Basic life support knowledge and skills of Iranian general dental practitioners to perform cardiopulmonary resuscitation

Background:

When cardiopulmonary arrest occurs, the dentist''s ability to perform cardiopulmonary resuscitation (CPR) is the most important factor to minimize morbidity and mortality. This study assessed the basic life support (BLS) knowledge and performance of general dental practitioners in Hamadan, Iran.

Materials and Methods:

The participants in the study were 80 Iranian general dental practitioners who were chosen randomly. Their CPR knowledge was evaluated by verbal questions and their CPR skills were determined by CPR execution on a special manikin. Nearly 39% (n = 31) of dentists answered none of the questions and only 2.50% (n = 2) answered all of the questions correctly. Thirty six dentists had been participated CPR course after graduation.

Result:

There was a significant difference between dentists who participated in CPR training course and those that did not participate (P value = 0.000). Only 3.75% (n = 3) were able to perform CPR properly.

Conclusion:

The results showed that the amount of CPR knowledge and skills were low in participated Iranian general dental practitioners. However, CPR training courses after graduation increased the amount of knowledge significantly, thus, retraining CPR courses is necessary for dentists.     

Knowledge,awareness and practice regarding needle stick injuries in dental profession in India: A systematic review

Background:

Hundreds of thousands of healthcare workers remain susceptible to deadly viruses throughout the year, including blood-borne pathogens. Needle stick injuries (NSI) constitute one of the most common occupational health hazards in healthcare profession. Dental professionals are at more risk of acquiring NSI due to their limited and restricted working area. The present systematic review was carried out to determine knowledge, awareness and practice regarding NSI in dental professionals and students in India.

Materials and Methods:

A systematic review of cross-sectional studies available in the literature on the knowledge, attitude and practice among dental professionals and students in India was carried out. We identified relevant articles through electronic and manual search such as Pubmed and MEDLINE. Two investigators independently identified studies that were included in the review.

Results:

Four articles were finally selected for inclusion in the review. All the studies were done involving dental students; 89.23% of the students had correct knowledge about NSI and 91.55% of the students had adequate level of awareness regarding its management in one of the studies. Also, 89% of students in one of the studies were aware of taking post-exposure prophylaxis after accidental NSI. In another study, 44% of the students destroyed the needles using a needle destroyer and 15% destroyed them in puncture-resistant containers.

Conclusion:

The knowledge and awareness of the dental students is adequate, although there is considerable variation in practice and management of NSI among different studies. There is a need for more studies involving dental professionals.     

Does concern about halitosis influence individual's oral hygiene practices?

Objective:

The objective of this study was to assess whether the concern about halitosis influence oral health attitude and practices among young literate adults in Nigeria.

Materials and Methods:

This cross-sectional survey of 400 randomly selected temporary camp resident adults in Anambra state, South Eastern Nigeria was conducted using a modified version of the Hiroshima University-Dental Behavioral Inventory questionnaire.

Results:

Out of the 400 questionnaires distributed, only 294 were filled and returned giving an overall response rate of 73.5%. Half (50.0%) of the participants in this study expressed concern about halitosis. The participants that expressed concern about halitosis were mostly in the 25- to 27-year-old age group, females, known smoker, regular dental floss, and mouth wash users, had incorrect tooth brushing knowledge, brushed teeth more frequently and more forcefully, had no previous dental treatment, prefer symptomatic dental visit, experienced gingival bleeding, expressed worry about the color of their gingiva and teeth but were satisfied with the dental appearance.

Conclusion:

Data from this study showed that concerns about halitosis-triggered behavioral reaction in oral self-care practices namely tooth brushing frequency, tooth brushing force, mouth wash, and dental floss use. Also revealed were poorer oral health and lower preventive dental visit practices among participants concerned about halitosis. There is need for improved public knowledge and awareness about halitosis by the dentist in Nigeria.     

Parental knowledge,attitudes and perceptions regarding infant basic life support

INTRODUCTION

Out-of-hospital cardiopulmonary arrest (CPA) in children is rare but significant, with poor survival rates and high morbidity. Asystole is the most common dysrhythmia, and cardiopulmonary resuscitation (CPR) is of great importance in such cases. We aimed to survey the knowledge, attitudes and perceptions of parents in Singapore regarding infant basic life support (IBLS).

METHODS

A questionnaire survey was administered to parents of children managed at the Neonatal Department of Singapore General Hospital, Singapore, between 1 September and 31 December 2008. The questionnaire consisted of three sections – section A collected demographic data, section B included questions on knowledge, and section C explored attitudes and perceptions. Knowledge T-scores were analysed for the entire cohort and subanalysed with respect to prior IBLS training.

RESULTS

In our study cohort (n = 375), the median Basic Knowledge (BK) T-score was 7 (range 1–9) and the pass rate was 55%. Median BK T-scores were significantly different between untrained (6; range 3 –9) and previously trained (8; range 3–9) participants. A majority of the trained participants obtained pass marks. Median Total Knowledge T-score, involving advanced questions, for previously trained participants was 11 (range 3–14), but pass rate was low (35.7%). Higher educational qualification was a significant factor impacting all scores. Untrained participants indicated interest in attending IBLS courses, while trained participants were interested in refresher courses.

CONCLUSION

IBLS training, as part of basic cardiac life support training, is important given that CPR can significantly alter the outcome in children with CPA. Our survey revealed knowledge gaps that could be bridged through formal training. Refresher courses to regularly update parents’ knowledge are recommended.     

Oral self-care practices among university students in Port Harcourt,Rivers State

Background:

The maintenance of optimum oral health is dependent on the efficacy of oral self-care. The objective of the present study was to evaluate oral self-care practices and knowledge among non-medical students at the University of Port Harcourt, Rivers State Nigeria.

Materials and Methods:

The cross-sectional survey was conducted among undergraduate students at the University of Port Harcourt Nigeria, in January, 2014. Self-administered questionnaire elicited information on demography, frequency of tooth brushing, type of tooth brush, use of dental floss and previous visit to the dentist.

Results:

A total of 360 young adults, 188 males and 172 females, aged 18-33 years participated in the study. Brushing habits of the study population was at least once a day (90%). Approximately half (52.5 %) of the samples used medium-sized bristles and about 28.8% of the students replaced their toothbrush every 3 months. Regarding oral hygiene aids, few students, 5.8% and 4.2% used dental floss and mouthwash, respectively, as oral cleaning aid. Most of the students (71.6%) had never visited the dentist, 18.1% visited due to dental pain and 8.1% for extraction. Regarding knowledge on oral hygiene practice, approximately 60% of students knew that we have to brush our teeth twice daily, 31% knew we need to visit the dentist twice a year and only 18% knew what was dental floss.

Conclusion:

Oral hygiene practices among the students were poor. Therefore, oral health education and promotion is required to improve oral hygiene practices and health among young adults and the general population.     

Techniques to administer oral,inhalational, and IV sedation in dentistry

Background

Sedation in dentistry is a controversial topic given the variety of opinions regarding its safe practice.

Aims

This article evaluates the various techniques used to administer sedation in dentistry and specific methods practiced to form a recommendation for clinicians.

Methods

An extensive literature search was performed using PubMed, Medline, Google Scholar, Google, and local library resources.

Results

Most of the literature revealed a consensus that light sedation on low-risk American Society of Anesthesiologists (ASA) groups, that is ASA I, and possibly II, is the safest method for sedation in a dental outpatient setting.

Conclusion

Formal training is essential to achieve the safe practice of sedation in dentistry or medicine. The appropriate setting for sedation should be determined as there is an increased risk outside the hospital setting. Patients should be adequately assessed and medication titrated appropriately, based on individual requirements.     

Denture care practice among patients attending the prosthetic clinic in a Nigerian teaching hospital

Background:

Good denture care practice by individuals using Removable Partial Denture (RPD) is an important component of oral health measures. An assessment of denture care practice of such individuals by dental care practitioners is necessary.

Objective:

To evaluate the denture care practice among prosthetics patients attending a tertiary Hospital Dental Centre in Nigeria.

Materials and Methods:

An interviewer administered questionnaire was used to obtain information from RPD wearers that were willing to participate. The questionnaire assessed among other things, patients’ bio-data, frequency, techniques and device used for cleaning their dentures. Data was analyzed using Chi-square test (P < 0.05).

Results:

One hundred and ninety eight denture wearers consisting of 100 (50.5%) males and 98 (49.5%) females participated in the study. Majority 110 (55.6%) cleaned their dentures once daily and toothbrush and pastes were used by 105 (53%) of the participants. More than 70% of the respondents removed their dentures at night. One hundred and sixty-six (83.8%) visited the dentist only when they needed treatment. There was a statistical significant relationship between frequency and technique of cleaning denture, and denture cleanliness (P < 0.05).

Conclusion:

This study shows that once daily cleaning of dentures and cleaning the denture with rest of the teeth are ineffective in prevention of plaque accumulation.     

Antibiotic prophylaxis against infective endocarditis in adult and child patients: Knowledge among dentists in Saudi Arabia

Objectives:

To evaluate dentists’ knowledge regarding the prevention of infective endocarditis in Saudi Arabia and their implementation of the 2007 American Heart Association guidelines.

Methods:

In this cross-sectional study, in March 2014, 801 dentists who practice in different regions of Saudi Arabia completed a questionnaire regarding the need for antibiotic prophylaxis for specific cardiac conditions and specific dental procedures, prophylaxis regimens in adults and children, and recommendations for patients on chronic antibiotics, and in dental emergencies. The data were analyzed using one-way analyses of variance (ANOVAs) and independent t-tests, and a p-value <0.05 was considered statistically significant.

Results:

The total knowledge level regarding antibiotic prophylaxis among all participants was 52.2%, with a significant difference between dentists who graduated before and after 2007. Comparing the level of knowledge among different dental specialists, surgeons and periodontists had the highest level of knowledge regarding the use of antibiotic prophylaxis. Amoxicillin was prescribed as the drug of choice by 63.9% of the participants.

Conclusion:

This study emphasized the need for continuous education and for formal inclusion of the guidelines in the students’ curriculum, as well as for strategic placement of the guidelines in locations throughout dental clinics.Infective endocarditis (IE) is a rare, potentially life-threatening infection of the heart valves or endocardium, and it is often found in association with congenital or acquired cardiac defects. Despite advances in IE diagnosis, antimicrobial therapy, surgical techniques, and the management of complications, high morbidity and mortality rates continue to be associated with this infection.1 The basic pathology of IE involves turbulent blood flow produced by certain types of congenital or acquired heart disease that can traumatize the endothelium, resulting in the deposition of platelets and fibrin on the damaged endocardium or endothelial surface.2 This deposition can result in the formation of sterile vegetation, a condition known as nonbacterial thrombotic endocarditis.2 Invasion of the bloodstream by microbes that can colonize these damaged sites can result in IE.1 The focus of infection is determined by the ability of various microbial species to adhere to specific anatomical sites.3 Once attached to an anatomical focus, these microorganisms stimulate further deposition of fibrin and platelets on their surfaces. After they are buried, the microorganisms can multiply rapidly, apparently uninhibited by host defenses.3 Manipulation of the teeth and periodontal tissues leads to bacteremia. Different dental procedures have been associated with a broad variation in the frequency, duration, and magnitude of bacteremia.3 For this reason, many published studies have focused on prevention or on decreasing the magnitude and/or duration of bacteremia using antimicrobial agents. Amoxicillin has had a significant impact on reducing the incidence, nature, and duration of bacteremia caused by dental procedures, but it does not eliminate the bacteremia.4-6 The data from Saudi Arabia on the epidemiology of IE is lacking due to the absence of nationwide epidemiological studies. In a review of more than 10 years of data, Nashmi and Memish7 reported that rheumatic heart disease remained the most common valvular heart disease in Saudi Arabia. In a study performed in 2006 that assessed the practice of antibiotic prophylaxis for bacterial endocarditis among Riyadh dentists,8 the findings showed that 96.9% of respondents were using prophylactic antibiotics in patients susceptible to IE.The American Heart Association (AHA) has regularly reviewed and revised its guidelines for the prevention of IE since 1955, and the most recent guidelines were published in 2007.3,9-16 There has been a paucity of information in published studies regarding dentists’ knowledge of IE prevention in Saudi Arabia. Therefore, the aim of this study was to evaluate the knowledge of dentists regarding the prevention of IE in Saudi Arabia and the implementation of the 2007 AHA guidelines.     

Cardio-pulmonary resuscitation in the intensive care unit: An experience from a tertiary hospital in Sub-Saharan Africa

Background:

Cardiopulmonary resuscitation (CPR) is one the most commonly performed procedures in the intensive care unit (ICU). However, success rate of CPR vary widely from 3.1% to 16.5%.

Patients and Methods:

We conducted a retrospective study of all cardiac arrests prompting CPR in our ICU for a period of 12 months. Data retrieved from ICU records included patients demographic characteristics, diagnosis at admission, length of ICU stay, time and day of cardiac arrest, cardiac rhythm, duration of CPR and outcome of CPR.

Results:

A total of 156 CPRs were performed within the study period with 8.3% success rate. Male: female ratio was 1.2:1. Indications for ICU admission, length of stay in ICU, time and day of cardiac and duration of CPR were found to be determinants of outcome.

Conclusions:

There is an urgent need to constitute a cardiac arrest team (CAT) which will be available at all times for improved successful outcome after cardiac arrest in our ICU.     

How do primary care physicians in Singapore keep healthy?

INTRODUCTION

Not much is known regarding how primary care physicians (PCPs) in Singapore keep themselves healthy and mitigate ill health. This study aims to determine the health-seeking behaviour of local PCPs and to identify the predictors of local PCPs attaining the recommended level of exercise.

METHODS

This study was a cross-sectional questionnaire survey, which included questions on the demographic characteristics, practice profiles and health-seeking behaviour of PCPs. The sampling frame was the 1,400 listed members of the College of Family Physicians Singapore. The anonymised survey was executed in two phases: a postal survey, followed by a web-based survey on the College of Family Physicians Singapore website. The two data sets were collated; the categorical variables, summarised; and the differences between subgroups (based on exercise engagement), compared using Fisher’s exact test. The effect of each risk factor on exercise duration was quantified using odds ratio (OR) estimate and 95% confidence interval (CI). Multivariate logistic regression analysis was performed to identify significant predictors of exercise engagement.

RESULTS

A total of 631 PCPs participated in the survey – 26% were ≤ 34 years old, 58% were male, 21% were single, 34% were singleton practitioners, and 56% were private practitioners. The percentage of PCPs who exercised ≥ 2.5 hours weekly was 29%, while 28% exercised < 0.5 hours weekly. Of the PCPs surveyed, 1% currently smoke, 0.8% drink more than 14 units of alcohol weekly, 60% undertook health screening, 65% had blood investigations done, and 64% had taken preventive measures such as getting influenza vaccination.

CONCLUSION

While local PCPs generally did not have undesirable habits such as smoking and alcohol abuse, they could further increase their exercise intensity and undertake more preventive measures such as getting vaccinated against various diseases.     

Extractive summarisation of medical documents using domain knowledge and corpus statistics

Background

Evidence Based Medicine (EBM) practice requires practitioners to extract evidence from published medical research when answering clinical queries. Due to the time- consuming nature of this practice, there is a strong motivation for systems that can automatically summarise medical documents and help practitioners find relevant information.

Aim

The aim of this work is to propose an automatic query- focused, extractive summarisation approach that selects informative sentences from medical documents.

Method

We use a corpus that is specifically designed for summarisation in the EBM domain. We use approximately half the corpus for deriving important statistics associated with the best possible extractive summaries. We take into account factors such as sentence position, length, sentence content, and the type of the query posed. Using the statistics from the first set, we evaluate our approach on a separate set. Evaluation of the qualities of the generated summaries is performed automatically using ROUGE, which is a popular tool for evaluating automatic summaries.

Results

Our summarisation approach outperforms all baselines (best baseline score: 0.1594; our score 0.1653). Further improvements are achieved when query types are taken into account.

Conclusion

The quality of extractive summarisation in the medical domain can be significantly improved by incorporating domain knowledge and statistics derived from a specialised corpus. Such techniques can therefore be applied for content selection in end-to-end summarisation systems.     

Dental knowledge of educators and healthcare providers working with children with autism spectrum disorders

Objectives:

To evaluate dental knowledge and attitudes toward oral health care among healthcare providers and educators working with children with autism spectrum disorders (ASD) in central Saudi Arabia.

Methods:

There were 305 questionnaires distributed to 7 special-needs centers between September and November 2014. A total of 217 questionnaires were collected with a response rate of 71.1%. The study took place in the College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia.

Results:

Approximately 50.2% of the participants did not offer any toothbrushing advice, and 73.3% never recommended dental checkup visits to parents, and 75.6% never performed dental examinations to children under their care. Ten percent thought that children should have their first dental visit after 6 years of age. Almost all participants agreed that children should practice oral hygiene, and 60.4% think they should brush twice per day. In general, the participants choose toothbrushes and toothpaste as the main tools to perform oral hygiene. There were 35% of participants who believed that parents should be responsible for the children’s oral hygiene, and a few participants mentioned teachers and therapists to be responsible. Most of the participants (71.4%) did not receive any dental information from dental professional resources, only 14.3% of participants believed bacteria to be the cause of dental cavities.

Conclusion:

There is a clear lack of dental knowledge and attitudes, and its practical application among the participating group of healthcare providers working with children with ASD in Riyadh.Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disability that affects children at a young age. Children with ASD usually show multiple, complicated deficiencies in their social, emotional, and communicative skills.1 Because of the multiple signs and symptoms of ASD, a multidisciplinary team is required to diagnose and offer comprehensive medical care for affected children. These teams usually include different specialists and subspecialists, such as general practitioners for primary diagnoses, and lead to referrals to relevant professionals or pediatricians who are able to confirm, or refute the ASD diagnosis. Clinical psychologists, psychiatrists, and psychotherapists (who are able to confirm the diagnosis of autism and introduce a customized individual behavior management plan), dieticians (who can provide advice and information concerning nutrition and diet), special educators (who can assess children’s educational needs), social workers (who can assess the care needs of children with ASD and their families), speech and language therapists (who can assess speech, language, and communication abilities), audiologists (who can evaluate possible hearing impairments), opticians (who can assess any visual difficulties that the children might have), in addition to specialists in oral health (OH [such as, pediatric dentist, who can perform early check-ups and introduce both primary and comprehensive preventive and therapeutic oral care]).2 From a medical point of view, the recognition and diagnosis of ASD in its early stages is significant. Early intervention and treatment can control, and in many cases improve, the symptoms.3,4 From a dental point of view, early examinations for intervention and prevention among children in general (and those with special needs specifically) are strongly recommended by major dental academies.2,5 However, because children with ASD have multiple medical issues, their dental issues might not receive equal consideration from healthcare providers (HCPs) trying to provide the best comprehensive care. In addition, several well-documented national and international studies have observed a lack of dental knowledge among primary HCPs,6-15 and educators16-20 who work with children. Most published studies have reported data collected from HCPs who work with healthy children, or those with disabilities, such as cerebral palsy, or Down syndrome, however, no studies have been conducted to assess the dental knowledge of educators and HCPs that interact with children diagnosed with ASD. Therefore, because of the unique characteristics of children with ASD, this study evaluated the dental knowledge of, and attitudes toward oral healthcare among different HCPs and educators interacting with children with ASD in Riyadh, Kingdom of Saudi Arabia (KSA).     

Knowledge of heart disease risk factors among workers in a Nigerian University: A call for concern

Introduction:

Cardiovascular disease is the commonest cause of mortality worldwide. Many risk factors predate the development of cardiovascular diseases. Adequate knowledge of risk factors for cardiovascular diseases is the first step towards effective preventive strategies to combat the cardiovascular diseases burden in any population. This study aims to determine the knowledge of workers in a Nigerian University on risk factors for cardiovascular diseases.

Materials and Methods:

A cross-sectional survey of 206 academic and non-academic staff of Ladoke Akintola University of Technology, Ogbomoso, Nigeria using the Heart Disease Fact Questionnaire (HDFQ). Demographic data were taken. The lipid profile and random blood sugar were taken. Statistical analysis was done using SPSS 17.0.

Results:

The mean age of the study participants was 45.3 ± 7.9 years. There were 96 males (46.6%). The mean HDFQ score was 48.6%. Only 41 (19.9%) of participants were assessed to have good knowledge of heart disease risk factors. Majority, 101 (49.0%) had poor knowledge while 64 (31.2%) had fair knowledge of heart disease risk factors. There was no significant difference between prevalence of CV risk factors between those with good or fair or low level of knowledge. Most participants did not have a good level of knowledge about risk factors, prevention, treatment and association with diabetes as it relates to heart diseases.

Conclusion:

Knowledge of heart disease risk factors is low among University workers in Nigeria. Effective education on heart disease risk factors and appropriate preventive strategies are indeed important to reduce cardiovascular disease burden in Nigerian University communities.     

Validity and reliability of an Arabic version of the modified dental anxiety scale in Saudi adults

Objectives:

To test the reliability and validity of an Arabic version of the modified dental anxiety scale (MDAS), and to correlate it with other demographic data.

Methods:

The original English version of the MDAS was translated into Arabic, and then translated back into English by experienced bilingual professionals. Four hundred and seventy-four patients referred to dental clinics for treatment at the Faculty of Dentistry Hospital, Jeddah, Kingdom of Saudi Arabia from November 2012 to June 2013 participated in the study. The assessment tool included questions regarding demographic characteristics, frequency of dental visits, the Arabic version of the MDAS, and the patient''s rating of their current level of anxiety using a visual analogue scale (VAS).

Results:

The Arabic version of the MDAS had excellent internal consistency and reliability (Alpha coefficients >0.90). The scale was unidimensional, and the percentage of patients with dental anxiety was 48.3% (using a cutoff total score of >15) and with dental phobia was 2.5% (using a cutoff total score of >16). Younger patients, females, and infrequent visitors to the dentist were more anxious than those who were older, male, and frequent visitors. Visual analogue scale scores correlated significantly with individual items on the MDAS questionnaire and total anxiety score, supporting the criterion validity.

Conclusion:

The Arabic version of the MDAS presented adequate internal consistency reliability, allowing its safe use to assess levels of dental anxiety in Arabic-speaking populations.Anxiety related to dental treatment is a well-known phenomenon that has been reported to cause 6% of the general population to avoid dental treatments.1 This emotional state can also affect the dentist who may become anxious dealing with patients who are known to be difficult to manage and who delay or even cancel their dental appointments.2 Dental anxiety is defined as a patient''s response to stress that is specific to dental situations.3 It is therefore, very important to rate patient anxiety for proper control and management. There is a wide range of psychometric self-assessment scales to assess anxiety in general that are commonly used for research and clinical purposes to assess the dental anxiety and fear. The Corah Dental Anxiety Scale (CDAS) is probably the most widely used scale.4Three shortcomings of the CDAS have been noted: the item responses vary, the responses are not necessarily ordered from lowest to highest anxiety, and the scale does not include an item referring to dental injections.2 A Modified Dental Anxiety Scale (MDAS) was proposed to overcome the psychometric and content validity issues of the original CDAS.5 The MDAS is a 5-item multiple-choice questionnaire, which includes an item that rates respondent anxiety upon receiving local anesthetic injections; thereby, differing from the CDAS. Other small, but important changes were also made to the English version response scheme, creating a simple, quick, and easy-to-complete instrument that will not increase patients’ fear and anxiety.6,7The original English-language version of the MDAS5 has been translated into different languages (which include, but are not limited to, Spanish, Greek, Chinese, Turkish, Romanian, and Tamil) and tested for readability and validity in adult populations in a variety of cross-cultural studies.8-13 It is desirable to establish a linguistic and cultural psychometric equivalent of the MDAS and other psychological scales translated from American or British scales. An Arabic version of the scale was used with Jordanian adolescents;14 the authors recommended that future researchers consider older age groups and differing countries where Arabic is spoken.Spoken Arabic varies considerably across different cultures and countries, especially with regards to colloquial or slang usage. Therefore, it is important to develop an Arabic version of the MDAS, which is suitable for all Arabic-speaking individuals, using simple Arabic, which would be understood by individuals from different cultures or countries. Different cultures, which share Arabic, as a common language would still benefit from different Arabic versions of this scale, which will add further evidence for the reliability, and validity of the MDAS. Therefore, the aim of this study was to test the reliability and validity of an Arabic version of the MDAS. In addition, we evaluated whether the Arabic MDAS can be utilized as an effective tool to assess dental anxiety among Arabic-speaking Saudi adult dental patients, by correlating scale scores with other demographic data.     

General practices’ perspectives on Medicare Locals’ performance are critical lessons for the success of Primary Health Networks

Background

Under a health reform after two decades, Primary Health Organisations (PHOs) in Australia were changed from Divisions of General Practice (DGP) to Medicare Locals (MLs). Following a review of Medicare Locals, in July 2015 Primary Health Networks (PHNs) replaced Medical Locals to potentially improve outcomes through supporting primary care and enhancing integration.

Aims

The aim of this paper was to gather front-line staff’s perspectives on MLs and identify any lessons applicable to PHNs.

Methods

A national purposive sample of 22 high-performing general practices representing all Australian states and territories was selected for semi-structured, face-to-face interviews, and a thematic analysis conducted.

Results

Fifty-three interviews were conducted: participants comprised 19 general practitioners (GPs), 18 practice managers (PMs), 15 practices nurses (PNs), and one community pharmacist. Most participants reflected on the difference between the DGP and MLs. Themes that emerged included ambiguity, community needs, professional development and education, communication and support, duplication in services and ignoring existing ones, recruitment and retention, and engagement and involvement.

Conclusion

Those MLs that did well continued in an expanded way the work DGP were doing beforehand and made a seamless transition. PHNs will need to build on the strengths of previous PHOs, and create locality structures and processes that maximise the potential for clinical engagement. They will actively guide the dialogue between related microsystems: to achieve this they will have to be clinically led, change management organisations.