Rural Clinical School publications
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Item Metadata only What are they thinking? Facilitating clinical reasoning through longitudinal patient exposure in rural practice(James Cook University, 2017) Campbell, D.; Walters, L.; Couper, I.; Greacen, J.Introduction: This article reports the findings from an international research workshop, held over 2 days in October 2014 in Bairnsdale, Australia, which brought together 19 clinician teachers and medical educators who work in rural primary care. The objectives of the workshop were to clarify and identify the key aspects of the development of clinical reasoning in students and junior doctors, particularly as a result of longitudinal immersion in rural community practice. Methods: Delegates were asked to prepare a 55-word vignette related to their experience of teaching clinical reasoning, and these case studies formed the basis of identification of key issues, further refined via a modified Delphi process. Results: The workshop identified four key themes: the patient’s story, the learner’s reasoning, the context of learning, and the role of the supervisor. Exposure to undifferentiated patient presentations is increasingly common in medical education, particularly in longitudinal integrated placements. Conclusions: This research explored clinicians’ perspectives of how students develop their clinical reasoning: by learning from patients, from their supervisors and by understanding the context of their clinical interactions.Item Metadata only Clinical encounters of Australian general practice registrars with paediatric patients(Taylor & Francis, 2017) Hiscock, H.; Freed, G.; Morgan, S.; Tapley, A.; Holliday, E.; Davey, A.; Ball, J.; Van Driel, M.; Spike, N.; McArthur, L.; Magin, P.Background: Whether general practitioner (GP) registrars have adequate exposure to, and feel confident in, managing children's health during training is unknown. Objectives: To determine the prevalence and associations of GP registrars' paediatric vs. non-paediatric consultations. Methods: Cross-sectional analysis from a cohort study of Australian GP registrars' 2010-2014 consultations. Results: 889 registrars contributed details for 26,427 (21.8% (95% CI: 21.4-22.2) paediatric consultations. Paediatric patients were more likely to be male and new to the practice. Although paediatric patients were less likely to have a chronic disease (OR 0.38, 95% CI 0.36, 0.40) and presented with fewer problems (OR 0.59, 95% CI 0.57, 0.61), registrars were more likely to seek in-consultation advice (OR 1.25, 95% CI 1.19, 1.31) and generate learning goals (OR 1.12, 95% CI 1.07, 1.18) for paediatric consultations. Discussion: GP registrars appear to feel less confident in managing paediatric compared with adult consultations, suggesting an unmet training need.Item Metadata only Assessing randomised clinical trials of cognitive and exposure therapies for gambling disorders: a systematic review(Cambridge University Press, 2013) Smith, D.P.; Dunn, K.I.; Harvey, P.W.; Battersby, M.W.; Pols, R.G.Aims: Problem or pathological gambling is associated with significant disruption to the individual, family and community with a range of adverse outcomes, including legal, financial and mental health impairment. It occurs more frequently in younger populations, and comorbid conditions are common. Cognitive–behaviour therapy (CBT) is the most empirically established class of treatments for problematic gambling. This article reports on a systematic review and evaluation of randomised clinical trials (RCTs) concerning two core techniques of CBT: cognitive and behavioural (exposure-based) therapies. Methods: PsycINFO, MEDLINE and the Cochrane library were searched from database inception to December 2012. The CONsolidated Standards Of Reporting Trials (CONSORT) for nonpharmacological treatments was used to evaluate each study. Results: The initial search identified 104 references. After two screening phases, seven RCTs evaluating either cognitive (n = 3), exposure (n = 3) or both (n = 1) interventions remained. The studies were published between 1983 and 2003 and conducted across Australia,Canada, and Spain.On average, approximately 31% ofCONSORTitems were rated as ‘absent’ for each study and more than 52% rated as ‘present with some limitations’. For all studies, 70.83% of items rated as ‘absent’ were in the methods section. Conclusions: The findings from this review of randomised clinical trials involving cognitive and exposure-based treatments for gambling disorders show that the current evidence base is limited. Trials with low risk of bias are needed to be reported before recommendations are given on their effectiveness and clinicians can appraise their potential utility with confidence.Item Restricted How we use patient encounter data for reflective learning in family medicine training(Taylor & Francis, 2015) Morgan, S.; Henderson, K.; Tapley, A.; Scott, J.; van Driel, M.; Thomson, A.; Spike, N.; McArthur, L.; Presser, J.; Magin, P.Introduction: Consulting with patients is the core learning activity of Australian family medicine (general practice/GP) training, providing a rich source of reflective learning for trainees. We have developed a reflective learning program for postgraduate vocational trainees based on clinical encounters. Methods: The Registrar Clinical Encounters in Training (ReCEnT) program is an educational program documenting GP trainees’ consultations in five Australian GP training providers. Trainees record patient demographics, consultation details, problems managed, management practices and educational factors from sixty consecutive consultations per six-month training term. Trainees receive a detailed feedback report comparing individual data to aggregated trainee data and national GP data. Results: The patient encounter system provides multiple opportunities for reflective learning across a number of domains of exposure and practice. Reflection can occur during completion of the encounter form; as self-reflection on the feedback report; as facilitated reflection with the GP trainer and medical educator; and as part of integration of data into teaching. We have identified areas for further development, including enhancing the reflective skills of trainees and trainers. Conclusion: The ReCEnT patient encounter program provides a rich platform for reflective learning for vocational trainees and supports development of skills in lifelong learning.Item Metadata only Towards an educational continuing professional development (EdCPD) curriculum for Australian general practice supervisors(Royal Australian College of General Practitioners, 2015) Morgan, S.; Ingham, G.; Wearne, S.; Saltis, T.; Canalese, R.; McArthur, L.Background: Within the apprenticeship model of general practice training, the majority of teaching and learning occurs in the practice under the guidance of the general practice supervisor. One of the foundations of a high-quality general practice training program is the delivery of relevant, evidence-based educational continuing professional development (EdCPD) for general practice supervisors. Despite The Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM) standards requiring EdCPD, there is currently no standardised educational curriculum for Australian general practice supervisors. There are a number of emerging themes with significant implications for future general practice supervisor EdCPD. These include clinical supervision and structural issues, capacity constraints, and emerging educational issues. Objective: We propose the development of a core curriculum for general practice supervisors that is competency-based and evidence-based, and reflects the changing landscape of Australian general practice training. Discussion: A national general practice supervisor core curriculum would provide standardisation, encourage collaboration, allow for regional adaptation, focus on developing competencies and require rigorous evaluation.Item Metadata only Early career location of University of Adelaide rural cohort medical students(James Cook University, 2014) Jamar, E.; Newbury, J.; Mills, D.INTRODUCTION: In 2001 the Australian Government Department of Health began what is now the Rural Clinical Training and Support (RCTS) program which funds rural background selection and rural clinical education in an attempt to increase the rural medical workforce. At the University of Adelaide, students of the 6-year undergraduate medical program have the opportunity to complete the whole of their fifth year of clinical studies at one of eight rural locations. This study seeks to track the early career movements of these graduates in order to determine the program's rural medical workforce impact. METHODS: The retrospective study involved graduates who had studied a rural fifth year between 2003 and 2010 inclusive. Only domestic students were included in the study. One hundred and twenty four out of a possible 127 participants were contacted by email and asked to complete a 28-question online survey using SurveyMonkey. The survey included questions regarding career choices since graduation and experiences during the RCTS program. Quantitative data was analysed using descriptive statistics and qualitative data underwent thematic analysis. RESULTS: The survey response rate was 58.2% with 74 useable responses. Respondents described the career choices they had made since graduation, including the stage they were at in their training, the speciality they had chosen and their location during each year. Data showed that between 2009 and 2012 between 20.8% and 34.1% of respondents were located in a rural area (Australian Standard Geographical Classification - Remoteness Areas 2-5). More than half of respondents have spent time in a rural area since graduation and 85.1% of respondents indicated they had intentions to work in a rural area in the future. In saying this, 8 years post-graduation is not long enough to assess the rural work force outcome. Graduates move frequently between practice locations even at 8 years post-graduation; only five respondents had completed postgraduate training. The RCTS program is important in the progression from medical school to rural practice, including the initial decision to take part in it. The interest of some respondents who were practising in rural areas in 2012, and were initially 'very interested' in rural practice, either 'slightly' or 'significantly increased'. CONCLUSIONS: These results show that the RCTS program can supplement an initial interest in rural medicine.Item Metadata only Incidence and associations of hemiplegic shoulder pain poststroke: prospective population-based study(W.B. Saunders, 2015) Adey-Wakeling, Z.; Arima, H.; Crotty, M.; Leyden, J.; Kleinig, T.; Anderson, C.; Newbury, J.Abstract not availableItem Open Access Low Vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study(Public Library of Science, 2013) Benson, J.; Phillips, C.; Kay, M.; Webber, M.; Ratcliff, A.; Correa-Velez, I.; Lorimer, M.; Wang, G.Background: Vitamin B12 deficiency is prevalent in many countries of origin of refugees. Using a threshold of 5% above which a prevalence of low Vitamin B12 is indicative of a population health problem, we hypothesised that Vitamin B12 deficiency exceeds this threshold among newly-arrived refugees resettling in Australia, and is higher among women due to their increased risk of food insecurity. This paper reports Vitamin B12 levels in a large cohort of newly arrived refugees in five Australian states and territories. Methods: In a cross-sectional descriptive study, we collected Vitamin B12, folate and haematological indices on all refugees (n = 916; response rate 94% of eligible population) who had been in Australia for less than one year, and attended one of the collaborating health services between July 2010 and July 2011. Results: 16.5% of participants had Vitamin B12 deficiency (<150 pmol/L). One-third of participants from Iran and Bhutan, and one-quarter of participants from Afghanistan had Vitamin B12 deficiency. Contrary to our hypothesis, low Vitamin B12 levels were more prevalent in males than females. A higher prevalence of low Vitamin B12 was also reported in older age groups in some countries. The sensitivity of macrocytosis in detecting Vitamin B12 deficiency was only 4.6%. Conclusion: Vitamin B12 deficiency is an important population health issue in newly-arrived refugees from many countries. All newly-arrived refugees should be tested for Vitamin B12 deficiency. Ongoing research should investigate causes, treatment, and ways to mitigate food insecurity, and the contribution of such measures to enhancing the health of the refugee communities.Item Restricted Factors affecting rural landholders' adaptation to climate change: insights from formal institutions and communities of practice(Elsevier Sci Ltd, 2013) Raymond, C.; Robinson, G.This study explores the factors affecting rural landholders' adaptation to climate change from the perspectives of formal institutions and communities of practice. Semi-structured interviews were conducted with formal institutions (e.g. South Australian government agencies) and communities of practice (e.g. farm systems groups) within two natural resource management regions in South Australia. Both groups noted that rural landholders autonomously adapt to a variety of risks, including those induced by climate variability; however, the types and levels of adaptation varied among individuals as a result of variety of barriers to adaptation. The lack of communication and engagement processes established between formal institutions and communities of practice was one major barrier. The paper presents and discusses a model for transferring knowledge and information on climate change among formal institutions, communities of practice, trusted individual advisors and rural landholders, and for supporting the co-management of climate change across multiple groups in rural agricultural areas in Australia and elsewhere. © 2012 Elsevier Ltd.Item Metadata only Who uses complementary and alternative therapies in regional South Australia?: evidence from the Whyalla Integrational Study of Health(CSIRO Publishing, 2013) D'Onise, K.; Haren, M.; Misan, G.; McDermott, R.OBJECTIVE: To assess the prevalence of complementary and alternative medicine (CAM) and service use for people with a chronic disease in rural and regional Australia, where reported prevalence of CAM use is higher. METHODS: Data were from the Whyalla Intergenerational Study of Health, a population representative cross sectional study of 1146 people recruited in 2008–2009. Self-reported chronic disease diagnosis and health service use including CAM use were collected. Complementary and other medicines were recorded at a clinic visit in a reduced sample (n = 722) and SF36 data were collected by questionnaire. RESULTS: Around 32% of respondents reported complementary medicine use and 27% CAM service use. There was no difference in the overall prevalence of CAM use among those with and without a chronic disease (OR 0.9, 95% CI 0.7–1.3). Greater age- and sex-adjusted use of complementary medicines was associated with the ability to save money (OR 1.75, 95% CI 1.17–2.63), but not with any other socioeconomic position indicator. Those who reported using prescribed medication were more likely to report using complementary medicines (OR 2.09, 95% CI 1.35–3.24). CONCLUSIONS: The prevalence of CAM use in this regional community appeared lower than reported in similar communities outside of South Australia. Mainstream medicine use was associated with complementary medicine use, increasing the risk of an adverse drug interaction. This suggests that doctors and pharmacists should be aware of the possibility that their clients may be using complementary medicines, and the need for vigilance regarding potential side effects and interactions between complementary and mainstream therapies. WHAT IS KNOWN ABOUT THIS TOPIC?: The prevalence of complementary and alternative therapy use in Australian rural and regional communities is high relative to urban communities. WHAT DOES THIS PAPER ADD?: The prevalence of complementary and alternative therapy use in a regional South Australian community is lower than reported elsewhere. In this community, mainstream medicine use was associated with an increased chance of complementary medicine use. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Doctors and pharmacists should be aware of the possibility that their clients may be using complementary medicines, and the need for vigilance regarding potential side effects and interactions between complementary and mainstream therapies.Item Metadata only Anthropometric estimates of total and regional body fat in children aged 6-17 years(Taylor & Francis As, 2012) Flavel, N.; Olds, T.; Buckley, J.; Haren, M.; Petkov, J.Aim: To develop prediction equations for total and regional (trunk, abdominal, arms and legs) body fat using surface anthropometric measures in children aged 6–17 years. Methods: This was a cross-sectional correlation study of 70 Caucasian children aged 6–17 years recruited from a larger randomly sampled population-based study. The independent variables included age, mass, height, body mass index, waist and hip girth, and skinfold thicknesses at eight sites. Subscapular/triceps skinfold ratio was also calculated and entered as an independent variable. The dependent variables were total body percentage fat, and fat mass for total body, trunk, abdominal region of interest, arms and legs measured using dual-energy X-ray absorptiometry (DXA). Partial least squares regression was used to determine the best predictive equation for fat percentage or fat mass in each body region in each sex. Results: Sex-specific prediction equations were developed with high coefficients of determination (r²), ranging from 0.869 to 0.936 in boys and from 0.900 to 0.979 in girls, absolute bias was low, and limits of agreement were narrow. Conclusion: Equations were developed, which were able to predict total and regional body fat of Caucasian children aged 6–17 years using surface anthropometric measurements with high predictive accuracy.Item Metadata only Understanding rural and remote health: a framework for analysis in Australia(Pergamon-Elsevier Science Ltd, 2012) Bourke, L.; Humphreys, J.; Wakerman, J.; Taylor, J.People living in rural and remote areas face challenges in accessing appropriate health services, many of which struggle to recruit and retain staff. While researchers have documented these issues in Australia and internationally, rural health remains reactive to current problems and lacks comprehensive understanding. This paper presents a conceptual framework that can be used to better understand specific rural and remote health situations. The framework consists of six key concepts: geographic isolation, the rural locale, local health responses, broader health systems, social structures and power. Viewed through Giddens' theory of structuration, the framework suggests that rural health is understood as spatial and social relations among local residents as well as the actions of local health professionals/consumers that are both enabled and constrained by broader health systems and social structures. The framework provides a range of stakeholders with a guide to understanding rural and remote health.Item Metadata only Point-of-Care Testing and Creatinine Measurement(Associated Business Publications Pty Ltd, 2011) Shephard, M.This paper reviews the current status of point-of-care testing (PoCT) devices that are available for measuring whole blood or serum/plasma creatinine globally and within Australasia. Information on non-analytical specifications and analytical performance is provided using data sourced from recently published literature, external quality assurance programs and evaluative work by the author’s unit. The limitations of current devices are summarised.Item Metadata only Health Systems Change in 2010(Common Ground Publishing LLC, 2011) Harvey, P.Whilst health science, epidemiology and public health developments have forged enormous progress in understanding, prevention and cure in the health care area we still appear to lack the motivation to tackle the fundamental antecedents of many of our emerging population-based community health problems; the prevention of chronic illness being a prime example. In spite of much progress in the area of health science, the social, economic and evolutionary forces that cast our physical being in the world still remain poorly understood or accepted in the health care arena. However, if our health care systems are to be manageable and sustainable in the future, these wider antecedents of our health status and wellbeing must be factored more fundamentally in to our management models with more effort being put into preventing lifestyle related chronic illnesses than is currently the case. As in the past where public health infrastructure innovations such as running water and efficient waste disposal systems served to add greatly to the wellbeing of individuals and communities, we now need to make similar efforts to control preventable illnesses such as metabolic syndrome, type 2 diabetes and lifestyle related cardio-vascular disease at their source rather than waiting until the manifestation of these conditions require major medical and chemical intervention and management before we act. Our young people are at risk of early onset chronic conditions as a result of their emerging sedentary lifestyles, un-healthy dietary habits and health related behaviours, yet we continue to concentrate our health management effort on managing those with existing chronic conditions while leaving younger generations with lifestyle practices and behaviours that pre-dispose individuals to developing chronic illness earlier and earlier in their lives. It is time we took notice of these emerging trends and began expending more effort to prevent what are essentially lifestyle related illnesses that can be eliminated before they become endemic. By concentrating more upon the social and environmental factors affecting our illness profiles as well as upon dealing more effectively with those who are already suffering from chronic illness we will reduce the need for major end-stage interventions and alleviate the impact and cost of early onset chronic disease. To achieve this new population health vision in Australia at least, we will not only need to utilize the new government funding structures more effectively; those structures that support coordination and more effective management of care, but also take a much broader, environmental and social view of cause and effect in relation to the health of populations.Item Metadata only A systematic review of the effectiveness of primary health education or intervention programs in improving rural women's knowledge of heart disease risk factors and changing lifestyle behaviours(Blackwell Publishing Asia, 2011) Crouch, R.; Wilson, A.; Newbury, J.Background
Cardiovascular disease is the leading cause of death and disability for women in Australia. Women living in rural areas are at greater risk of heart disease, because of limited access and availability of healthcare in rural areas. Lifestyle is a major determinant to the risk of heart disease. Risk factors such as smoking, hypertension, diet, physical activity and alcohol intake can be controlled or modified by lifestyle changes. As heart disease develops over many years, women need to be following healthy lifestyle practices and reduce their chance of a first or recurrent heart attack.Aim
To determine the effectiveness of primary health education or intervention programs for cardiac risk reduction in healthy women living in rural areas.Inclusion criteria
Types of participants. Women aged 16-65 years, living in rural areas, who participated in primary healthcare education programs. Types of interventions. Primary health education or intervention programs aimed at improving rural women's knowledge of their risk of heart disease, for example group work, videos, telephone, workshops, educational material and counselling. Types of outcomes. Primary outcomes included: • Knowledge level of heart disease risk factors. • Lifestyle modification, for example dietary improvements such as reduced daily salt intake, increased intake of fruit and vegetables and decreased intake of fat, increased frequency of exercise, decreased levels of smoking, alcohol intake within national guidelines. • Health assessment measures, for example blood pressure, body weight, cholesterol levels. Types of studies. Any randomised controlled trials, other experimental studies, as well as cohort, case-control and cross-sectional studies were considered for inclusion. Search strategy. A search for published and unpublished studies in the English language was undertaken.Methodological quality
Each study was appraised independently by two reviewers using the standard Joanna Briggs Institute instruments.Data collection and analysis
Information was extracted from studies meeting quality criteria using the standard Joanna Briggs Institute tools. Although similar outcomes are explored in many of the studies, the variable outcome measures precluded the use of meta-analysis. Data are therefore summarised in tables or by using narrative analysis.Results
Nine trials were included in the review. Three trials compared the effects of interventions on physical activity, one on smoking and five on multiple risk factors. Studies following interventions targeting physical activity reported that women's physical activity can be increased and that these increases can be sustained at 12 months. While there were decreases in blood pressure at 6 months, studies with a 5-year follow up found no decreases for both systolic and diastolic blood pressure. Overall results of studies into dietary modification programs also did not sustain an effect over a longer period of time.Conclusion
The results of this review suggest that in rural areas, lifestyle interventions delivered by primary care providers in primary care settings to patients at low risk appeared to be of marginal benefit. Resources and time in primary care might be better spent on patients at higher risk of cardiovascular disease, such as those with diabetes or existing heart disease.Item Metadata only Towards a conceptual understanding of Aboriginal and Torres Strait Islander community and community functioning(Oxford University Press, 2012) Taylor, J.; Edwards, J.; Champion, S.; Cheers, S.; Chong, A.; Cummins, R.; Cheers, B.This paper reports on research to build concepts about Australian Aboriginal and Torres Strait Islander community and community functioning that might be useful in community development. Three groups of inter-related concepts are presented in this paper; achieving social cohesion, managing community affairs, and imaging a community future. Aboriginal and Torres Strait Islander understandings of community and community functioning differ from Western understandings and there is an imperative to use this knowledge if we are to properly address the serious challenges facing the development of communities. The concepts outlined in this paper are a first step in the development of more refined indicators of Aboriginal and Torres Strait Islander community wellbeing.Item Metadata only Colorectal cancer screening in rural and remote areas: analysis of the National Bowel Cancer Screening Program data for South Australia(Deakin University, 2011) Martini, A.; Javanparast, S.; Ward, P.; Baratiny, G.; Gill, T.; Cole, S.; Tsourtos, G.; Aylward, P.; Jiwa, M.; Misan, G.; Wilson, C.; Young, G.Introduction
In Australia, colorectal cancer is the second most commonly diagnosed cancer and cause of death from malignant diseases, and its incidence is rising. The aim of this article was to present an analysis of National Bowel Cancer Screening Program (NBCSP) data for rural and remote South Australia (SA), in order to identify geographical areas and population groups that may benefit from targeted approaches to increase participation rates in colorectal cancer screening.Methods
De-identified data from the NBCSP (February 2007 to July 2008) were provided by Medicare Australia. Mapping and analysis of the NBCSP data was performed using ESRI ArcGIS (http://www.esri.com/software/arcgis/index.html) and MapInfo (http://slp.pbinsight.com/info/mipro-sem-au). Data were aggregated to postcode and Accessibility/Remoteness Index of Australia (ARIA) and participation was then mapped according to overall participation rates, sex, age, Indigenous status and Socio-Economic Indexes for Areas (SEIFA)-Index of Relative Socio-Economic Disadvantage (IRSD). The participants were South Australians who turned 55 and 65 years between 2007 and 2008 who returned the completed NBCSP test sent to them by Medicare Australia.Results
The overall participation rate was 46.1% in rural and remote SA, although this was statistically significantly different (p<.001) according to sex (46.7% for males and 53.3% for females), age (45.2% for those 55 years, and 52% for those 65 years), socio-economic status (from 43% in 'most deprived' quintile to 50% in 'most affluent' quintile) and remoteness (45.6% for metropolitan, 46% for remote and 48.6% for rural areas). Indigenous participation was 0.5%.Conclusions
The findings of this study suggest lower NBCSP participation rates for people from metropolitan and remote areas, compared with those from rural areas. The uptake of cancer screening is lower for older rural and remote residents, men, Indigenous people, lower socioeconomic groups and those living in the Far North subdivision of SA.Item Metadata only Pneumomediastinum and subcutaneous emphysema in labour: Two case reports(Blackwell Publishing Asia, 2009) Baillie, S.; Newbury, J.Item Metadata only Clinical outcomes of a collaborative, home-based postdischarge warfarin management service(Harvey Whitney Books Co, 2011) Stafford, L.; Peterson, G.; Bereznicki, L.; Jackson, S.; van Tienen, E.; Angley, M.; Bajorek, B.; McLachlan, A.; Mullan, J.; Misan, G.; Gaetani, L.BACKGROUND: Warfarin remains a high-risk drug for adverse events, especially following discharge from the hospital. New approaches are needed to minimize the potential for adverse outcomes during this period. OBJECTIVE: To evaluate the clinical outcomes of a collaborative, home-based postdischarge warfarin management service adapted from the Australian Home Medicines Review (HMR) program. METHODS: In a prospective, nonrandomized controlled cohort study, patients discharged from the hospital and newly initiated on or continuing warfarin therapy received either usual care (UC) or a postdischarge service (PDS) of 2 or 3 home visits by a trained, HMR-accredited pharmacist in their first 8 to 10 days postdischarge. The PDS involved point-of-care international normalized ratio (INR) monitoring, warfarin education, and an HMR, in collaboration with the patient's general practitioner and community pharmacist. The primary outcome measure was the combined incidence of major and minor hemorrhagic events in the 90 days postdischarge. Secondary outcome measures included the incidences of thrombotic events, combined hemorrhagic and thombotic events, unplanned and warfarin-related hospital readmissions, death, INR control, and persistence with therapy at 8 and 90 days postdischarge. RESULTS: The PDS (n = 129) was associated with statistically significantly decreased rates of combined major and minor hemorrhagic events to day 90 (5.3% vs 14.7%; p = 0.03) and day 8 (0.9% vs 7.2%; p = 0.01) compared with UC (n = 139). The rate of combined hemorrhagic and thrombotic events to day 90 also decreased (6.4% vs 19.0%; p = 0.008) and persistence with warfarin therapy improved (95.4% vs 83.6%; p = 0.004). No significant differences in readmission and death rates or INR control were demonstrated. CONCLUSIONS: This study demonstrated the ability of appropriately trained accredited pharmacists working within the Australian HMR framework to reduce adverse events and improve persistence in patients taking warfarin following hospital discharge. Widespread implementation of such a service has the potential to enhance medication safety along the continuum of care.Item Metadata only Rural children's perceptions of child farm safety printed communication strategies(Deakin University, 2007) Bryant, L.; Hoon, E.Introduction: Child farm safety has been identified as a key public health concern in Australia. To date, communication strategies for child farm safety have primarily targeted rural based adults as custodians of children, and because the greatest proportion of deaths occur in pre-school children. However, emerging international literature acknowledges the importance of understanding the perceptions and practices of children and adolescents as active agents for identifying and preventing hazard risks and accidents. This qualitative exploratory study examined how rural students aged 7-12 years read farm safety messages in printed farm safety communication tools, developed predominantly by Farmsafe Australia and Farmsafe Queensland. The study also identifies students’ ideas to improve communication tools. Methods: Seventeen focus groups were conducted in rural-based schools in a number of commodity regions across Australia. There was an average of eight students in each of these focus groups. The sample included children aged between 7 and 12 years. Focus groups were generally split into two age cohorts: 7-9 years (seven focus groups) and 10-12 years (eight focus groups). Two focus groups were conducted with students in a composite age range of 7-12 years, due to the small number of students in those schools. Semi-structured questioning was used to explore students’ perceptions of child farm safety printed communication tools, predominantly developed by Farmsafe Australia. The tools used for discussion were: a poster on the provision of a safe play area and the dangers of moving vehicles; a fridge magnet with dot points used to emphasis five farm based behaviours that address child safety; and a child farm safety educational resource kit developed by Farmsafe Queensland (Safety on the Land), which included activity sheets, stickers and a build-it-yourself money-box. Focus group discussions were audiotaped, transcribed and analysed using qualitative interpretative methods. Results: There was variance in the way children read meanings in child farm safety messages on the poster. In particular, there were misinterpretations of the messages portrayed in the poster by 7-9 years olds. Students found the Safety on the Land kit helpful for delivering the farm-safe message, due to its participatory format. The findings show that the use of cartoon style illustrations and comic formats to communicate child farm safety messages was positively perceived by the age groups in this sample. Conclusions: Farmsafe Australia’s poster was open to varied interpretations by students, some of which missed the safety message altogether. The use of a broad communication tool such as a poster is problematic because it is displayed in public places which, by implication, reach a wide audience. Future design of farm safety communication tools should take into account the views of primary school children as a specific target audience. Students enjoyed the participatory nature of the Safety on the Land kit and made suggestions about how this tool could effect change in behaviour. The findings of the study also indicate the potential effectiveness of cartoon style illustrations and comic formats for delivering child farm safety messages to a target audience of 7-12 year olds.