Australian Association for Academic Primary Care

ABSTRACTYouth friendly health care with a comprehensive assessment of health and wellbeing needs for adolescent and young adults (AYA) within the health-promoting university concept is lacking in Indonesian context. This research aims to comprehensively develop suitable interventions for improving services for AYA in the context of health-promoting universities. Guided by the theoretical framework of Consolidated Framework for Implementation Research (CFIR) and Practical, Robust, Implementation and Sustainability Model (PRISM), our research consist of three phases in 4 years. Phase 1, aims to explore the health needs of the university students, the current utility of the university health clinics, and the stakeholders’ perceptions of the current health service. Phase 2 aims to develop suitable interventions through codesigning process for improving the health services at the university. Phase 3 will implement the interventions at three affiliate university clinics in Indonesia: Universitas Indonesia, Universitas Gadjah Mada and Universitas Airlangga. This research fills a gap in evidence on how to improve health care and wellbeing services for AYA within the health-promoting university context in low- and middle-income countries. The phased research design from mapping current capabilities and needs to codesigning solutions with stakeholders and trialing implementation in three different universities, will enable assessment of feasibility, and scalability to other settings. The potential for impact of this research are to enhance the university services and promoting the attention to the needs of AYA in primary care, being undertaken by a unique collaboration between three leading universities in Indonesia.

Retention of general practice registrars in their training practices is important for addressing the GP workforce deficit and maldistribution of GPs. Given that rural and remote general practices are disproportionately affected by low retention, identifying the factors that promote retention may be as important as developing recruitment strategies in these areas. Quantifying the impact of relevant factors on registrar retention will enable a better understanding of how to incentivise retention and attenuate the loss of the rural workforce to other areas. We sought to establish the prevalence and associations of retention of general practice registrars in their training practices. This analysis was a component of the New alumni Experience of Training and independent Unsupervised Practice (NEXT-UP) study: a cross-sectional questionnaire-based study of early-career GPs in conjunction with evaluation of data contemporaneously recorded as part of vocational training. Participants were former registrars of three regional training organisations delivering general practice training in New South Wales, Tasmania, the Australian Capital Territory and Eastern Victoria, who had attained Fellowship of the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine between January 2016 and July 2018. The outcome measured was whether the registrar had previously worked at their current practice during vocational training. Multivariable logistic regression was used to estimate the association between relevant explanatory variables and the outcome. A total of 354 alumni responded (response rate 28%), of whom 322 provided data regarding previous training practice retention, with 190 (59%) having previously worked at their current practice as registrars. Among respondents who reported currently working in a regional-rural practice location (n=100), 69% reported having previously worked at their current practice during training. GPs were more likely to be retained by a practice they had trained at if it was of lower socioeconomic status (adjusted odds ratio (aOR) 0.82 (95% confidence interval (CI) 0.73-0.91), p<0.001 for each decile of socioeconomic status) and if the practice provided two or more of home visits, nursing home visits or after-hours services (aOR 4.29 (95%CI 2.10-8.75), p<0.001). They were less likely to be retained by the practice if training was completed in a regional-rural area (aOR 0.35 (95%CI 0.17-0.72), p=0.004). Regional-rural training location is associated with reduced odds of subsequent retention of general practice registrars. This is occurring despite significant government investment in expansion of general practice training in regional and rural areas. The practice factor most strongly associated with GP retention was the provision of out-of-practice and after-hours care. There may be altruistic, rather than monetary, reasons that explain this finding. Such training opportunities, if provided to all trainees, especially in regional and rural areas, would be a learning opportunity, a way of promoting holistic community-based care and an incentive for subsequent retention within the practice and community as an established GP.

Abstract We present the outcomes of a program designed to engage primary school students with both Indigenous knowledge and biodiversity conservation, through the lens of “Totemic” species. The program provided resources for genuine engagement with Traditional Owners, and for the coordinating teachers to dedicate time to curriculum development and delivery. The material was embedded within a cross‐school core curriculum topic (biology), presenting both Indigenous and Western knowledge in parallel. Students' understanding of ecology and conservation increased significantly post‐program, as did their cultural awareness and appreciation of traditional knowledge. Care for the totemic species was also shown to increase and enthusiasm for this approach to teaching science was expressed by students. The co‐benefits of this program include creating habitat for threatened species, improvements in the health and wellbeing of students through engagement with biodiversity and the potential for ecosystem services such as cooling of the school grounds. Effective ways of embedding cultural awareness and Indigenous knowledge into the Australian curriculum are urgently needed and it is our hope that this program provides evidence of effective ways of embedding these knowledges moving forward.

BackgroundSurvival rates following a diagnosis of cancer vary between countries. The International Cancer Benchmarking Partnership (ICBP), a collaboration between six countries with primary care led health services, was set up in 2009 to investigate the causes of these differences. Module 3 of this collaboration hypothesised that an association exists between the readiness of primary care physicians (PCP) to investigate for cancer – the ‘threshold’ risk level at which they investigate or refer to a specialist for consideration of possible cancer – and survival for that cancer (lung, colorectal and ovarian). We describe the development of an international survey instrument to test this hypothesis.MethodsThe work was led by an academic steering group in England. They agreed that an online survey was the most pragmatic way of identifying differences between the jurisdictions. Research questions were identified through clinical experience and expert knowledge of the relevant literature.A survey comprising a set of direct questions and five clinical scenarios was developed to investigate the hypothesis. The survey content was discussed and refined concurrently and repeatedly with international partners. The survey was validated using an iterative process in England. Following validation the survey was adapted to be relevant to the health systems operating in other jurisdictions and translated into Danish, Norwegian and Swedish, and into Canadian and Australian English.ResultsThis work has produced a survey with face, content and cross cultural validity that will be circulated in all six countries. It could also form a benchmark for similar surveys in countries with similar health care systems.ConclusionsThe vignettes could also be used as educational resources. This study is likely to impact on healthcare policy and practice in participating countries.