Health Services Research

CURRENT

2018-2021

Building on Our Strengths (BOOSt): Developing and Evaluating Birthing On Country Primary Maternity Units

Staff: Professor Lesley Barclay

The project, led by The University of Queensland’s Professor Sue Kildea and researchers from the University of Sydney and the Institute for Urban Indigenous Health, will implement Birthing on Country on a number of sites with a view to an Australia-wide roll out.

Optimal healthcare during the year before and after birth can provide benefits for a lifetime. Our project will deliver this optimal care by implementing and evaluating Birthing on Country Service Delivery Models in urban, regional and remote sites. Birthing on Country combines Indigenous knowledge and governance, culturally safe care, continuity of midwifery carer, birth in an Indigenous birth centre and development of the Indigenous maternal and infant workforce.

Collaborators:

Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) Brisbane, the Waminda South Coast Women’s Health and Welfare Aboriginal Corporation, the Australian College of Midwives, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, and the Rhodanthe Lipsett Indigenous Midwifery Charitable Fund.

Funding:

NHMRC Project Grant $1,090,701.00

 

2017-2020

Developing evidence-based strategies for addressing childhood vaccination rejection.

Staff: Professor Lesley Barclay

Led by Associate Professor Julie Leask, University of Sydney, parental rejection of vaccines is a global concern that threatens to undermine disease control. A lack of evidence hampers the responses to this complex and persistent problem. We will interview parents who don’t vaccinate their children to learn what influences their decisions. We will then hold community juries and a public engagement process to refine strategies for responding to vaccination rejection that is acceptable to a well-informed citizenry, practical and ethically justified.

Collaborators:

NHMRC Centre of Research Excellence in Immunisation in Understudied and Special-Risk Populations

Funding:

NHMRC Project Grant $743,927

 

2017-2019

Do Aboriginal Australians have a lower incidence of low-impact neck of femur fractures compared to Non-Aboriginal Australians?

Staff: Dr Sabrina Pit, Dr Margaret Rolfe

Collaborators:

NNSWLHD (Dr James Wheeler, Craig Knox), Falls, Balance and Injury Research Centre at Neuroscience Research Australia (Professor Jacqui Close).

 

2014-2019   

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

Staff: Dr Sabrina Pit

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 the 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.

Collaborators:

Northern Sydney Medicare Local; Clinical Excellence Commission (Falls Prevention)

Funding:

NHMRC Partnerships. Partnership Project for Better Health $1,132,720.00

 

2014-2019   

Birthing in our Community

Staff involved: Associate professor Megan Passey;  Led by University of Queensland

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.

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.

Funding:

NHMRC Partnership Grant $1,297,911

 

2014-2018   

Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Project

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

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.

Collaborators:

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

Funding:

Mid North Coast Local Health District $140,000 (2014-2015)

North Coast Primary Health Network $95,000 (2014-2015)

NSW Agency for Clinical Innovation $65,000 (2014-2015) and $135,000 (2015-2018)

Western Sydney LHD $180,570 (2015-18)

 

2014-2018   

Improving Implementation of Smoking Cessation Guidelines in Antenatal Care

Staff involved: Associate Professor Megan Passey; Dr Jo Longman; Dr Jennifer Johnston; Dr Margaret Rolfe

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. It then uses the findings to develop interventions to overcome these barriers while leveraging the enablers.

The study uses the Theoretical Domains Framework to ensure a systematic and robust approach to identifying the barriers and enablers. It then uses the Behaviour Change Wheel approach to identify and develop appropriate intervention components. 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.

Collaborators:

Nursing & Midwifery Directorate, Northern NSW Local Health District.

Funding:

NHMRC Early Career Research Fellowship (Passey), $334,596 (2014-2017);

Cancer Institute NSW Early Career Fellowship (Passey), $447,824 (2014-2017)

Cancer Institute NSW Innovations Grant (Northern NSW LHD), $72,000 (2017-2018)

 

2012-2018   

Improving decision making on health interventions: factoring in the long-term economic impacts of informal (unpaid) caring

Staff involved: Associate Professor Megan Passey

This research program, led by Prof Schofield at the NHMRC Clinical Trials Centre at the University of Sydney, estimated the impact of caring for people with long-term conditions on the employment and finances of informal carers.

Collaborators:

Clinical Trials Centre, University of Sydney; NATSEM, University of Canberra; University of Queensland; Pfizer Australia; Carers Australia.

Funding:

NHMRC Partnership Grant (1055037), $609,900; Pfizer Australia, $505,398 plus in-kind; Carers Australia (in-kind)

 

2011-2019   

Rural birthing services

Staff involved: Professor Lesley Barclay; Dr Jo LongmanDr Margaret Rolfe; Ms Sarah Robin

This project provided 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 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.

The project is now investigating the closure of a rural birthing service in Northern NSW and how this has impacted on the local community including women and their families.

Collaborators:

Northern NSW LHD

Funding:

Internal UCRH funding. (2011-2014)

COMPLETED

2017                

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

Staff involved: Ms Elizabeth (Liz) Rix; Professor Lesley Barclay

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.

Collaborators:

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

Funding:

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

 

2017                

Increasing Home Medicine Reviews in Aboriginal and Torres Strait Islander Communities

Staff: Ms Lindy Swain; Professor Lesley Barclay

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.

 

2016-2017

Nambucca Valley Integrated Care Initiative: Social Network Research

Staff involved: Dr Jo Longman; Dr Megan Passey

This project used social network methodology to investigate the integration of physical and mental health services in the Nambucca Valley. The project was part of the MNCLHD’s Nambucca Valley Integrated Care Initiative (NVICI) project evaluation. The purpose of the project was to take a ‘snap shot’ describing the current network of mental and physical health care services in the Nambucca Valley and to investigate the nature of the integration between these services. The findings of the project have contributed to the evaluation of integration initiatives in the NVICI.

Collaborators: University of Sydney’s School of Civil Engineering, Mid North Coast Local Health District (MNCLHD)

Funding:

Mid North Coast Local Health District (MNCLHD)

 

2016                

Networking the nurseries of Australia and New Zealand

Staff involved: Ms Deborah Donoghue; Supervisor: Professor Lesley Barclay

This doctoral thesis investigated 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

 

2015                

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

Staff: Dr Sabrina Pit

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

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

 

2014-2017   

Smoke-free homes

Staff involved: Dr Jo Longman; Dr Megan Passey

For children the primary source of second-hand smoke (SHS) exposure is their home. Nearly 45 per cent of rural households with children contain a smoker, and around 50,000 rural households with children contain someone who smokes inside the home daily. The best way to reduce this SHS exposure would be for household members and/or visitors to quit smoking. For those unable or unwilling to quit, the next best option is making homes completely smoke-free.

However, some households may face significant barriers to establishing a smoke-free home. This research explored the barriers and enablers for families making and maintaining smoke-free homes, including a systematic literature review and qualitative research with rural families. Findings were used to develop health policy recommendations and are being used to develop on-line resources to support families in making their homes smoke-free.

Collaborators:

Northern NSW LHD, Hunter New England Population Health, University of Birmingham (UK), University of Liverpool (UK)

Funding:

NHMRC Early Career Research Fellowship (Passey) $334,596 (2014-2016);

Cancer Institute NSW Early Career Fellowship (Passey) $447,824.

 

2013                

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

Staff: Dr Sabrina Pit

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.

Collaborators:

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

Funding:

Australian Government Department of Health and Ageing, NHMRC

 

2012-2016   

The Australian Rural Birthing Index

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

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 in Australia.  We 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.  The ARBI was validated with an expert group who critiqued and guided our work from the beginning.

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

View/download Toolkit

Collaborators:

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

Funding:

NHMRC, $473,512 (2012-2014)

 

2011-2014   

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

Staff involved: Associate Professor Geoff Morgan; Dr Margaret Rolfe

Lead by Prof Kerry Mengersen from the Queensland University of Technology, this project was funded by the Cooperative Research Centre for Spatial Information (CRCSI) and furthered our understanding and management of disease through the development and application of new ways of modelling disease data and potential explanatory variables, new ways of visualising the results of these models, and new ways of using the models for cost-effective allocation of resources and services.

Associate Professor Morgan also co-supervised a PhD candidate who is applying these new methods to an assessment of the factors influencing multiple hospital admissions for diabetes in North Coast NSW.

Collaborators:

University of Sydney, Queensland University of Technology

Funding:

Cooperative Research Centre for Spatial Information $510,000

 

2011-2012   

Breast-feeding in Australia

Staff involved: Professor Lesley Barclay; Dr Jo Longman; Dr Margaret Rolfe

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.

Collaborators:

University of Western Sydney, Avondale College and Griffith University

Funding:

Internal UCRH funding

 

2010-2012   

Understanding frequent hospitalisations of older people (UFHOP)

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

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.

Collaborators:

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

Funding:

NSW Institute of Rural Clinical Services and Teaching (now HETI) $97,0000

Internal UCRH funding

 

2009-2012   

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

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

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”.

Collaborators:

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

Funding:

Department of Health and Ageing $620,000

 

 

2007-2009   

Health Improvement and Prevention Study (HIPS)

Staff involved: Dr Megan Passey; Ms Liz Rix

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.

Collaborators:

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

Funding:

NHMRC (455268), $722,700

 

2007-2012   

The 1 plus 1 study; a Healthy Start to Life

Staff involved: Professor Lesley Barclay

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. This project was awarded one of NHMRC’s 10 best projects in 2014.

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 20 publications with one paper in preparation.

 

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

 

Funding:

NHMRC Health Start to Life Grant 380.000.

Bori Leiberman award to a PhD scholar, 3 NHMRC PhD scholarships. (2007-2012)