Health Services Research

Health Services Research

Working with policy makers, managers and practitioners, our research addresses identified priority areas. Our work includes research designed to better understand the health service needs of rural communities, as well as the development and evaluation of innovative models of care that meet these needs.

Current Health Services Research Projects

Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Project

The number of potentially preventable hospitalisations (PPH) continues to grow. Although hospital funding is tied to rates of PPH, the validity of PPH as an indicator of effectiveness or access to care has not been confirmed, and the proportion of PPH admissions that is deemed to be preventable is unknown. Furthermore, the factors contributing to PPH admission are unclear, limiting our ability to develop and target appropriate interventions.

This project aims to generate an evidence base identifying modifiable factors driving PPH admissions for chronic conditions, in order to improve measures of health system performance and develop effective interventions to reduce preventable admissions.

Funding: Mid North Coast Local Health District, $140,000 (2014-2015); North Coast Medicare Local, $65,000 (2014-2015); NSW Agency for Clinical Innovation, $65,000 (2014-2015) and $135,000 (2015-2017), Western Sydney LHD, $180,570 (2015-17)

Staff involved: Dr Megan Passey, Dr Jo Longman, Dr Jennifer Johnston, Associate Professor Geoff Morgan, Professor Lesley Barclay, Dr Sabrina Pit, Dr Margaret Rolfe, Dr Liz Rix, Elayne Mitchell

Collaborators: University of Western Sydney, North Coast Primary Health Network, Mid North Coast Local Health District, Western Sydney Local Health District, NSW Agency for Clinical Innovation.

The Australian Rural Birthing Index

A large number of maternity units across rural and remote Australia have been closed over the last decade, without evidence. In response to similar closures in Canada colleagues established a tool (the Rural Birthing Index [RBI]) to assess whether birthing units were ‘needed’ locally or should close.

We, with our Canadian colleagues, were successful in getting an NHMRC grant to test this tool here and have mapped catchments for all birthing services and a range of non-birthing facilities for rural populations of between 1,000 and 25,000 across Australia; applied the Canadian RBI to these Australian birthing services and developed a slightly ‘tweaked’ A[Australian]RBI; and undertaken substantial validation of the ARBI tool with an expert group who has critiqued and guided our work from the beginning.

The ARBI study has developed an evidence-based Toolkit to assess and plan the appropriate level of maternity services for rural and remote communities. The Toolkit is intended for use by planners and communities and is available for downloading and sharing.

View/download Toolkit

Funding: NHMRC, $473,512 (2012-2014)

Staff involved: Professor Lesley Barclay, Associate Professor Geoff Morgan, Dr Margaret Rolfe, Dr Jo Longman, Dr Deborah Donoghue, Ms Jen Pilcher, Ms Sarah Robin

Collaborators: University of Melbourne, University of Queensland and health service personnel from WA, NT, Qld and NSW.

Establishing pathways to implement and sustain evidence based fall prevention in primary care: The iSOLVE project. Integrated SOLutions for sustainable fall preVEntion (iSOLVE)

This project, led by Professor Lindy Clemson from the Ageing, Work & Health Research Unit at the University of Sydney, aims to implement and evaluate a pathways model to facilitate practice change by general and allied health professionals to achieve evidence-based fall prevention outcomes.

The model will be integrated within one region, the Northern Sydney Medicare Local and also partners with the Clinical Excellence Commission (Falls Prevention). The implementation project includes development of pathways, integration of evidence based falls prevention, facilitating training of health professionals, educational detailing of GPs, application of risk management algorithm to identify fallers into GP practices, embedding referral strategies within GP practices and establishing pathways to fall prevention services. The iSOLVE project incorporates a hybrid evaluation design including a cluster randomised trial, and a process and an ecological evaluation. The aim is to implement a sustainable area wide fall prevention model.

Staff: Dr Sabrina Pit

Funding: NHMRC Partnerships. Partnership Project for Better Health. $1,132,720.00 (2014-2019)

Collaborators: Professor Lindy Clemson, Professor Catherine Sherrington, Associate Professor Chris Roberts, Associate Professor David Peiris, Associate Professor Karen Willis, Associate Professor Lynette Mackenzie, Dr Sabrina Pit, Dr Roslyn Poulos, Dr Mary Lam, Dr Meryl Lovarini, Associate Professor Helena Britt, Professor Judy Simpson, Dr Anne Tiedemann, Professor Constance Pond, Professor Liaquat Hossain.

Aboriginal e-Social and Emotional Wellbeing Project

As part of a national federally funded ‘e-mental health project (eMHPrac)’, the UCRH is working with local Aboriginal and Torres Strait Islander service providers and community members to promote the use of ‘e-mental health/social and emotional wellbeing programs.

e-wellbeing programs’ include social and emotional wellbeing apps and online mental health programs. This will be achieved by developing and conducting a training program for Aboriginal health professionals and others working with Aboriginal and Torres Strait Islander people to promote and support the use of e-wellbeing programs with their clients.

Funding: Department of Health and Aging: national $6.5 million funded project (e-MHPrac) (2013-2016)

Staff involved: Associate Professor James Bennett-Levy, Ms Darlene Rotumah, Dr Judy Singer; Ms Liz Lewis

Collaborators: Lismore and Tweed Advisory Groups; Queensland University Technology; Menzies School of Health Research; the Royal Flying Doctor Service; the Black Dog Institute (UNSW) and Australian National University, Canberra

Increasing Home Medicine Reviews in Aboriginal and Torres Strait Islander Communities

Home Medicine Review (HMR) has been found to be an important tool to raise patients’awareness of medication safety, reduce adverse events and improve medication adherence.

Aboriginal and Torres Strait Islander people are under-serviced by the HMR program and are the most likely of all Australians to miss out on HMRs, despite their high burden of chronic disease

The research explored Aboriginal and Torres Strait Islander patients’ perspectives of the Home Medicines Review program. It also explored the perspectives of health professionals working at Aboriginal Health Services and surveyed the views of HMR accredited Pharmacists.

Findings will be used to suggest an improved or more readily accessible model of service for Aboriginal and Torres Strait Islander People.

Staff: Ms Lindy Swain, Professor Lesley Barclay

Birthing in our Community

This study aims to improve maternal and infant health (MIH) outcomes for Aboriginal and Torres Strait Islander Australians. A maternity care model integrating best practice MIH care which is culturally tailored to the needs and preferences of Indigenous women will be implemented and rigorously evaluated.

Key components include: a multi-agency Steering Committee; shared clinical governance with Indigenous cultural guidance and oversight; an enhanced community based midwifery group practice for continuity of care through pregnancy, birth and up to six weeks postnatally; and an innovative smoking cessation program using incentives. This research will provide high level evidence to inform both policy and practice in providing innovative best-evidence MIH care. The UCRH is leading the smoking cessation component, which will include the ‘Stop Smoking in its Tracks’ program previously developed.

Funding: NHMRC Partnership Grant, $1,297,911 (2014-2019)

Staff involved: Dr Megan Passey

Collaborators: University of Queensland, the Institute of Urban Indigenous Health, the Mater Mothers Hospital, and the Brisbane Aboriginal and Torres Strait Islander Community Health Service

Rural birthing services

This project aims to provide a detailed description of the evolution of two small rural birthing services in Northern NSW over the last 10 years using both qualitative and quantitative data.

The project has directly involved a number of medical students in the data collection, analysis and writing up, who have learned a significant amount about research practice in the process.

Funding: Internal UCRH funding. 2011-2014

Staff involved: Professor Lesley Barclay, Dr Jo Longman,  Dr Margaret Rolfe and Ms Sarah Robin

Collaborators: Northern NSW LHD

Improving Implementation of Smoking Cessation Guidelines in Antenatal Care

Smoking during pregnancy causes significant health problems for both mother and baby. This study explores the barriers and enablers for clinicians in implementing antenatal smoking cessation guidelines in public antenatal clinics across NSW.

The study uses the Theoretical Domains Framework to ensure a systematic and robust approach to collecting and analysing data. The findings will improve support for smoking cessation among pregnant women through the identification of interventions and strategies to enhance smoking cessation guideline implementation, and will inform the design of an implementation trial.

Funding: NHMRC Early Career Research Fellowship (Passey), $334,596 (2014-2016); Cancer Institute NSW Early Career Fellowship (Passey), $447,824

Staff involved: Dr Megan Passey, Dr Jo Longman, Dr Jennifer Johnston

Collaborators: Nursing & Midwifery Directorate, Northern Sydney Local Health District.

Avoiding the ‘costly’ crisis: Informing renal services design and delivery for Aboriginal people in rural New South Wales

The incidence of chronic kidney disease progressing to end-stage kidney disease is at least eight times higher for Aboriginal people than the non-Aboriginal population. Rural patients are often forced to travel or relocate to access dialysis. The resulting dislocation and disruption to families and communities can be devastating. This PhD study aimed to inform renal services improvement for Aboriginal people.

Earlier screening, an Aboriginal specific pre-dialysis pathway, increased renal nurse support for home dialysis and employing a renal specific Aboriginal support person to help address shortfalls in cultural safety within hospitals are among the findings that can inform health services improvement.

Funding: Clinical Excellence Commission: The Ian O’Rourke Scholarship in patient safety

Staff involved: Ms Elizabeth (Liz) Rix

Collaborators: A Community Reference Group of Bundjalung Elders, Aboriginal renal patients and Aboriginal health workers.

Networking the nurseries of Australia and New Zealand

This doctoral thesis investigates the elements to ensure a successful and sustainable clinical network using the Australian and New Zealand Neonatal Network as an example.

Funding: NHMRC post graduate public health scholarship Staff involved: Ms Deborah Donoghue. Supervisors: Professor Lesley Barclay, Dr Shawn Wilson

Evaluation of the Bowraville Safe Families Project

The incidence of serious injury among Aboriginal communities is significantly higher than in non-Aboriginal populations. The Bowraville Safe Families Project will provide a whole of community, strengths-based program utilising education, community capacity building and increased community awareness to address family violence within the Aboriginal Community.

This project aims to improve the wellbeing of Aboriginal people within the Bowraville,NSW Community. The UCRH is contracted to evaluate the project. The evaluation will assess evidence of the implementation and effectiveness of the project, how well it engaged with diverse sectors of the Bowraville Aboriginal community, and whether it may be transferable to other Aboriginal communities.

Funding: NSW Ministry of Health, $250,788 for project, $50,000 to UCRH for evaluation (2013-2015)

Staff involved: Dr Megan Passey, Ms Elizabeth (Liz) Rix

Collaborators: Miimi Aboriginal Corporation; Nambucca Valley Phoenix; NSW Ministry of Health; Department of Aboriginal Affairs; Education Centre Against Violence (ECAV); NAPCAN; North Coast Institute of TAFE; Mid North Coast Local Health District; NSW Police – Northern Region; Interrelate Family Centre.

 

Recently Completed Health Services Research Projects

The 1 plus 1 study; a Healthy Start to Life

This health services research project used mixed methods and numerous sub studies designed to stimulate sustainable health service reform. It was a five-year collaborative program between stakeholders and researchers that consisted of baseline studies that informed reform and evaluation projects that occurred later in the grant.

The target and setting was improvement in the maternity services for remote-dwelling Aboriginal women and their infants in the Top End of Australia. The study also focused on capacity building and has prepared an Honours student, two completed and two continuing doctorates, and spawned another related study with a fifth PhD student. The study has produced 13 publications with another three papers in preparation.

Funding: NHMRC Health Start to Life Grant, 380.000. Bori Leiberman award to a PhD scholar, 3 NHMRC PhD scholarships. (2007-2012)

Staff involved: Professor Lesley Barclay, Dr Sarah Bar-Zeev ( PhD completed 2014) Dr Malinda Steenkamp (PhD completed 2013) Ms Cath Josif PhD student, Associate Professor Terry Dunbar (PhD student enrolled at Charles Darwin University)

Collaborators: NT Steering Group, Charles Darwin University, Menzies School of Health Research, University of Queensland, Mater Research Institute, Women’s Hospital Melbourne, Maningrida and Wadeye Elders

Older rural people with chronic conditions who have frequent and/or avoidable hospital admissions

The rising number of older people with chronic conditions being admitted to hospital is a significant and complex issue facing health services in Australia, particularly in rural areas, and internationally. Frequent hospital admissions that are potentially avoidable stretch health services and budgets, and directly impact upon patients and their carers/families.

In this pilot project, the UCRH worked closely with local health and community services, and patients, to better understand the factors associated with frequent and/or avoidable admissions in rural northern NSW. This work identified that this is a complex topic, and clarified what we have yet to learn. The work forms a strong foundation for our “DaPPHne” project which aims to conduct more comprehensive research with this group of patients.

Funding: NSW Institute of Rural Clinical Services and Teaching (now HETI) $97,0000 (2010-2012) and internal UCRH funding

Staff involved: Associate Professor Geoff Morgan, Dr Jo Longman, Dr Kathy Heathcote, Dr Megan Passey, Dr Margaret Rolfe, Professor Lesley Barclay, Dr Judy Singer, Ms Liz Rix

Collaborators: North Coast NSW Medicare Local, North Coast Area Health Service, Northern Rivers GP Network

Complementary Therapies (CTs) in Public Health: A pilot scoping study

This study investigated the role and perspectives of Managers of public healthcare services that have included complementary and alternative medicine (CAM) as part of their overall service delivery. The research is the first study to specifically investigate the role of health service managers (HSM) in facilitating effective integrative healthcare practice. HSMs from seven services were interviewed.

The services addressed trauma and chronic conditions and comprised: five community-based programs, including drug and alcohol rehabilitation, refugee mental health and women’s health; and two hospital-based specialist services. The CAM practices included in the investigated services included acupuncture, naturopathy, Western herbal medicine and massage.

Funding: Primary Health Care Research Evaluation Development (PHCRED) – Research Development Program (RDP) under the clinical research stream (12 month position): $34,400 (2011).

Staff involved: Dr Judy Singer

Collaborators: University of Technology Sydney

beyondblue: Development of an Action Research Design and Implementation Plan for a Men’s Specific Low-Intensity Psychological Support Service

This scoping study explored a new kind of self-help mental health approach, designed specifically for men, called low intensity cognitive behaviour therapy (LI-CBT). People engaged in LI-CBT are supported to use internet-based or written self-help materials. The study consulted consumers and service providers as to how this service might work to best effect, exploring possible advantages and disadvantages, what might encourage or discourage men to use it, and how LI-CBT fits with current service activities and culture.

The outcome of this study was used to help design a pilot a program ‘New Access’, implemented by beyondblue in 2014 across three sites, including within the North Coast Medicare Local.

Funding: beyondblue, $140,000 (2011-2012)

Staff involved: Associate Professor James Bennett-Levy; Dr Judy Singer

Collaborators: Queensland University of Technology

beyondblue: Increased Access to Psychological Therapies (IAPT) Study

The advent of new technologies has opened the way for new forms of mental health services that can potentially increase access and choice for people with mild to moderate depression and anxiety, especially those in remote and rural communities. These services are known as ‘low intensity cognitive behavioural therapy’ (LI-CBT) interventions. This feasibility study aimed to establish the framework and procedures for the implementation of a LI-CBT service in a rural Australian context by consulting with local service providers and consumers.

The outcomes of this study informed the design and implementation of the 2011-12 beyondblue study and the ‘New Access’ program delivered through the North Coast Medicare Local in 2014.

Funding: beyondblue $292,000 (2009)

Staff involved: Associate Professor James Bennett-Levy; Dr Judy Singer

Collaborators: Flinders University

Aboriginal Cognitive Behavioural Therapy project (2009-2012)

The advent of new technologies has opened the way for new forms of mental health services that can potentially increase access and choice for people with mild to moderate depression and anxiety, especially those in remote and rural communities. These services are known as ‘low intensity cognitive behavioural therapy’ (LI-CBT) interventions. This feasibility study aimed to establish the framework and procedures for the implementation of a LI-CBT service in a rural Australian context by consulting with local service providers and consumers.

The outcomes of this study informed the design and implementation of the 2011-12 beyondblue study and the ‘New Access’ program delivered through the North Coast Medicare Local in 2014.

Funding: beyondblue $292,000 (2009)

Staff involved: Associate Professor James Bennett-Levy; Dr Judy Singer

Collaborators: Flinders University

A randomised trial of a low intensity intervention model within a university health service to improve the mental health of students

Low intensity CBT interventions are a way to greatly increase access to evidence-based psychological therapies. Instead of one-to-one therapy with a specialist therapist, low intensity therapies package the ‘therapeutic expertise’ within online or book-based materials, and provide ‘guided self-help’ to support the person doing a low intensity therapy program.

This project, led by UQ and QUT, evaluated the impact of low intensity interventions in a student counselling service, with support provided by graduate psychologists. The random controlled trial demonstrated a positive impact of the intervention.

 

Funding: Australian Rotary Health, $78,000

Staff involved: Associate Professor James Bennett-Levy

Collaborators: University of Queensland, QUT

Supporting Mums to Quit: Smoking intervention research for pregnant rural Aboriginal women

Smoking rates among pregnant Aboriginal women are known to be three times higher than for pregnant non-Indigenous women. This has significant adverse consequences for both mothers and babies. The UCRH worked closely with local services and a community reference group to identify the factors contributing to the high rates of smoking as well as the preferences of Aboriginal women for quit-smoking supports.

Based on these findings and international evidence, we developed and pilot tested a smoking cessation program for pregnant Aboriginal women – “Stop Smoking in its Tracks”.

Further research on this quitting program is planned.

Funding: Department of Health and Ageing, $620,000 (2009-2012)

Staff involved: Dr Megan Passey, Associate Professor Janelle Stirling, Ms Jenny Gale

Collaborators: University of Newcastle, NSW Aboriginal Maternal and Infant Health Services, Community Reference Group

Evaluation of the Nimbin Integrated Services project

This project evaluated an innovative mental health service based in Nimbin on the far North Coast of NSW. The evaluation provided evidence of the effectiveness of the service as well as appraising the extent to which the model might be applied to other rural sites.

Funding: NSW Department of Premier and Cabinet $30,000, UCRH internal funds (2012)

Staff involved: Dr Jo Longman, Ms Frances Barraclough, Dr Margaret Rolfe, Dr Gao Yu and Professor Lesley Barclay

Collaborators: All steering committee members of the Nimbin Integrated Services project, in particular including the Northern NSW LHD and Department of Premier and Cabinet.

Breast-feeding in Australia

In this research we undertook a new analysis of the first nationally consistent Australian data set reporting breast-feeding practices of Australian women, and explored major policy initiatives and the establishment and growth of lactation consultants in Australia to see what differences this may have made to rates of breast feeding at six months.

We found that the considerable effort invested in trying to improve duration of breast-feeding amongst women in Australia appeared to have failed to improve sustained breast-feeding rates, and argued that this might be because we as a society have lost sight of the importance of the relationship between mother and baby, knowledge and skills of mothers and loss of woman to woman support.

Funding: Internal UCRH funding. 2011-2012

Staff involved: Professor Lesley Barclay, Dr Jo Longman and Dr Margaret Rolfe

Collaborators: University of Western Sydney, Avondale College and Griffith University

Health Improvement and Prevention Study (HIPS)

Lifestyle risk factors such as smoking, poor nutrition, overweight, inactivity and excessive alcohol consumption place many Australians at increased risk of cardiovascular disease and other health problems.

This large cluster, randomised controlled trial was led by Prof Mark Harris at the University of NSW. The study tested the effect of a lifestyle intervention provided within primary health care settings to reduce these risk factors.

Funding: NHMRC (455268), $722,700, (2007-2009).

Staff involved: Dr Megan Passey, Ms Liz Rix

Collaborators: University of NSW; Broken Hill UDRH, University of Sydney; NSW Health; Divisions of General Practice

Accuracy of self-reported medicines use compared to pharmaceutical claims data amongst a national sample of older Australian women.

This study assessed agreement between two measures of medicine use: self-report by mail; and pharmaceutical claims data, for a national sample (N = 4687) of older women aged 79 to 84 in 2005, from the Australian Longitudinal Study on Women’s Health. Medicines used for common chronic diseases in older people were selected, with pharmaceutical claims data retrieval periods of three and six months.

 

Women were least able to accurately report use of nervous system medicines, and most accurately report glucose lowering medicines use. Women could accurately report using a medicine. Pharmaceutical claims data can assist evaluation of judicious medicines use, changes to availability and uptake of medicines, and track medicine expenditure for chronic conditions. Over-the-counter medicines, medicines not covered by pharmaceutical subsidies and those used on an as-needed basis may be best measured by self-report, as use may be underestimated using pharmaceutical claims data.

 

Funding: Australian Government Department of Health and Ageing, NHMRC

Staff: Dr Sabrina Pit

Collaborators: University of Newcastle (Dr Xenia Dolja-Gore, Professor Lynne Parkinson, Professor Anne Young, Professor Julie Byles.

The Effectiveness Analysis of Local Infiltration Analgesia (LIA) for Total Knee Replacement Surgery

This study determined the effectiveness of Local Infiltration Analgesia (LIA) for Total Knee Replacement Surgery among patients in the Northern Rivers.

Staff: Dr Sabrina Pit

Collaborators: Orthopaedic registrars (Dr Mayuran Suthersan (Lead), Dr Mark Loman) Northern Rivers Local Health District (Ms Loris Gordon), Private consultants: (Dr Brian Pezzutti, Dr Richard Freihaut).


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