary J. Abstract: Objective: To inform national evidence gaps on cardiovascular disease (CVD) preventive medication use and factors relating to under-treatment - including primary healthcare engagement - among CVD survivors in Australia. Methods: Data from 884 participants with self-reported CVD from the 2014–15 National Health Survey were linked to primary care and pharmaceutical dispensing data for 2016 through the Multi-Agency Data Integration Project. Logistic regression quantified the relation of combined blood pressure- and lipid-lowering medication use to participant characteristics. Results: Overall, 94.8% had visited a general practitioner (GP) and 40.0% were on both blood pressure- and lipid-lowering medications. Medication use was least likely in: women versus men (OR=0.49[95%CI:0.37-0.65]), younger participants (e.g. 45–64y versus 65–85y: OR=0.58[0.42–0.79])and current versus never-smokers (OR=0.73[0.44–1.20]). Treatment was more likely in those with ≥9 versus ≤4 conditions (OR=2.15[1.39–3.31]), with ≥11 versus 0–2 GP visits/year (OR=2.62[1.53–4.48]) and with individual CVD risk factors (e.g. high blood pressure OR=3.13 [2.34–4.19]) versus without); the latter even accounting for GP service-use frequency. Conclusions: Younger people, smokers, those with infrequent GP visits or without CVD risk factors were the least likely to be on medication. Implications for public health: Substantial under-treatment, even among those using GP services, indicates opportunities to prevent further CVD events in primary care. Mon, 01 Aug 2022 00:00:00 GMT http://localhost:8080/xmlui/handle/123456789/4610 2022-08-01T00:00:00Z http://localhost:8080/xmlui/handle/123456789/4609 Title: Are Australian junior doctors failing to act as health advocates? A qualitative analysis Authors: Maloney, Daniel P.D.; Moodie, Rob; Daube, Mike; Wilson, Alyce N. Abstract: Objective: To explore junior doctors’ attitudes towards and experiences of health advocacy practice and teaching in Australia. Methods: Semi-structured interviews were conducted with 15 junior doctors across Australia. Data were thematically analysed. Results: Three themes were identified: i) participants inconsistently understood and practised health advocacy, with many failing to conduct any advocacy work; ii) distinct factors motivated and enabled participants to undertake health advocacy; however, these were largely unrelated to any formal medical education; iii) the current medical workplace and education system is non-conducive to health advocacy practice given the numerous barriers faced by junior doctors when engaging with health advocacy. Conclusions: Health advocacy is generally poorly taught, weakly understood, and rarely performed despite being one of the four core graduate competencies of the Australian Medical Council (AMC). The AMC must clearly define health advocacy and its scope in their outcome statements, and this must be translated into medical education curricula and advocacy opportunities in the workplace. Implications for public health: Doctors are well-placed to act as public health advocates, yet they are denied the encouragement and training to do so. With the growing burden of complex and sensitive public health issues, junior doctors should be trained and encouraged in health advocacy. Mon, 01 Aug 2022 00:00:00 GMT http://localhost:8080/xmlui/handle/123456789/4609 2022-08-01T00:00:00Z http://localhost:8080/xmlui/handle/123456789/4608 Title: The impact of a 24-hour syringe dispensing machine on a face-to-face needle and syringe program and targeted primary healthcare clinic Authors: Uthurralt, Natalia; McGlinn, Anica; O’Donnell, Martin; Haber, Paul S.; Day, Carolyn A. Abstract: Objective: Automatic syringe dispensing machines (ADM) have become an important adjunct to Australia’s needle and syringe programs (NSP). However, concerns that they reduce face-toface contact with health staff and other health interventions remain. We examined changes in the number of needle/syringes dispensed at an ADM and occasions of service at a co-located face-to-face NSP and targeted primary healthcare clinic during the first wave of COVID-19 restrictions. Methods: We reviewed data from an inner-city harm reduction program during the study period of April 2020 to March 2021 compared to the previous year. Multivariable linear regression models were used to estimate the association between occasions of service and equipment distribution. Results: ADM-dispensed equipment increased significantly by 41.1%, while face-to-face NSP occasions decreased by 16.2%. Occasions provided by the targeted primary healthcare clinic increased by 59.7% per month. Conclusion: We have shown that 24-hour ADM access did not adversely affect the number of people using targeted primary healthcare when provided within close proximity. Implication for public health: These findings reinforce the demand for 24-hour needle/syringe access and can be used to support the expanded access to ADMs, especially where people who inject drugs (PWID) have access to appropriate healthcare. Mon, 01 Aug 2022 00:00:00 GMT http://localhost:8080/xmlui/handle/123456789/4608 2022-08-01T00:00:00Z