Primary Care

The Australian government is seeking to encourage multidisciplinary team-based care as part of reforms to strengthen primary care. This initiative seeks to use the full scope of the health workforce to deliver continuity of care by supporting staff to work together to address patients health needs. It will be supported by incentive payments and programs to expand the nursing workforce.

The research team is undertaking a scoping review to better understand what to expect from these reforms and help inform policy and advocacy in this area.

The Australian government introduced voluntary patient enrolment with general practices as part of reforms to strengthen primary care. The initiative, MyMedicare, is intended to improve continuity of care and provide a mechanism to support the delivery other reforms.

The research team is seeking to better understand what to expect from these reforms to help inform policy and further advocacy in this area.

Cancer Shared Care Program

This project aims to establish and evaluate a web-based interactive cancer shared care plan that supports long term integrated care of cancer patients for colorectal and breast cancers. Also, to evaluate a GPCanShare Assessment for patients with lung cancer. Current models of cancer follow-up care involve either specialist services continuing to provide routine care for long periods or transfer of care to general practice with little or no specialist involvement. Our previous research demonstrated that a shared model of care is acceptable to patients and providers.

Waterloo Redevelopment: Health Needs Assessment and Longitudinal Study

This project aims to evaluate, and protect, the health and wellbeing of tenants of the Waterloo public housing estate as it is redeveloped to an ultra-high density and mixed tenure precinct. The Waterloo public housing estate has about 2,000 medium/high-density dwellings, many in need of refurbishment. Approximately 8% of residents are Aboriginal and/or Torres Strait Islanders.  The NSW Government in 2015 announced plans to redevelop the estate at a higher density to include 7,000 dwellings, with two thirds private housing and one third social housing. Construction is expected to commence in 2022 and to last 15 to 20 years.

Evaluating the role of Community Health Workers (CHWs) in primary health care in Australia

This program aims to develop and evaluate the role of Community Health Navigators (CHNs) in health care in Australia.  It includes a range of projects and activities including The Community Health workers Extending Care in the Community (CHECC) study, which is a NHMRC funded trial of CHNs providing support and care in the community after hospitalisation, and a program of trials of CHNs in bilingual general practices.

Development of Mental Health Shared Care e-plans

The aim of this project is to evaluate the feasibility of an online shared care plan supporting communication for clozapine treatment, preventive care and behavioural change in the long-term shared management of people with a lived experience of severe mental illness. The care plan has been developed to support communication between general practitioners, specialist services, consumers, carers and other care team members. This intervention is being implemented with the My GP & Me shared care program running in the South Eastern Sydney Local Health District with the Eastern Suburbs Mental Health Service.

Partnership payment - Community Health Workers extending care in the community

This is a study of Community Health Navigators (CHNs) providing follow-up care for patients as they move from hospital to the community. The study addresses a major challenge of the health system in supporting people with multiple long-term conditions and vulnerabilities who are at risk of hospitalisation and re-hospitalisation due to a range of problems including medication errors, challenges in self-management, and limited access to care. The first phase of the study is a co-design exercise that involves the key stakeholders working together to identify training and supervision needs. The second phase is a randomised trial evaluating the impact of CHN involvement following discharge from hospital.

Bilingual Community Navigators in General Practice

This project explores the feasibility and acceptability of involving bilingual community navigators working in general practice settings to facilitate access to health and social services for people from Culturally and Linguistically Diverse (CALD) backgrounds with chronic health conditions.

Evaluation of a Housing Relocation Referral Pathway for clients identified as experiencing moderate to severe mental illness during relocation

The Health and Housing Partnership has a focus on developing innovative approaches to improve the health and access to health services by social housing tenants in South Western Sydney. 

Phase 3 of the Central and Eastern Sydney Primary and Community Health Cohort/Linkage Resource

The Central and Eastern Sydney Primary and Community Health Research Consortium commenced in 2016 to inform primary and community services planning, program development and evaluation, in response to ageing of the population and an increase in people living with long term medical conditions. The resource is based on data from the 45 and Up study which is linked to primary, secondary and tertiary health care data, including MBS, PBS, hospitalisations, emergency department, community health and outpatient clinic use, and the cancer registry and death registry. The resource contains data on 30,600 people living in Central and Eastern Sydney between 2006 and 2020. Recent studies based on this resource have explored health service use amongst older people, social isolation, health of carers, telehealth, cancer screening, integrated care, and multimorbidity. The resource has also led to competitive research grant applications, as well as early career and PhD student projects.

Review of general practice incentives - international evidence and literature review

The Australian Department of Health and Aged Care commissioned ICFHS to undertake a review of the international literature to inform the future design of payment models and performance incentives for primary health care as part of a broader reform of general practice incentives which was announced in the 2023-24 Federal Budget responding to recommendations of the Strengthening Medicare Taskforce report. This rapid literature review focused on systematic reviews related to funding models in general practice, emphasising multidisciplinary care, preventive services for complex chronic conditions, efficacy of payment models and drivers of behavioural change among providers.