Healthed Research

Australia’s national zoster vaccination program: Knowledge, attitudes and behaviour of general practitioners

Harunor Rashid, Aditi Dey, Ramesh Manocha, Mohamed Tashani, Kristine Macartney, Frank Beard

To assess knowledge, attitudes and behaviour of Australian general practitioners (GPs) regarding herpes zoster vaccination under the National Immunisation Program (NIP) from 2016 for adults aged 70–79 years. Design, setting, participants National cross-sectional online survey of GPs, October–November 2017. Outcome measures Knowledge, attitudes and behaviour regarding zoster vaccination, including challenges experienced and recommendations for improvement. Results Of the 1026 GPs who responded (response rate 7.9%), 98.5% were aware that zoster vaccine is NIP funded for adults aged 70–79 years and 85.4% that it is recommended for age 60–69 years; however, 51.3% incorrectly thought it is routinely recommended for age 50–59 years. A minority (4.6%) incorrectly believed that being immunocompromised is not a contraindication to zoster vaccination and 16.0% that it cannot be co-administered with influenza or pneumococcal vaccine. Almost half (48.9%) rarely or never reported zoster vaccination data to the Australian Immunisation Register (AIR). Challenges perceived included lack of adequate information on vaccine contraindications; efficacy and safety concerns; and difficulty applying age criteria for NIP eligibility in general practice. Respondents indicated a desire for program expansion to include younger and older adult age groups. Conclusion This Australian GP survey, conducted one year after the introduction of the national zoster vaccination program, identified some knowledge gaps. A repeat survey of GPs is warranted to determine whether these issues persist, particularly regarding contraindication to vaccination for immunocompromised individuals. We encourage all GPs to offer zoster vaccination in line with current Australian evidence-based guidelines, particularly for the NIP-funded 70–79 years cohort; ensuring compliance with relevant contraindications; and reporting to AIR.
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Towards One Health clinical management of zoonoses: A parallel survey of Australian general medical practitioners and veterinarians

Sandra G Steele, Robert Booy, Ramesh Manocha, Siobhan M Mor, Jenny-Ann L M L Toribio

General medical practitioners (GPs) and veterinarians have different but complementary knowledge and skills, with potential to enhance clinical management of zoonoses in human and animal patients through taking a One Health approach that promotes cross‐professional collaboration. Ability and willingness to engage within this framework is contingent on knowledge of endemic zoonoses and an understanding of the diversity of professional roles; however, previous research suggests that this is lacking. A unique parallel survey of Australian GPs and veterinarians was implemented to ascertain clinician experience, concern, confidence and current practices regarding zoonoses management as well as willingness to engage in cross‐professional collaboration where it is beneficial to overall health outcomes. Responses from 528 GPs and 605 veterinarians were analysed. Veterinarians in clinical practice were found to more frequently diagnose zoonoses; have greater concern about zoonoses; be more confident in diagnosing, managing and giving advice about the prevention of zoonoses; more likely to give advice about managing the risk of zoonoses; and more likely to initiate cross‐professional referral compared to GPs (p < .001 in all areas, adjusted for other factors). The findings of this study indicate a need for change in both clinical and continuing professional education, especially for GPs, in order to better equip them in the area of zoonoses management. Exploration of pathways to encourage and facilitate cross‐professional referral and collaboration will further improve clinical outcomes for both human and animal patients.
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Engagement of General Practice in an Australian Organised Bowel Cancer Screening Program: A Cross-Sectional Survey of Knowledge and Practice

Carol A Holden, Oliver Frank,Ming Li, Ramesh Manocha, Joanna Caruso,Deborah Turnbull, Richard L Reed, Caroline L Miller, David Roder, Ian Olver

Understanding factors causing variation in family physicians/general practitioners (GPs) screening knowledge, understanding and support of organised population-based colorectal cancer (CRC) programs can direct interventions that maximise the influence of a CRC screening recommendation from a GP. This study aims to assess contextual factors that influence knowledge and quality improvement (QI) practice directed to CRC screening in Australian general practice. A convenience sample of anonymous general practice staff from all Australian states and territories completed a web-based survey. Multivariate analyses assessed the association between CRC screening knowledge and QI-CRC practice scores and patient, organisational and environmental-level contextual factors. Of 1,013 survey starts, 918 respondents (90.6%) completed the survey. Respondents less likely to recommend FOBT screening had lower knowledge and QI practice scores directed to CRC screening. Controlling for individual and practice characteristics, respondents’ rating of the Australian National Bowel Cancer Screening Program (NBCSP) support for preventive care, attending external education, and sufficient practice resources to implement QI practice (generally) were the strongest factors associated with QI practice directed towards CRC screening. Knowledge scores were less amenable to the influence of contextual factors explored. More active engagement of family medicine/general practice to improve screening promotion could be achieved through better QI resourcing without changing the fundamental design of population-based CRC screening programs.
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