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MJA

    Beyond rural clinical schools to “by rural, in rural, for rural”: immersive community engaged rural education and training pathways

    Roger P Strasser
    Med J Aust 2022; 216 (11): . || doi: 10.5694/mja2.51525
    Published online: 20 June 2022

    Cradle‐to‐grave regional programs featuring immersive community engaged education are needed to ensure a sustainable rural medical workforce

    In this issue of the MJA, Seal and colleagues1 report a multi‐university investigation that found that extended rural clinical school (RCS) placements have a positive impact on rural workforce recruitment and the retention of both rural and metropolitan origin medical graduates. The authors examined the practice locations of medical graduates, as listed in the Australian Health Practitioner Regulation Agency (AHPRA) register, five and eight years after graduation; many doctors were probably still registrars in training locations five years after graduation. The authors considered a limited range of variables in their study, and did not adjust their analyses for registrars who had received bonded or other scholarships, nor for factors such as incentives to relocate and employment opportunities for partners. Nevertheless, there is merit in their conclusion that their “findings reinforce the importance of longitudinal rural and regional training pathways, and the role of RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives.”1

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      Selective personality‐targeted prevention of suicidal ideation in young adolescents: post hoc analysis of data collected in a cluster randomised controlled trial

      Lucinda R Grummitt, Jennifer Debenham, Erin Kelly, Emma L Barrett, Katrina Champion, Patricia Conrod, Maree Teesson and Nicola Newton
      Med J Aust 2022; 216 (10): . || doi: 10.5694/mja2.51536
      Published online: 6 June 2022

      Abstract

      Objective: To assess the efficacy of a selective, personality‐targeted intervention for reducing suicidal ideation in adolescents.

      Design: Post hoc analysis of survey data collected in the Climate and Preventure (CAP) study, a cluster randomised controlled trial that compared strategies for reducing alcohol misuse by adolescents, 2012–2015.

      Setting, participants: Year 8 students at 16 New South Wales non‐government schools and one Victorian non‐government school.

      Intervention: Preventure, a selective, personality‐targeted intervention designed to help adolescents with personality risk factors for alcohol misuse, comprising two 90‐minute sessions, one week apart. For our post hoc analysis, we combined data from the two CAP trial groups in which Preventure was offered (the Preventure and the Preventure/Climate Schools [a non‐selective prevention strategy] groups) as the intervention group; and data from the two groups in which Preventure was not offered (usual health education only [control] and Climate Schools groups) as the control group.

      Main outcome measure: Difference between post hoc control and intervention groups in the change in proportions of students reporting suicidal ideation during the preceding six months (single item of Brief Symptom Inventory depression subscale) over three years.

      Results: A total of 1636 students (mean age at baseline, 13.3 years; standard deviation, 0.5 years) were included in our analysis, of whom 1087 (66%) completed the suicidal ideation item in the three‐year follow‐up assessment. The post hoc control group included 755 students (nine schools), the intervention group 881 students (eight schools). After adjusting for nesting of students in schools and sex, reporting of suicidal ideation by students who had received Preventure had declined over three years, compared with the control group (per year: adjusted odds ratio, 0.80; 95% CI, 0.66–0.97).

      Conclusion: Personality‐targeted selective prevention during early secondary school can have a lasting impact on suicidal ideation during adolescence.

      Trial registration (CAP study only): Australian and New Zealand Clinical Trials Registry, ACTRN12612000026820 (prospective).

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      • 1 The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW
      • 2 University of Montreal, Montreal, Canada
      • 3 Sainte Justine Hospital Research Centre, University of Montreal, Montreal, Canada


      Acknowledgements: 

      The Climate and Preventure (CAP) study was funded by the National Health and Medical Research Council (APP1004744). We acknowledge the schools, students, teachers, and research assistants who were involved in the study. We also acknowledge the assistance of the New South Wales Department of Education and Communities for access to their schools (reference, SERAP 2011201).

      Competing interests:

      No relevant disclosures.

      • 1. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015 (Australian Burden of Disease series no. 19; Cat. no. BOD 22). Canberra: AIHW, 2019. https://www.aihw.gov.au/reports/burden‐of‐disease/burden‐disease‐study‐illness‐death‐2015 (viewed Sept 2021).
      • 2. John A, Pirkis J, Gunnell D, et al. Trends in suicide during the COVID‐19 pandemic. BMJ 2020; 371: m4352.
      • 3. Lifeline. More Australians than ever seeking crisis support [media release]. 4 Aug 2021. https://www.lifeline.org.au/media/yxab453i/20210804‐lifeline‐more‐australians‐than‐ever‐seeking‐support.pdf (viewed Sept 2021).
      • 4. Tanaka T, Okamoto S. Increase in suicide following an initial decline during the COVID‐19 pandemic in Japan. Nat Hum Behav 2021; 5: 229‐238.
      • 5. Michelmore L, Hindley P. Help‐seeking for suicidal thoughts and self‐harm in young people: a systematic review. Suicide Life Threat Behav 2012; 42: 507‐524.
      • 6. Robinson J, Bailey E, Witt K, et al. What works in youth suicide prevention? A systematic review and meta‐analysis. EClinicalMedicine 2018; 4‐5: 52‐91.
      • 7. Castellanos N, Conrod P. Brief interventions targeting personality risk factors for adolescent substance misuse reduce depression, panic and risk‐taking behaviours. J Ment Health 2006; 15: 645‐658.
      • 8. O’Connor RC, Nock MK. The psychology of suicidal behaviour. Lancet Psychiatry 2014; 1: 73‐85.
      • 9. Gvion Y, Apter A. Suicide and suicidal behavior. Public Health Rev 2012; 34: 9.
      • 10. Conrod PJ, Castellanos‐Ryan N, Mackie C. Personality‐targeted interventions delay the growth of adolescent drinking and binge drinking. J Child Psychol Psychiatry 2008; 49: 181‐190.
      • 11. Conrod PJ. Personality‐targeted interventions for substance use and misuse. Curr Addict Rep 2016; 3: 426‐436.
      • 12. Newton NC, Conrod PJ, Slade T, et al. The long‐term effectiveness of a selective, personality‐targeted prevention program in reducing alcohol use and related harms: a cluster randomized controlled trial. J Child Psychol Psychiatry 2016; 57: 1056‐1065.
      • 13. Stanley B, Brown G, Brent DA, et al. Cognitive‐behavioral therapy for suicide prevention (CBT‐SP): treatment model, feasibility, and acceptability. J Am Acad Child Adolesc Psychiatry 2009; 48: 1005‐1013.
      • 14. Kelly EV, Newton NC, Stapinski LA, et al. A novel approach to tackling bullying in schools: personality‐targeted intervention for adolescent victims and bullies in Australia. J Am Acad Child Adolesc Psychiatry 2020; 59: 508‐518.e2.
      • 15. O’Leary‐Barrett M, Topper L, Al‐Khudhairy N, et al. Two‐year impact of personality‐targeted, teacher‐delivered interventions on youth internalizing and externalizing problems: a cluster‐randomized trial. J Am Acad Child Adolesc Psychiatry 2013; 52: 911‐920.
      • 16. Newton NC, Teesson M, Barrett EL, et al. The CAP study, evaluation of integrated universal and selective prevention strategies for youth alcohol misuse: study protocol of a cluster randomized controlled trial. BMC Psychiatry 2012; 12: 118.
      • 17. Teesson M, Newton NC, Slade T, et al. Combined universal and selective prevention for adolescent alcohol use: a cluster randomized controlled trial. Psychol Med 2017; 47: 1761‐1770.
      • 18. Newton NC, Stapinski L, Teesson M, et al. Evaluating the differential effectiveness of social influence and personality‐targeted alcohol prevention on mental health outcomes among high‐risk youth: a novel cluster randomised controlled factorial design trial. Aust N Z J Psychiatry 2019; 54: 259‐271.
      • 19. Newton NC, Teesson M, Vogl LE, Andrews G. Internet‐based prevention for alcohol and cannabis use: final results of the Climate Schools course. Addiction 2010; 105: 749‐759.
      • 20. Woicik PB, Stewart SH, Pihl RO, Conrod P. The Substance Use Risk Profile Scale: a scale measuring traits linked to reinforcement‐specific substance use profiles. Addict Behav 2009; 32: 1042‐1055.
      • 21. Newton NC, Barrett EL, Castellanos‐Ryan N, et al. The validity of the Substance Use Risk Profile Scale (SURPS) among Australian adolescents. Addictive Behav 2016; 53: 23‐30.
      • 22. Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med 1983; 13: 595‐605.
      • 23. Johnston AK, Pirkis JE, Burgess PM. Suicidal thoughts and behaviours among Australian Adults: findings from the 2007 National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2009; 43: 635‐643.
      • 24. Australian Bureau of Statistics. 2033.0.55.001. Census of Population and Housing: Socio‐Economic Indexes for Areas (SEIFA), Australia, 2016. IRSD interactive map. 27 Mar 2018. https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001~2016~Main%20Features~IRSD%20Interactive%20Map~15 (viewed Sept 2021).
      • 25. Lawrence D, Johnson S, Hafekost J, et al. The mental health of children and adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Aug 2015. https://www.health.gov.au/sites/default/files/documents/2020/11/the‐mental‐health‐of‐children‐and‐adolescents_0.pdf (viewed Dec 2021).
      • 26. Slade T, Johnston A, Oakley Browne MA, et al. 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Aust N Z J Psychiatry 2009; 43: 594‐605.
      • 27. Nock MK, Borges G, Bromet EJ, et al. Cross‐national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 2008; 192: 98‐105.
      • 28. Keyes KM, Gary D, O’Malley PM, et al. Recent increases in depressive symptoms among US adolescents: trends from 1991 to 2018. Soc Psychiatry Psychiatr Epidemiol 2019; 54: 987‐996.
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        Achieving person‐centred primary health care through value co‐creation

        Tina Janamian, Paresh Dawda and Walid Jammal
        Med J Aust 2022; 216 (10): . || doi: 10.5694/mja2.51538
        Published online: 6 June 2022

        Value co‐creation supports the delivery of optimal person‐centred care in an efficient way

        Primary health care is the backbone of a high performing and efficient health system and is most people’s first contact with the health care system.1,2 The supplement accompanying this issue of the MJA reports on initiatives and approaches that strive to build high performing person‐centred primary health care that is critical to achieving the Quadruple Aim, a well regarded framework for optimising the health care system by simultaneously focusing on improving patient experience, improving population health, reducing costs, and improving the health care team experience.3

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        • 1 Client Focused Evaluation Program (CFEP) Surveys, Brisbane, QLD
        • 2 University of Canberra, Canberra, ACT
        • 3 Hills Family General Practice, Sydney, NSW
        • 4 University of Sydney, Sydney, NSW


        Competing interests:

        No relevant disclosures.

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          Should clinicians and the general population be concerned about seasonal affective disorder in Australia?

          Adriana G Nevarez Flores, Emmanuelle CS Bostock and Amanda L Neil
          Med J Aust 2022; 216 (10): . || doi: 10.5694/mja2.51518
          Published online: 6 June 2022

          Seasonal affective disorder, a well documented syndrome in northern latitudes, has limited credence in Australia

          Seasonal affective disorder (SAD), also known as “winter depression”, refers to the recurrence of major depressive episodes (for a minimum of 2 consecutive years) during a particular season, typically winter.1 While the construct is widely acknowledged,1,2,3 the condition is not recognised as a stand‐alone mental disorder by current classification systems. Rather, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM‐5) includes “seasonal pattern” as a specifier for recurrent major depressive disorder,4 and the International Classification of Diseases, 11th revision (ICD‐11) has included “seasonal depressive disorder” under the category of “recurrent depressive disorder”.5 As such, the validity of the construct as an individual mental disorder remains debatable,6,7 with some suggesting the syndrome is a “temporary expression of a mood disorder rather than a specific disorder”.8 However, the condition’s potential as a stand‐alone disorder remains extant given both its continuous identification2,3,9,10 and the ongoing inclusion of seasonal pattern specifiers in diagnostic classification systems.


          • 1 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
          • 2 University of Tasmania, Hobart, TAS


          Competing interests:

          No relevant disclosures.

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            The impact of COVID‐19 on chronic disease management in primary care: lessons for Australia from the international experience

            Anne Parkinson, Sethunya Matenge, Jane Desborough, Sally Hall Dykgraaf, Lauren Ball, Michael Wright, Elizabeth A Sturgiss and Michael Kidd
            Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51497
            Published online: 16 May 2022

            The continuation of chronic disease management in primary care remains essential during the COVID‐19 pandemic

            International primary care responses to the coronavirus disease 2019 (COVID‐19) pandemic have seen the prioritisation of acute and urgent services for people with COVID‐19 as well as seeing many practitioners involved in COVID‐19 vaccination counselling and delivery.1,2 This prioritisation has often resulted in partial or complete disruption to chronic disease management (CDM),1 including care for conditions such as hypertension, diabetes and cancer.2 CDM in Australian primary care has been similarly disrupted, with reports of decreased time spent on CDM activities and preventive care,3 particularly for elements of care that require in‐person examination or testing,4 and delays in investigation, diagnosis, referred appointments and elective procedures, resulting in prolonged pain, anxiety and deterioration for patients.5 The introduction of telehealth items under the Medicare Benefits Schedule (MBS) may have both alleviated and contributed to disruption.5,6,7 Although early data suggested that there was little reduction in the total volume of services provided against the MBS, when accounting for telehealth services, and little change in medications used to manage chronic diseases,8 these data paint a complex and dynamic picture with differential changes in certain service types, such as allied health and referred and non‐referred services. A recent study from the United Kingdom has suggested that few studies have reported the impact of increases in COVID‐19‐related respiratory consultations in primary care and that these consultations might mask other reductions in service volume.9

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            • 1 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
            • 2 Australian National University, Canberra, ACT
            • 3 Centre for Health Practice Innovation, Griffith University, Brisbane, QLD
            • 4 Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW
            • 5 Monash University, Melbourne, VIC
            • 6 COVID‐19 Primary Care Response Group, Australian Government Department of Health, Canberra, ACT


            Correspondence: anne.parkinson@anu.edu.au
            Competing interests:

            No relevant disclosures.

            • 1. Matenge S, Sturgiss E, Desborough J, et al. Ensuring the continuation of routine primary care during the COVID‐19 pandemic: a review of the international literature. Fam Pract 2021; doi: https://doi.org/10.1093/fampra/cmab115 [Epub ahead of print].
            • 2. World Health Organization. Rapid assessment of service delivery for NCDs during the COVID‐19 pandemic 2020 https://www.who.int/publications/m/item/rapid‐assessment‐of‐service‐delivery‐for‐ncds‐during‐the‐covid‐19‐pandemic (viewed Dec 2021).
            • 3. Halcomb E, McInnes S, Williams A, et al. The experiences of primary healthcare nurses during the COVID‐19 pandemic in Australia. J Nurs Scholarsh 2020; 52: 553‐563.
            • 4. Dimopoulos‐Bick T, Walsh L, Sutherland K. Indirect impacts of COVID‐19: a case study of evidence, advice and representation from consumer and community members in New South Wales Australia. J Patient Exp 2021; 8: 2374373521998628.
            • 5. Douglas K, O’Brien, Hall S, et al. Quick COVID Clinician Survey Summary (Australia), Series 9‐13 [preprint]. Ann Fam Med 2021; https://doi.org/10.7302/385.
            • 6. Royal Australian College of General Practitioners. General practice: health of the nation 2020. https://www.racgp.org.au/health‐of‐the‐nation/health‐of‐the‐nation (viewed Dec 2021).
            • 7. Javanparast S, Roeger L, Reed RL. Experiences of patients with chronic diseases of access to multidisciplinary care during COVID‐19 in South Australia. Aust Health Rev 2021; https://doi.org/10.1071/AH20328 [Epub ahead of print].
            • 8. Australian Institute of Health and Welfare. Impacts of COVID‐19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme service use [updated 17 Dec 2021]. https://www.aihw.gov.au/reports/health‐care‐quality‐performance/covid‐impacts‐on‐mbs‐and‐pbs/contents/impact‐on‐mbs‐service‐use (viewed Dec 2021).
            • 9. Dambha‐Miller H, Hounkpatin HO, Morgan‐Harrisskitt J, et al. Primary care consultations for respiratory tract symptoms during the COVID‐19 pandemic: a cohort study including 70 000 people in South West England. Fam Pract 2021; https://doi.org/10.1093/fampra/cmab127 [Epub ahead of print].
            • 10. Beran D, Aebischer Perone S, Castellsague Perolini M, et al. Beyond the virus: ensuring continuity of care for people with diabetes during COVID‐19. Prim Care Diabetes 2021; 15: 16‐7.
            • 11. Mobula LM, Heller DJ, Commodore‐Mensah Y, et al. Protecting the vulnerable during COVID‐19: treating and preventing chronic disease disparities. Gates Open Res 2020; 4: 125.
            • 12. Brey Z, Mash R, Goliath C, Roman D. Home delivery of medication during coronavirus disease 2019, Cape Town, South Africa: short report. Afr J Prim Health Care Fam Med 2020; 12: e1‐e4.
            • 13. Haldane V, Zhang Z, Abbas RF, et al. National primary care responses to COVID‐19: a rapid review of the literature. BMJ Open 2020; 10: e041622.
            • 14. Desborough J, Hall Dykgraaf S, de Toca L, et al. Australia’s national COVID‐19 primary care response. Med J Aust 2020; 213: 104‐106. https://www.mja.com.au/journal/2020/213/3/australias‐national‐covid‐19‐primary‐care‐response
            • 15. Danhieux K, Buffel V, Pairon A, et al. The impact of COVID‐19 on chronic care according to providers: a qualitative study among primary care practices in Belgium. BMC Fam Pract 2020; 21: 255.
            • 16. van Weert H. After the first wave: what effects did the COVID‐19 measures have on regular care and how can general practitioners respond to this? Eur J Gen Pract 2020; 26: 126‐128.
            • 17. Franzosa E, Gorbenko K, Brody AA, et al. “At home, with care”: lessons from New York City home‐based primary care practices managing COVID‐19. J Am Geriatr Soc 2020; 69: 300‐306.
            • 18. Williams R, Jenkins DA, Ashcroft DM, et al. Diagnosis of physical and mental health conditions in primary care during the COVID‐19 pandemic: a retrospective cohort study. Lancet Public Health 2020; 5: 543‐550.
            • 19. Donohue D. A primary care answer to a pandemic: keeping a population of patients safe at home through chronic care management and remote patient monitoring. Am J Lifestyle Med 2020; 14: 595‐601.
            • 20. Wright A, Salazar A, Mirica M, et al. The invisible epidemic: neglected chronic disease management during COVID‐19. J Gen Intern Med 2020; 35: 2816‐2817.
            • 21. Royal Australian College of General Practitioners. Home‐care guidelines for patients with COVID‐19. https://www.racgp.org.au/clinical‐resources/covid‐19‐resources/other‐health‐issues/covid‐19‐home‐care‐guidelines (viewed Dec 2021).
            • 22. Hall Dykgraaf S, Desborough J, de Toca L, et al. “A decade’s worth of work in a matter of days”: the journey to telehealth for the whole population in Australia. Int J Med Inform 2021; 151: 104483.
            • 23. Bhaskar S, Bradley S, Chattu VK, et al. Telemedicine across the globe — position paper from the COVID‐19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1). Front Public Health 2020; 8: 556720.
            • 24. Spelman JF, Brienza R, Walsh RF, et al. A model for rapid transition to virtual care, VA Connecticut primary care response to COVID‐19. J Gen Intern Med 2020; 35: 3073‐3076.
            • 25. Copp T, Isautier JMJ, Nickel B, et al. COVID‐19 challenges faced by general practitioners in Australia: a survey study conducted in March 2021. Aust J Prim Health 2021; 27: 357‐363.
            • 26. Modenese A, Gobba F. Increased risk of COVID‐19‐related deaths among general practitioners in Italy. Healthcare (Basel) 2020; 8: 155.
            • 27. Barrett E, Hingle ST, Smith CD, Moyer DV. Getting through COVID‐19: keeping clinicians in the workforce. Ann Intern Med 2021; 174: 1614‐1615.
            • 28. Sullivan EE, Phillips RS. Sustaining primary care teams in the midst of a pandemic. Isr J Health Policy Res 2020; 9: 77.
            • 29. Anderson M, O’Neill C, Macleod Clark J, et al. Securing a sustainable and fit‐for‐purpose UK health and care workforce. Lancet 2021; 397: 1992‐2011.
            • 30. Wright M, Versteeg R. Introducing general practice enrolment in Australia: the devil is in the detail. Med J Aust 2021; 214: 400‐402. https://www.mja.com.au/journal/2021/214/9/introducing‐general‐practice‐enrolment‐australia‐devil‐detail
            • 31. Australian Government Department of Health. Consultation draft — Primary Health Care 10 Year Plan. https://consultations.health.gov.au/primary‐care‐mental‐health‐division/draft‐primary‐health‐care‐10‐year‐plan/ (viewed Dec 2021).
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              It is time to reinvest in quality improvement collaboratives to support Australian general practice

              Andrew W Knight, John Fraser and C Dimity Pond
              Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51502
              Published online: 16 May 2022

              Supporting improved general practice is urgent, and quality improvement collaboratives are an effective Australian strategy

              Australia faces serious challenges to the effectiveness and sustainability of its health system, including barriers to access, rising costs, chronic disease rates, an ageing population, and overstretched hospitals.1,2 High quality primary care is recognised to underpin effective and efficient health systems.2,3,4 The coronavirus disease 2019 (COVID‐19) pandemic has starkly illuminated the problems and demonstrated the importance of supporting general practice for health care delivery in Australia.

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              • 1 South Western Sydney Local Health District, Sydney, NSW
              • 2 UNSW Sydney, Sydney, NSW
              • 3 University of New England, Armidale, NSW
              • 4 University of Newcastle, Newcastle, NSW


              Correspondence: awknight@aapt.net.au
              Acknowledgements: 

              Andrew Knight is a general practitioner who has written about the Australian Primary Care Collaboratives (APCC) as a participant, academic and leader. He is completing a PhD on the impact of the APCC. Dimity Pond is a GP researcher and educator with a special interest in dementia. John Fraser is a rural GP researcher and educator with a special interest in public health. We thank Michael Tam for providing advice on this manuscript.

              Open access: Open access publishing facilitated by University of New South Wales, as part of the Wiley ‐ University of New South Wales agreement via the Council of Australian University Librarians.

              Competing interests:

              Andrew Knight received payment from the Improvement Foundation Australia in his role as Chair of the Expert Reference Panel on Access during the Australian Primary Care Collaboratives Program.

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                Access to abortion services in Australia: we must do better

                Andrew F Pesce and Gayathri Jayasinghe
                Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51509
                Published online: 16 May 2022

                Clinicians should be mindful of the importance of post‐abortion contraception counselling for preventing further unintended pregnancies

                Unintended pregnancy has significant adverse effects on both mother and child,1,2 as well as social and financial costs.3 As South Australia is the only Australian state to collect abortion data, we rely on secondary sources for national information. For example, the most recent estimated national annual abortion rate — 17.3 per 1000 Australian women aged 15–44 years — was derived from Pharmaceutical Benefits Scheme (PBS) and National Hospital Morbidity Database (NHMD) data.4


                • Westmead Hospital, Sydney, NSW


                Competing interests:

                No relevant disclosures.

                • 1. Bahk J, Yun SC, Kim YM, Khang YH. Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy Childbirth 2015; 15: 85.
                • 2. Singh A, Chalasani S, Koenig MA, Mahapatra B. The consequences of unintended births for maternal and child health in India. Popul Stud (Camb) 2012; 66: 223‐239.
                • 3. Yazdkhasti M, Pourreza A, Pirak A, Abdi F. Unintended pregnancy and its adverse social and economic consequences on health system: a narrative review article. Iran J Public Health 2015; 44: 12‐21.
                • 4. Keogh LA, Gurrin LC, Moore P. Estimating the abortion rate in Australia from National Hospital Morbidity and Pharmaceutical Benefits Scheme data. Med J Aust 2021; 215: 375‐376. https://www.mja.com.au/journal/2021/215/8/estimating‐abortion‐rate‐australia‐national‐hospital‐morbidity‐and
                • 5. Grzeskowiak LE, Rumbold AR, Subasinghe A, et al. Long‐acting reversible contraception use after medical abortion is associated with reduced likelihood of a second medical abortion. Med J Aust 2022; 216: 476‐477.
                • 6. Schmidt‐Hansen M, Hawkins JE, Lord J, et al. Long‐acting reversible contraception immediately after medical abortion: systematic review with meta‐analyses. Hum Reprod Update 2020; 26: 141‐160.
                • 7. Boesen HC, Rørbye C, Norgaard M, Nilas L. Sexual behavior during the first eight weeks after legal termination of pregnancy. Acta Obstet Gynecol Scand 2004; 83: 1189‐1192.
                • 8. Donnet ML, Howie M, Cooper W, Lewis M. Return of ovarian function following spontaneous abortion. Clin Endocrinol (Oxf) 1990; 33: 13‐20.
                • 9. Duijkers IJM, Heger‐Mahn D, Drouin D, et al. Maintenance of ovulation inhibition with a new progestogen‐only pill containing drospirenone after scheduled 24‐h delays in pill intake. Contraception 2016; 93: 303‐309.
                • 10. Weisberg E. Progestogen‐only methods of contraception. Aust Prescr 1999; 22: 6‐8.
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                  Achieving continuity of care in general practice: the impact of patient enrolment on health outcomes

                  Mark F Harris and Joel Rhee
                  Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51508
                  Published online: 16 May 2022

                  The search for a cost‐effective Australian model of comprehensive, coordinated patient‐centred care that improves outcomes continues

                  Continuity of care has long been regarded as a core characteristic of general practice.1 It is thought important because it encourages more appropriate and proactive use of health care services (including hospital care), improves communication between doctors and patients, reduces inconsistency of care, and increases the chances of early diagnosis and effective management of long term conditions. Continuity of care is also associated with greater patient satisfaction, self‐management, and chronic disease management, as well as with fewer hospitalisations and lower mortality.2,3


                  • 1 Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
                  • 2 University of New South Wales, Sydney, NSW


                  Correspondence: m.f.harris@unsw.edu.au
                  Competing interests:

                  No relevant disclosures.

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                    Poor achievement of lipid targets after acute coronary syndrome: what can we improve?

                    Sher May Ng, Jiliu Pan and Ajay K Gupta
                    Med J Aust 2022; 216 (9): . || doi: 10.5694/mja2.51507
                    Published online: 16 May 2022

                    Overcoming problems that impede the delivery of evidence‐based care is needed to bridge gaps between science and improving health

                    The benefits of lipid‐lowering therapy for the secondary prevention of atherosclerotic cardiovascular disease, including its effect on mortality, have been recognised since the publication of the seminal 4S trial in 1994.1 Recent clinical trials of novel lipid‐lowering therapies in people taking statins have found that the lower the low‐density lipoprotein cholesterol (LDL‐C) level achieved, the lower the risk of adverse cardiovascular events.2 It is beyond doubt that people at high risk of adverse cardiovascular events, including those with a history of acute coronary syndrome, benefit most from aggressive lipid‐lowering therapy. Accordingly, the recommended LDL‐C targets are lowest for such people, and have been continually reduced in international guidelines over time.3


                    • 1 Barts Health NHS Trust, London, United Kingdom
                    • 2 Harefield Hospital, Harefield, United Kingdom
                    • 3 Centre for Clinical Pharmacology, Queen Mary University of London, London, United Kingdom


                    Correspondence: ajay.gupta@qmul.ac.uk
                    Competing interests:

                    No relevant disclosures.

                    • 1. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383‐1389.
                    • 2. Sabatine MS, Giugliano RP, Keech AC, et al; FOURIER Steering Committee and Investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Eng J Med 2017; 376: 1713‐1722.
                    • 3. The task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111‐188.
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                      Hip fracture surgery: the importance of evidence‐based practice

                      Peter FM Choong
                      Med J Aust 2022; 216 (8): . || doi: 10.5694/mja2.51493
                      Published online: 2 May 2022

                      Registries are invaluable assets that not only benefit medical research, but also health care for all

                      During 2015–16, almost 18 700 hip fractures were recorded in Australia; the incidence rate was nearly 200 times as high among people aged 45 years or more than among younger people, and 1.7 times as high for women as men.1 As longevity increases and the prevalence of osteoporosis, sarcopaenia, obesity, and dementia rise in Western countries,2 the numbers of people at risk of fractures will continue to climb.


                      • 1 University of Melbourne, Melbourne, VIC
                      • 2 St Vincent's Hospital, Melbourne, VIC


                      Correspondence: pchoong@unimelb.edu.au
                      Acknowledgements: 

                      I am supported by a National Health and Medical Research Council Practitioner Fellowship.

                      Competing interests:

                      I have received consultancy fees and support for travel to designer surgeon meetings related to tumour prostheses from Stryker and Johnson & Johnson.

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                      • 11. Harvey L, Harris IA, Mitchell RJ, et al. Improved survival rates after hip fracture surgery in New South Wales, 2011–2018. Med J Aust 2022; 216: 420‐421.
                      • 12. Australian and New Zealand Hip Fracture Registry Steering Group. Australian and New Zealand guideline for hip fracture care: improving outcomes in hip fracture management of adults. Sept 2014. https://anzhfr.org/wp‐content/uploads/sites/1164/2021/12/ANZ‐Guideline‐for‐Hip‐Fracture‐Care.pdf (viewed Mar 2022).
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                      Online responses are no longer available. Please refer to our instructions for authors page for more information.
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