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Article ; Online: Comparing dietary strategies to manage cardiovascular risk in primary care: a narrative review of systematic reviews.

Greenwood, Hannah / Barnes, Katelyn / Ball, Lauren / Glasziou, Paul

The British journal of general practice : the journal of the Royal College of General Practitioners

2024

Abstract: Background: Nutrition care in general practice is crucial for cardiovascular disease (CVD) prevention and management, although comparison between dietary strategies is lacking.: Aim: To compare the best available (most recent, relevant, and high- ... ...

Abstract	Background: Nutrition care in general practice is crucial for cardiovascular disease (CVD) prevention and management, although comparison between dietary strategies is lacking. Aim: To compare the best available (most recent, relevant, and high-quality) evidence for six dietary strategies that are effective for primary prevention/absolute risk reduction of CVD. Design and setting: A pragmatic narrative review of systematic reviews of randomised trials focused on primary prevention of cardiovascular events. Method: Studies about: 1) adults without a history of cardiovascular events; 2) target dietary strategies postulated to reduce CVD risk; and 3) direct cardiovascular or all-cause mortality outcomes were included. Six dietary strategies were examined: energy deficit, Mediterranean-like diet, sodium reduction (salt reduction and substitution), the Dietary Approaches to Stop Hypertension (DASH) diet, alcohol reduction, and fish/fish oil consumption. Reviews were selected based on quality, recency, and relevance. Quality and certainty of evidence was assessed using GRADE. Results: Twenty-five reviews met inclusion criteria; eight were selected as the highest quality, recent, and relevant. Three dietary strategies showed modest, significant reductions in cardiovascular events: energy deficit (relative risk reduction [RRR] 30%, 95% confidence interval [CI] = 13 to 43), Mediterranean-like diet (RRR 40%, 95% CI = 20 to 55), and salt substitution (RRR 30%, 95% CI = 7 to 48). Still, some caveats remain on the effectiveness of these dietary strategies. Salt reduction, DASH diet, and alcohol reduction showed small, significant reductions in blood pressure, but no reduction in cardiovascular events. Fish/fish oil consumption showed little or no effect; supplementation of fish oil alone showed small reductions in CVD events. Conclusion: For primary prevention, energy deficit, Mediterranean-like diets, and sodium substitution have modest evidence for risk reduction of CVD events. Strategies incorporated into clinical nutrition care should ensure guidance is person centred and tailored to clinical circumstances.
Language	English
Publishing date	2024-02-19
Publishing country	England
Document type	Journal Article
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/BJGP.2022.0564
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Article ; Online: Long-Term Effect of Salt Substitution for Cardiovascular Outcomes : A Systematic Review and Meta-Analysis.

Greenwood, Hannah / Barnes, Katelyn / Clark, Justin / Ball, Lauren / Albarqouni, Loai

Annals of internal medicine

2024

Abstract: Background: Salt substitution is a simple yet increasingly promising strategy to improve cardiovascular outcomes.: Purpose: To evaluate the long-term effects of salt substitution on cardiovascular outcomes.: Data sources: PubMed, EMBASE, Cochrane ... ...

Abstract	Background: Salt substitution is a simple yet increasingly promising strategy to improve cardiovascular outcomes. Purpose: To evaluate the long-term effects of salt substitution on cardiovascular outcomes. Data sources: PubMed, EMBASE, Cochrane CENTRAL, and CINAHL searched from inception to 23 August 2023. Trial registries, citation analysis, and hand-search were also done. Study selection: Randomized controlled trials (RCTs) comparing provision of or advice to use a salt substitute with no intervention or use of regular salt among adults for 6 months or longer in total study duration. Data extraction: Two authors independently screened articles, extracted data, and assessed risk of bias. Primary outcomes include mortality, major cardiovascular events (MACE), and adverse events at 6 months or greater. Secondary and post hoc outcomes include blood pressure, cause-specific mortality, and urinary excretion at 6 months or greater. Random-effects meta-analyses were done and certainty of effect estimates were assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Data synthesis: Of the 16 included RCTs, 8 reported on primary outcomes. Most ( Limitations: The evidence base is dominated by a single, large RCT. Most RCTs were from China or Taiwan and involved participants with higher-than-average cardiovascular risk; therefore, generalizability to other populations is very limited. Conclusion: Salt substitution may reduce all-cause or cardiovascular mortality, but the evidence for reducing cardiovascular events and for not increasing serious adverse events is uncertain, particularly for a Western population. The certainty of evidence is higher among populations at higher cardiovascular risk and/or following a Chinese diet. Primary funding source: National Health and Medical Research Council. (PROSPERO: CRD42022327566).
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M23-2626
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Article ; Online: Low agreement among patients and clinicians about urgency and safety to wait for assessment in primary care after hours medical care: results of cross-sectional matched surveys.

Barnes, Katelyn / Arpel, Caitlin / Douglas, Kirsty

BMC health services research

2023 Volume 23, Issue 1, Page(s) 422

Abstract: Background: Discordance between patient and clinician perceived urgency may drive "inappropriate" presentations to after-hours medical services. This paper investigates the level of agreement between patient and clinicians' perceptions of urgency and ... ...

Abstract	Background: Discordance between patient and clinician perceived urgency may drive "inappropriate" presentations to after-hours medical services. This paper investigates the level of agreement between patient and clinicians' perceptions of urgency and safety to wait for an assessment at after-hours primary care services in the ACT. Methods: Cross-sectional survey voluntarily completed by patients and then clinicians at after-hours medical services in May/June, 2019. Agreement between patients and clinicians is measured by Fleiss kappa. Agreement is presented overall, within specific categories of urgency and safety to wait, and by after-hours service type. Results: 888 matched records were available from the dataset. Overall inter-observer agreement between patients and clinicians on the urgency of presentations was slight (Fleiss kappa = 0.166; 95% CI 0.117-0.215, p < 0.001). Agreement within specific ratings of urgency ranged from very poor to fair. Overall inter-rater agreement on how long it would be safe to wait for assessment was fair (Fleiss kappa = 0.209; 95% CI 0.165-0.253, p < 0.001). Agreement within specific ratings ranged from poor to fair. By site type, agreement between patients and clinicians on urgency ranged from not significant to fair and agreement for safety to wait ranged from very poor to slight. Agreement on urgency of issue was more often reported among patients attending their usual health service or seeing their usual clinician compared to patients attending an unfamiliar health service or clinician (χ Conclusions: Low levels of agreement between patients and clinicians on perceived urgency and safety to wait for issues to be assessed indicate potential inefficiency in primary care use after-hours. Agreement on urgency of issues was more common among patients attending a familiar health service or familiar clinician. Improving health literacy, particularly health system literacy, and supporting continuity of care may help to support patients to engage with the most appropriate level of care at the most appropriate time.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Patient Care ; Patients ; Health Literacy ; Primary Health Care ; Emergency Service, Hospital
Language	English
Publishing date	2023-05-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-023-09399-3
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Article ; Online: Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study.

Choy, Melinda Ada / O'Brien, Kathleen / Barnes, Katelyn / Sturgiss, Elizabeth Ann / Rieger, Elizabeth / Douglas, Kirsty

Journal of medical Internet research

2024 Volume 26, Page(s) e50410

Abstract: Background: The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally ... ...

Abstract	Background: The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. Objective: This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. Methods: We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. Results: In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7% (52/487) were low- to medium-frequency users and 48.5% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. Conclusions: While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide.
MeSH term(s)	Humans ; Australia ; Digital Health ; Digital Divide ; Patient-Centered Care ; Chronic Disease
Language	English
Publishing date	2024-04-11
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1438-8871
ISSN (online)	1438-8871
ISSN	1438-8871
DOI	10.2196/50410
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Article ; Online: After-hours presentations to community-based primary care in the Australian Capital Territory.

Barnes, Katelyn / Agostino, Jason / Ceramidas, Dagmar / Douglas, Kirsty

Australian journal of primary health

2022 Volume 28, Issue 3, Page(s) 232–238

Abstract: This study describes patient characteristics and presentations to community-based primary care medical services in the after-hours period. A cross-sectional survey completed by practitioners was voluntarily conducted over one weeknight and weekend in ... ...

Abstract	This study describes patient characteristics and presentations to community-based primary care medical services in the after-hours period. A cross-sectional survey completed by practitioners was voluntarily conducted over one weeknight and weekend in 2019 at 31 of 51 extended hours general practices (GP), three of three medical deputising services and three of three nurse-led walk-in clinics (WICs). Of 3371 community-based after-hours presentations, 934 consultation records were obtained (overall response: 28%). Emergency departments reported 524 triage code 4 and 5 patients within the study period. Problems managed in community-based after-hours services were most often rated as non-urgent (n = 482; 51.6%) and new (n = 606; 64.9%). The most common community-based after-hours presentations were diagnostic or disease related (e.g. infections or injury; n = 667; 59.5%). The most common body systems impacted were respiratory (n = 329; 29.6%), skin (n = 164; 16.4%) and general/unspecified (e.g. fever; n = 164; 16.4%). Community-based after-hours services reported different types of presentations, with medical deputising services reporting more urgent presentations, GPs reporting more procedural presentations and walk-in clinics reporting more skin-related issues (e.g. wound care). Community-based after-hours medical services contribute significantly to after-hours medical care in the ACT. Patients are self-selecting community-based after-hours medical services appropriately based on problems managed by practitioners.
MeSH term(s)	After-Hours Care ; Australia ; Australian Capital Territory ; Cross-Sectional Studies ; Emergency Service, Hospital ; General Practitioners ; Humans ; Primary Health Care
Language	English
Publishing date	2022-04-07
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2566332-X
ISSN	1836-7399 ; 1448-7527
ISSN (online)	1836-7399
ISSN	1448-7527
DOI	10.1071/PY21261
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Article ; Online: Why patients attend after-hours medical services: a cross-sectional survey of patients across the Australian Capital Territory.

Barnes, Katelyn / Ceramidas, Dagmar / Douglas, Kirsty

Australian journal of primary health

2022 Volume 28, Issue 6, Page(s) 549–555

Abstract: Background: Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). This paper reports patient ... ...

Abstract	Background: Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). This paper reports patient reasons for presenting for medical care after hours, and reasons for selection of specific services across a health system. Methods: A cross-sectional survey was conducted across the Australian Capital Territory. Patients voluntarily completed questionnaires in waiting rooms during the after-hours periods of one weekday and one weekend in 2019 at 28/51 extended hours GPs, 3/3 medical deputising services (MDS), 3/3 nurse-led walk-in-clinics (WICs), and 2/2 public emergency departments (EDs). Results: Of 3371 presentations, 1992 patients completed a survey, with 58% from GPs (n =1149), 16% from WIC (n =317), 10% from MDS (n =193), and 17% from EDs (n =333). Most patients presented with self-rated new issues (n =987, 49.5%) and were uncertain of the urgency of their issues (n =723, 36.7%). Common reasons for presenting to WIC, MDS, and EDs included the problem occurring after hours, and patients concern about the issue. Common reasons for presenting to GP were related to personal preference for after-hours care. Conclusions: Patients present to after-hours medical services for both perceived need and convenience. Most patients appear to be self-selecting after-hours services appropriately aligned with advertised services; except for GP patients who were attending after hours for care that is often non-urgent and could be seen in usual working hours. This study should be replicated to account for local health systems, and coronavirus disease 2019 (COVID-19)-related changes to health care.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Australia ; COVID-19 ; Australian Capital Territory
Language	English
Publishing date	2022-08-31
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2566332-X
ISSN	1836-7399 ; 1448-7527
ISSN (online)	1836-7399
ISSN	1448-7527
DOI	10.1071/PY22087
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Article ; Online: Mapping young people's journeys through mental health services: A prospective longitudinal qualitative study protocol.

Pilbeam, Caitlin / Walsh, Erin / Barnes, Katelyn / Scholz, Brett / Olsen, Anna / Stone, Louise

PloS one

2023 Volume 18, Issue 6, Page(s) e0287098

Abstract: Mental ill health is a major health risk for young people. There is unmet need for mental health assessment and treatment across Australia despite significant investment in government-funded plans to cover mental health and youth-oriented services. ... ...

Abstract	Mental ill health is a major health risk for young people. There is unmet need for mental health assessment and treatment across Australia despite significant investment in government-funded plans to cover mental health and youth-oriented services. Understandings of mental health care for young people are impeded by a lack of longitudinal research. Without this research, it is difficult to understand how services do or do not support the recovery of young people over time. This project will analyse the healthcare journeys of young people aged 16-25 years experiencing their first episode of mental ill health for which they have sought GP support, over 12 months in the Australian Capital Territory. The study team will recruit up to 25 diverse young people and their general practitioners (GPs), and conduct four qualitative semi-structured interviews over 12 months with each participant. GP interviews will explore their role in the mental health care and care coordination for the young person. Interviews with young people will explore experiences and perceptions of navigating the health system, and the supports and resources they engaged with during the 12-month period. In between interviews, young people will be asked to keep a record of their mental health care experiences, through their choice of media. Participant-produced materials will also form the basis for interviews, providing stimuli to discuss the lived experience of care. Through analysing the narratives of both young people and their GPs, the study will establish how young people understand value in mental health care delivery. The study will use longitudinal qualitative mapping of healthcare journeys to identify key barriers and enablers to establishing effective, person-centred health care for young people with mental ill health.
MeSH term(s)	Adolescent ; Humans ; Prospective Studies ; Australia ; Mental Health Services ; Mental Health ; Australian Capital Territory
Language	English
Publishing date	2023-06-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0287098
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Article ; Online: Providing food to patients in primary care to induce weight loss: a systematic literature review.

Ball, Lauren / Somerville, Mari / Crowley, Jennifer / Calleja, Zoe / Barnes, Katelyn

BMJ nutrition, prevention & health

2021 Volume 4, Issue 1, Page(s) 333–341

Abstract: Purpose: Primary care is the ideal setting to promote weight management, warranting innovative ways to support patients. This systematic review aimed to determine whether providing food to patients in primary care can help to reduce body weight.: ... ...

Abstract	Purpose: Primary care is the ideal setting to promote weight management, warranting innovative ways to support patients. This systematic review aimed to determine whether providing food to patients in primary care can help to reduce body weight. Methods: Four databases were searched for studies that aimed to elicit weight loss by directly providing foodstuffs and/or supplements to patients in primary care settings. Interventions with adults of any gender or race were included. Interventions that involved other components such as exercise classes or education sessions were excluded. The methodological quality of each study was appraised using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results: Four heterogeneous studies met the eligibility criteria, representing 476 adults. Two studies used meal-replacement products but differed in length and intensity, another study provided green tea and vitamin E supplementation, and the final study provided vouchers for use at a farmers' market hosted at a primary care clinic. Interventions ranged in length from 4 to 13 weeks. Three of the four studies observed weight loss in some form and all studies observed at least one other improvement in a health outcome such as waist circumference, blood pressure or fasting insulin levels. Conclusions: A small yet notable body of literature supports the concept of providing food to patients in primary care settings to support weight loss. Further, high-quality research is needed on the efficacy and cost-effectiveness of this approach to ultimately inform policy initiatives for primary care.
Language	English
Publishing date	2021-03-26
Publishing country	England
Document type	Journal Article ; Review
ISSN	2516-5542
ISSN (online)	2516-5542
DOI	10.1136/bmjnph-2020-000195
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Article ; Online: COVID-19 vaccinations and counselling: a mixed-methods survey of Australian general practice in July 2021.

O'Brien, Kathleen / Barnes, Katelyn / Hall Dykgraaf, Sally / Douglas, Kirsty A

Australian journal of primary health

2022 Volume 28, Issue 5, Page(s) 399–407

Abstract: Background: GPs are integral to the COVID-19 vaccination rollout, providing education and administering vaccines. We sought to describe how counselling relating to COVID-19 vaccination was impacting Australian general practice consultations.: Methods!# ...

Abstract	Background: GPs are integral to the COVID-19 vaccination rollout, providing education and administering vaccines. We sought to describe how counselling relating to COVID-19 vaccination was impacting Australian general practice consultations. Methods: We conducted an online, mixed-methods, cross-sectional survey of Australian community-based primary care from 7 to 15 July 2021. This survey, number 15 in a series of recurrent cross-sectional surveys conducted over a 14-month period, explored how counselling relating to COVID-19 vaccination was impacting general practice consultations, through multiple selection and open text responses; it also included questions on respondent and practice characteristics, and pandemic-related stress and strain. We calculated descriptive statistics for quantitative variables, and analysed free-text responses using an inductive content analysis approach. Results: We received 73 responses (72 GPs) across all states/territories. Discussions with patients about COVID-19 vaccines and vaccination were common, increasing the duration of routine consultations by 6min on average (s.d. 2.9). Respondents described the impact of the resulting time pressures, and the stress and challenges of participating in COVID-19 vaccine communication and administration. Although our results are illuminating, they are limited by the small sample, with some different characteristics from national estimates, an uncertain response rate and the inability to pilot the survey prior to distribution. Conclusions: The significant impact on general practice consultation from COVID-19 vaccine counselling is on a background of ongoing pandemic-related stress and strain. With a strong track record of population vaccination, GPs are well-placed to deliver COVID-19 immunisations to the Australian population. However, they must be represented in planning and coordination, to reduce the overall burden on primary care.
MeSH term(s)	Australia ; COVID-19/prevention & control ; COVID-19 Vaccines ; Counseling ; Cross-Sectional Studies ; General Practice ; Humans ; Surveys and Questionnaires ; Vaccination ; Vaccines
Chemical Substances	COVID-19 Vaccines ; Vaccines
Language	English
Publishing date	2022-06-13
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2566332-X
ISSN	1836-7399 ; 1448-7527
ISSN (online)	1836-7399
ISSN	1448-7527
DOI	10.1071/PY21301
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Article ; Online: Primary care is the ideal setting to promote COVID-19 vaccination for children.

Barnes, Katelyn / Hall Dykgraaf, Sally / de Toca, Lucas / Wright, Michael / Kidd, Michael

The Medical journal of Australia

2022 Volume 217, Issue 11, Page(s) 575–577

MeSH term(s)	Child ; Humans ; COVID-19 Vaccines ; COVID-19/epidemiology ; COVID-19/prevention & control ; Vaccination ; Primary Health Care
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-11-20
Publishing country	Australia
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	186082-3
ISSN	1326-5377 ; 0025-729X
ISSN (online)	1326-5377
ISSN	0025-729X
DOI	10.5694/mja2.51769
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