Australian Journal of Primary Health
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Published By Csiro Publishing

Updated Saturday, 16 October 2021

Michael Crowe ◽  
Lorraine Sheppard

Sarah Haines ◽  
Pallavi Prathivadi

Angela Crombie ◽  
Donna Borkowski ◽  
Marcus Gardner ◽  
Kevin Masman ◽  
Owen Howlett

2021 ◽  
Vol 27 (1) ◽  
pp. 1
Natasha Jennings ◽  
Grainne Lowe ◽  
Kathleen Tori

With 2020 being designated the Year of the Nurse and Midwife, it is opportune to acknowledge and recognise the role that nurses undertake in primary care environments. Nurses and midwives play a pivotal role in the delivery of high-quality health care, particularly in geographically challenged areas of Australia, where they may be the only provider of care within their communities. Rural and remote health services require strategic planning to develop and implement solutions responsive to the challenges of rural and remote communities. Maintenance of health services in rural and remote areas is a challenge, crucial to the equity of health outcomes for these communities. Many small communities rely on visiting medical officers to provide the on-call care to facility services, including emergency departments, urgent care centres, acute wards and aged care facilities. It is increasingly difficult to maintain the current rural workforce models, particularly the provision of after-hours ‘on-call’ care necessary in these communities. An alternative model of health care service delivery staffed by nurse practitioners (NP) is one proposed solution. NPs are educated, skilled and proven in their ability to provide an after-hours or on-call service to meet the expectations of rural and remote communities. Achievement of high-quality health care that is cost-efficient, safe and demonstrates improved patient outcomes has been reported in NP-led health care delivery impact evaluations. The value of an NP locum service model is the provision of a transparent, reliable service delivering consistent, equitable and efficient health care to rural and remote communities.

Raechel A. Damarell ◽  
Deidre D. Morgan ◽  
Jennifer J. Tieman ◽  
David F. Healey

Lynette Mackenzie ◽  
Jeannine Liddle ◽  
Lindy M. Clemson ◽  
Amy C. W. Tan ◽  
Meryl Lovarini ◽  

Eleanor K. L. Mitchell ◽  
Angelo D'Amore

Diana Guzys ◽  
Kathleen Tori ◽  
Carey Mather

Kathryn Ogden ◽  
Emily Ingram ◽  
Joanna Levis ◽  
Georgia Roberts ◽  
Iain Robertson

2021 ◽  
Vol 27 (4) ◽  
pp. 338
Raechel A. Damarell ◽  
Deidre D. Morgan ◽  
Jennifer J. Tieman ◽  
David F. Healey

This study assessed Australian clinical practice guidelines for life-limiting index conditions for the extent to which they acknowledged comorbidities and framed management recommendations within the context of older age and reduced life expectancy. A comprehensive search identified current, evidence-based Australian guidelines for chronic life-limiting conditions directed at general practitioners. Guideline content was analysed qualitatively before comorbidity acknowledgements were quantified using a 17-item checklist. Full guidelines were quality appraised using AGREE-II. Ten documents covering chronic obstructive pulmonary disease, heart failure, cancer pain, dementia and palliative care in aged care were identified. Most guidelines addressed one ‘comorbid’ condition and prompted clinicians to consider patient quality of life and personal preferences. Fewer addressed burden of treatment and half suggested modifying treatments to account for limited life expectancy, age or time horizon to benefit. Half warned of potential adverse drug interactions. Guidelines were of moderate to very high quality. Guidelines naturally prioritised their index condition, directing attention to only the most common comorbidities. However, there may be scope to include more condition-agnostic guidance on multimorbidity management. This might be modelled on the ‘guiding principles’ approach now emerging internationally from organisations such as the American Geriatrics Society in response to increasing multimorbidity prevalence and evidence limitations.

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