School of Public Health and Community Medicine

image - Primary Health Nick Joel

Primary Health Care

Primary Health Care research is a major strength of the School through staff located at the School’s affiliated Research Centre for Primary Health Care and Equity (CPHCE) and through researchers located within the School and at the General Practice Unit, Fairfield Hospital. The Primary Health Care Group has research under the following streams:

1. Prevention and management of chronic disease
This theme aims to conduct research on the prevention and management of chronic disease within primary health care. It encompasses research, which focuses on specific chronic diseases including diabetes, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD). The prevention of chronic disease is also a priority, particularly in relation to the SNAP risk factors: Smoking, Nutrition, Alcohol and Physical Activity. There is a particular focus on obesity through the COMPaRE-PHC centre for research excellence. Underlying this disease and prevention aspect is a focus on the organisation and capacity required to improve the quality of care in general practice. The work applies the internationally recognised Chronic Care Model, in particular the elements of delivery system design, self management support and decision support.

2. Primary Health Care System Development
This stream is focussed on developing and evaluating the conceptual frameworks, infrastructure and capacity needed for a strong Primary Health Care system; improving integration of services and continuity of care; and access to primary health care including patterns of access and studies on data linkage.

3. Understanding and Intervening to Reduce Health Inequalities
The Equity Stream is primarily located within the Centre for Health Equity Training, Research and Evaluation (CHETRE). There are currently three main program areas within this stream: Early Childhood, Health Impact Assessment (or Healthy Public Policy and Practice) and Disadvantaged Communities and Populations. The focus of this stream is on the development and implementation of interventions that will prevent or redress the impact of health inequalities.

Much of the work takes place within the UNSW Research Centre for Primary Health Care and Equity and project descriptions are available at the CPHCE website.

Within the School itself the researchers working on Primary Health Care Research are closely linked to CPHCE and are also involved in collaborations with other members of the School, with others in the Faculty of Medicine and with other Universities. The focus of the work in management of chronic disease includes evaluating change in delivery system design such as increasing the role of practice nurses and eHealth interventions.

UNSW also provides support for Primary Health Care research capacity building. This program has provided basic research skills training framing and mentoring through a Primary Health Care research network (PHReNet). The capacity building program has established a practice based research network to support and facilitate general practice involvement in research. This has been further developed by Professor Siaw-Teng Liaw has been leading the establishment of an electronic practice based research (ePBRN). In this network primary care data is linked to community and secondary care data for purposes of research, evaluation and service improvement. The ePBRN has been established around the General Practice Unit at Fairfield and we are working to expand in a hub and spoke model with collaborators from other Universities.

For more information about the capacity building program, including the work on the ePBRN, see cphce.unsw.edu.au.

Management of chronic disease

Primary health care academics within the School are leading or involved in projects on improved care of chronic illness. These projects include:

  • Nurse and general practice partnership for care of chronic obstructive pulmonary disease (COPD)
  • Early diagnosis and intervention for COPD
  • Culturally appropriate diabetes care in mainstream general practice for urban Aboriginal and Torres Strait Islander people
  • Systematic review of interventions for care of chronic disease in primary health care
  • Multidisciplinary teamwork for chronic disease care
  • Advance care planning in Australian primary care
  • Improved care of atrial fibrillation to prevent stroke.

All of these projects address health conditions of high prevalence and impact where improved care in the community has the potential for important health benefit for the population.

The 2013 CPHCE Annual Report including outlines of these projects can be viewed here.

Prevention including intervention of risk factors for chronic disease

Tobacco smoking remains the most common preventable cause of death and illness in Australia today. Smoking cessation programs are some of the most effective and cost effective strategies that can be undertaken in health care settings, including general practice. Nicholas Zwar and Robyn Richmond are leading a project (Quit in General Practice) in collaboration with colleagues at University of Western Sydney, University of Melbourne and the Australian National University to develop and test the role of general practice nurse to provide smoking cessation advice. This project tests a new approach to supporting smoking cessation in general practice. This involves the practice nurse, GP and Quitline working in partnership to provide a flexible program of support to meet the needs of smokers. Academic general practice registrar Nicole Clancy is examining the interaction of depressive illness with quitting smoking in participants in this project.

Siaw Teng Liaw is leading work on developing the local health neighbourhood, including use of eHealth data and linkages, to improve chronic disease care. Primary Care group staff are also involved in projects on absolute cardiovascular risk assessment in general practice, vascular disease prevention, lifestyle risk factor management in the 45-49 year old health check in general practice and implementation of preventive guidelines in general practice.

Prevention of cardiovascular disease is a major focus though uses of absolute risk tools. The impact of absolute risk assessment on quality use of medicines is being explored by Sanjyot Vagholkar. Nick Zwar is leading a project on improved control of hypertension in people at high cardiovascular risk. Suzanne McKenzie, who is now at James Cook University but who remains a conjoint academic with the school, is exploring the impact of psychological distress on the prevention of cardiovascular disease.

Primary health care policy

Nick Zwar has led a team to perform a systematic review on optimising skill-mix in the primary health care workforce for care of older Australians. The issue of distribution of roles and responsibilities is an important policy and practice questions given the major problems with health workforce.

Further information and opportunities for Independent Learning Project, Masters and PhD students

For more detailed information about the streams of prevention management of chronic disease, health informatics, primary health care policy and health equity see the CPHCE website or contact one of the members of the group. For further information about projects in tobacco control contact Professor Robyn Richmond.

A Masters of Public Health in Primary Health Care is available.

For more information this course, view the Postgraduate Program Prospectus.