Susan Sawyer | University of Melbourne (original) (raw)

Papers by Susan Sawyer

Research paper thumbnail of Adolescence on the health agenda

Research paper thumbnail of Quality-of-life assessment in children and adolescents with asthma

European Respiratory Journal, 1998

Research paper thumbnail of Critical evaluation of three chest radiograph scores in cystic fibrosis

Thorax, 1994

Background -A number of chest radiographic scores have been developed to assess the severity of r... more Background -A number of chest radiographic scores have been developed to assess the severity of respiratory disease in cystic fibrosis but critical statistical evaluation has been limited. In particular, the chest radiograph component of the National Institutes of Health (NIH) clinical score has not previously been validated. Three different chest radiograph scores have been compared and the association between them and lung function tests investigated. Methods -The interobserver and intraobserver variation of the Brasfield, NIH chest radiograph, and the Royal Children's Hospital (RCH) chest radiograph score was assessed by three observersa paediatric radiologist, a junior and a senior respiratory physicianwho independently scored, on separate occasions, 62 chest radiographs randomly selected from three age strata of patients ranging from 7 to 18 years. Lung function tests were available for 61 patients obtained within three months of the chest radiograph. Two way analysis of variance was used to estimate components of variation in scores. Results -Results were similar for the Brasfield and NIH scores, both of which demonstrated greater precision than the RCH score, but the estimated repeatability of the Brasfield and NIH scores can be expected to differ by up to 20% of the maximum score. The reliabilities (intraclass correlation) are all reasonably high at 0 74, 0 73, and 0*61 for the Brasfield, NIH, and RCH scores, respectively. The estimated correlation between radiographic scores and lung function tests, adjusted for attenuation caused by measurement error, showed a similar correlation for all three scoring methods ranging from 0 55 to 0*78. Correlations were slightly greater with FEV1% than FVC%. These correlations are substantial but not high, indicating that a large proportion ofthe variability in radiographic scores cannot be explained by lung function measurements. Conclusions -The Brasfield and NIH chest radiograph scores have very similar statistical profiles and can be equally recommended if a chest radiograph score is to be used. The RCH radiographic score appears to be less reliable. The limitations of these scores need to be understood.

Research paper thumbnail of Development and validation of the Adolescent Asthma Quality of Life Questionnaire (AAQOL)

European Respiratory Journal, 2001

Current asthma-speci®c quality of life questionnaires have major conceptual and methodological de... more Current asthma-speci®c quality of life questionnaires have major conceptual and methodological de®ciencies for use in adolescents. The aim of this study was to develop and validate the "Adolescent Asthma Quality of Life Questionnaire (AAQOL)", speci®cally developed for adolescents with asthma.

Research paper thumbnail of Improving Paediatric Asthma Management Through Provider Education: : A Randomized Controlled Trial

B102. UNDERSTANDING ADHERENCE IN LUNG DISEASE: AN INTERNATIONAL LOOK AT BARRIERS AND OPPORTUNITIES, 2010

Page 1. / B102 UNDERSTANDING ADHERENCE IN LUNG DISEASE: AN INTERNATIONAL LOOK AT BARRIERS AND OPP... more Page 1. / B102 UNDERSTANDING ADHERENCE IN LUNG DISEASE: AN INTERNATIONAL LOOK AT BARRIERS AND OPPORTUNITIES Poster Discussion Session / Monday, May 17/1:30 PM-4:00 PM / Room 265-266 (Second Level), Morial Convention Center ...

Research paper thumbnail of Children and Adolescents With Eating Disorders: The State of the Art

PEDIATRICS, 2003

Background. Eating disorders in children and adolescents remain a serious cause of morbidity and ... more Background. Eating disorders in children and adolescents remain a serious cause of morbidity and mortality in children, adolescents, and young adults. The working knowledge of pathophysiology, recognition, and management of eating disorders continues to evolve as research in this field continues.

Research paper thumbnail of A qualitative study of action plans for asthma

BMJ, 2002

Objectives To investigate the perspectives of patients with asthma on the use of an action plan a... more Objectives To investigate the perspectives of patients with asthma on the use of an action plan and the implementation of this plan during an asthma attack that culminated in a visit to an emergency department. Design Qualitative study. Setting Tertiary teaching hospital, suburban hospital, and rural hospital. Participants 62 patients aged 18 to 69 years who presented to an emergency department with asthma over a two month period.

Research paper thumbnail of Patients' views of the burden of asthma: a qualitative study

The Medical journal of Australia, Jan 16, 2002

To explore the burden of asthma on the lives of people presenting to hospital emergency departmen... more To explore the burden of asthma on the lives of people presenting to hospital emergency departments for asthma treatment. A qualitative study. Consenting individuals with asthma who presented to emergency departments were interviewed in-depth, and interviews were taped, transcribed and thematically analysed. Questionnaire data on medication use, respiratory health and asthma knowledge were also collected. Asthma severity was determined from the medical records. A tertiary teaching hospital and a suburban hospital during March and April 2000, and a rural hospital during July and August 2000. Sixty-two participants (19 male and 43 female), aged 18-70 years. The burden of asthma was broad, affecting social life, personal relationships, employment and finances. The cost of asthma medication was an issue for nearly two-thirds of participants. Individuals performed their own "cost-benefit analysis" for medication use, weighing up expense, perceived side effects and potential ben...

Research paper thumbnail of Over-the-counter β2-agonist purchase versus script: A cross-sectional study

Respiratory Medicine, 2012

Research paper thumbnail of Choosing to attend an asthma doctor: a qualitative study in adults attending emergency departments

Family Practice, 2004

SM. Choosing to attend an asthma doctor: a qualitative study in adults attending emergency depart... more SM. Choosing to attend an asthma doctor: a qualitative study in adults attending emergency departments. Family Practice 2004; 21: 166-172.

Research paper thumbnail of Enhancing Validity: What Counts as an Asthma Attack?

Journal of Asthma, 2004

Major epidemiological studies in asthma use the question: "How many attacks of asthma ha... more Major epidemiological studies in asthma use the question: "How many attacks of asthma have you had in the last 12 months?" We set out to study what constitutes an asthma attack from the perspective of people with asthma. We also examined concordance between qualitative responses and standard quantitative measures of this question. Individuals aged 18 to 70 years who sought care for asthma at Emergency Departments in an Australian central city, a suburban and a regional hospital were recruited. Sixty two (43 women and 19 men) participants were interviewed in depth. All interviews were taped, transcribed and thematically analyzed. Demographic data and responses to respiratory health data were also collected. Widely varying responses to the question, "How many attacks of asthma have you had in the last 12 months?" were found in the quantitative data set. Comparison of quantitative and qualitative data sets showed good agreement between these two responses (intraclass correlation 0.66). People defined asthma attacks as "major" and "minor," as determined by the degree of personal control they were able to exercise. A strongly unifying description of a severe attack was that it was "out of control." Patient's recognized that upper respiratory tract infections commonly triggered major attacks. A commonly asked question about the number of asthma attacks in the past year needs refinement in order to enhance validity. Asthma action plans should use the words "out of control" when defining a severe attack of asthma.

Research paper thumbnail of Barriers to delivering asthma care: a qualitative study of general practitioners

The Medical journal of Australia, Jan 7, 2005

To ascertain what general practitioners' priorities are for achieving optimal outcomes in peo... more To ascertain what general practitioners' priorities are for achieving optimal outcomes in people with asthma, and the barriers they face in delivering this care. A qualitative study using the Nominal Group Technique (a highly structured meeting to gain information from experts about a particular issue) was conducted between August 2002 and September 2003. GPs in six discussion groups were asked "What do you think is needed to achieve best outcomes for asthma care?" To augment analysis of the discussion, sessions were taped and transcribed. Forty-nine GPs were recruited: 34 from metropolitan and 15 from rural areas. All groups nominated asthma education for patients and continuing professional education for GPs as major priorities, but they also described educational and structural barriers to achieving these priorities. Other priorities were: medication adherence, facilitating regular patient review, negotiated treatment/management plans, making the correct diagnosis, ...

Research paper thumbnail of Back for more: a qualitative study of emergency department reattendance for asthma

The Medical journal of Australia, Jan 2, 2004

To explore the reasons why individuals recurrently present with asthma to hospital emergency depa... more To explore the reasons why individuals recurrently present with asthma to hospital emergency departments. A predominantly qualitative study in which participants were interviewed in-depth about their asthma. Data on medication use, respiratory health and asthma knowledge were also collected, and asthma severity was determined from medical records. A tertiary teaching hospital and a suburban hospital emergency department (ED) from 1 March to 30 April 2000, and a rural hospital ED from 1 July to 31 August 2000. The participation rate was 32% of an initial 195 ED attendees (183 of whom were eligible) aged 18-70 years: 32 had presented to an ED for asthma care on more than one occasion over the preceding 12 months (reattendees), and 29 were non-reattendees. Two-thirds (22/32) of reattendees had chronic severe asthma and presentation to ED was deemed appropriate for 18 of these, indicated by recurrent severe asthma attacks despite seeking prior medical intervention. Reasons for re-presen...

Research paper thumbnail of The prevention access and risk taking in young people (PARTY) project protocol: A cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice

BMC Public Health, 2012

Background: There are growing worldwide concerns about the ability of primary health care systems... more Background: There are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. Main outcomes: clinicians' detection of risk-taking and emotional distress, young people's intention to change and reduction of risk taking. Secondary outcomes: pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol.

Research paper thumbnail of Responding to Young People’s Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing

PLOS ONE, 2015

To evaluate the effectiveness of a complex intervention implementing best practice guidelines rec... more To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians' detection of health risks and patients' risk taking behaviour, compared to a didactic seminar on young people's health. Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. General practices in metropolitan and rural Victoria, Australia. General practices with at least one interested clinician (general practitioner or nurse) and their 14-24 year old patients. This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients' risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients' sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524…

Research paper thumbnail of Eating disorders in adolescents

Journal of Adolescent Health, 2003

Research paper thumbnail of Global burden of disease in young people aged 10–24 years – Authors' reply

Research paper thumbnail of Chronic illness and disability

BMJ (Clinical research ed.), Jan 26, 2005

Young people with chronic conditions often face more difficulties negotiating the tasks of adoles... more Young people with chronic conditions often face more difficulties negotiating the tasks of adolescence than their healthy peers. National, population based studies from Western countries show that 20-30% of teenagers have a chronic illness, defined as one that lasts longer than six months. However, 10-13% of teenagers report having a chronic condition that substantially limits their daily life or requires extended periods of care and supervision.

Research paper thumbnail of Barriers and facilitators to patient recruitment to a cluster randomized controlled trial in primary care: lessons for future trials

BMC medical research methodology, 2015

Primary-care based randomized controlled trials (RCTs) build an important evidence base for gener... more Primary-care based randomized controlled trials (RCTs) build an important evidence base for general practice but little evidence exists about barriers to recruitment which often hamper such trials. We investigated the issues that impeded and facilitated recruitment to a clinical trial in general practice. GPs participating in a cluster RCT that tested interventions for improving medication adherence and asthma control completed a survey comprising quantitative and free text questions about their recruitment experiences. We used backward regression to analyze quantitative data and coded free text responses into themes. 40/55 of enrolled GPs recruited patients, but only one-third reached the planned recruitment target (5 patients/GP). In univariate analyses, poor patient recruitment by GPs was significantly associated with longer time to first patient enrolment, GP-perceived poor access to eligible patients and GP working in a practice training medical students. In regression analysis...

Research paper thumbnail of Asthma control in Australia: a cross-sectional web-based survey in a nationally representative population

The Medical journal of Australia, Jan 18, 2015

To identify patterns of asthma control and treatment in Australian adults with asthma. Cross-sect... more To identify patterns of asthma control and treatment in Australian adults with asthma. Cross-sectional web-based survey, conducted 1-27 November 2012. Adults with current asthma, at least 16 years of age, drawn randomly from a web-based panel and weighted to reflect national population proportions for people with asthma. Asthma Control Test (ACT) scores; health care utilisation; medication use. 2686 participants completed the survey (57.1% female; median age group, 40-49 years). Mean ACT score was 19.2 (95% CI, 18.9-19.3), with asthma classified as "well controlled" for 54.4% of participants, "not well controlled" for 22.7% and "very poorly controlled" for 23.0%. 60.8% reported using preventer medication (mostly combined inhaled corticosteroid/long-acting β2-agonist) during the previous year. 23.4% had made at least one urgent visit to a general practitioner concerning their asthma, 10.0% at least one emergency department visit. Urgent consultations wer...

Research paper thumbnail of Adolescence on the health agenda

Research paper thumbnail of Quality-of-life assessment in children and adolescents with asthma

European Respiratory Journal, 1998

Research paper thumbnail of Critical evaluation of three chest radiograph scores in cystic fibrosis

Thorax, 1994

Background -A number of chest radiographic scores have been developed to assess the severity of r... more Background -A number of chest radiographic scores have been developed to assess the severity of respiratory disease in cystic fibrosis but critical statistical evaluation has been limited. In particular, the chest radiograph component of the National Institutes of Health (NIH) clinical score has not previously been validated. Three different chest radiograph scores have been compared and the association between them and lung function tests investigated. Methods -The interobserver and intraobserver variation of the Brasfield, NIH chest radiograph, and the Royal Children's Hospital (RCH) chest radiograph score was assessed by three observersa paediatric radiologist, a junior and a senior respiratory physicianwho independently scored, on separate occasions, 62 chest radiographs randomly selected from three age strata of patients ranging from 7 to 18 years. Lung function tests were available for 61 patients obtained within three months of the chest radiograph. Two way analysis of variance was used to estimate components of variation in scores. Results -Results were similar for the Brasfield and NIH scores, both of which demonstrated greater precision than the RCH score, but the estimated repeatability of the Brasfield and NIH scores can be expected to differ by up to 20% of the maximum score. The reliabilities (intraclass correlation) are all reasonably high at 0 74, 0 73, and 0*61 for the Brasfield, NIH, and RCH scores, respectively. The estimated correlation between radiographic scores and lung function tests, adjusted for attenuation caused by measurement error, showed a similar correlation for all three scoring methods ranging from 0 55 to 0*78. Correlations were slightly greater with FEV1% than FVC%. These correlations are substantial but not high, indicating that a large proportion ofthe variability in radiographic scores cannot be explained by lung function measurements. Conclusions -The Brasfield and NIH chest radiograph scores have very similar statistical profiles and can be equally recommended if a chest radiograph score is to be used. The RCH radiographic score appears to be less reliable. The limitations of these scores need to be understood.

Research paper thumbnail of Development and validation of the Adolescent Asthma Quality of Life Questionnaire (AAQOL)

European Respiratory Journal, 2001

Current asthma-speci®c quality of life questionnaires have major conceptual and methodological de... more Current asthma-speci®c quality of life questionnaires have major conceptual and methodological de®ciencies for use in adolescents. The aim of this study was to develop and validate the "Adolescent Asthma Quality of Life Questionnaire (AAQOL)", speci®cally developed for adolescents with asthma.

Research paper thumbnail of Improving Paediatric Asthma Management Through Provider Education: : A Randomized Controlled Trial

B102. UNDERSTANDING ADHERENCE IN LUNG DISEASE: AN INTERNATIONAL LOOK AT BARRIERS AND OPPORTUNITIES, 2010

Page 1. / B102 UNDERSTANDING ADHERENCE IN LUNG DISEASE: AN INTERNATIONAL LOOK AT BARRIERS AND OPP... more Page 1. / B102 UNDERSTANDING ADHERENCE IN LUNG DISEASE: AN INTERNATIONAL LOOK AT BARRIERS AND OPPORTUNITIES Poster Discussion Session / Monday, May 17/1:30 PM-4:00 PM / Room 265-266 (Second Level), Morial Convention Center ...

Research paper thumbnail of Children and Adolescents With Eating Disorders: The State of the Art

PEDIATRICS, 2003

Background. Eating disorders in children and adolescents remain a serious cause of morbidity and ... more Background. Eating disorders in children and adolescents remain a serious cause of morbidity and mortality in children, adolescents, and young adults. The working knowledge of pathophysiology, recognition, and management of eating disorders continues to evolve as research in this field continues.

Research paper thumbnail of A qualitative study of action plans for asthma

BMJ, 2002

Objectives To investigate the perspectives of patients with asthma on the use of an action plan a... more Objectives To investigate the perspectives of patients with asthma on the use of an action plan and the implementation of this plan during an asthma attack that culminated in a visit to an emergency department. Design Qualitative study. Setting Tertiary teaching hospital, suburban hospital, and rural hospital. Participants 62 patients aged 18 to 69 years who presented to an emergency department with asthma over a two month period.

Research paper thumbnail of Patients' views of the burden of asthma: a qualitative study

The Medical journal of Australia, Jan 16, 2002

To explore the burden of asthma on the lives of people presenting to hospital emergency departmen... more To explore the burden of asthma on the lives of people presenting to hospital emergency departments for asthma treatment. A qualitative study. Consenting individuals with asthma who presented to emergency departments were interviewed in-depth, and interviews were taped, transcribed and thematically analysed. Questionnaire data on medication use, respiratory health and asthma knowledge were also collected. Asthma severity was determined from the medical records. A tertiary teaching hospital and a suburban hospital during March and April 2000, and a rural hospital during July and August 2000. Sixty-two participants (19 male and 43 female), aged 18-70 years. The burden of asthma was broad, affecting social life, personal relationships, employment and finances. The cost of asthma medication was an issue for nearly two-thirds of participants. Individuals performed their own "cost-benefit analysis" for medication use, weighing up expense, perceived side effects and potential ben...

Research paper thumbnail of Over-the-counter β2-agonist purchase versus script: A cross-sectional study

Respiratory Medicine, 2012

Research paper thumbnail of Choosing to attend an asthma doctor: a qualitative study in adults attending emergency departments

Family Practice, 2004

SM. Choosing to attend an asthma doctor: a qualitative study in adults attending emergency depart... more SM. Choosing to attend an asthma doctor: a qualitative study in adults attending emergency departments. Family Practice 2004; 21: 166-172.

Research paper thumbnail of Enhancing Validity: What Counts as an Asthma Attack?

Journal of Asthma, 2004

Major epidemiological studies in asthma use the question: "How many attacks of asthma ha... more Major epidemiological studies in asthma use the question: "How many attacks of asthma have you had in the last 12 months?" We set out to study what constitutes an asthma attack from the perspective of people with asthma. We also examined concordance between qualitative responses and standard quantitative measures of this question. Individuals aged 18 to 70 years who sought care for asthma at Emergency Departments in an Australian central city, a suburban and a regional hospital were recruited. Sixty two (43 women and 19 men) participants were interviewed in depth. All interviews were taped, transcribed and thematically analyzed. Demographic data and responses to respiratory health data were also collected. Widely varying responses to the question, "How many attacks of asthma have you had in the last 12 months?" were found in the quantitative data set. Comparison of quantitative and qualitative data sets showed good agreement between these two responses (intraclass correlation 0.66). People defined asthma attacks as "major" and "minor," as determined by the degree of personal control they were able to exercise. A strongly unifying description of a severe attack was that it was "out of control." Patient's recognized that upper respiratory tract infections commonly triggered major attacks. A commonly asked question about the number of asthma attacks in the past year needs refinement in order to enhance validity. Asthma action plans should use the words "out of control" when defining a severe attack of asthma.

Research paper thumbnail of Barriers to delivering asthma care: a qualitative study of general practitioners

The Medical journal of Australia, Jan 7, 2005

To ascertain what general practitioners' priorities are for achieving optimal outcomes in peo... more To ascertain what general practitioners' priorities are for achieving optimal outcomes in people with asthma, and the barriers they face in delivering this care. A qualitative study using the Nominal Group Technique (a highly structured meeting to gain information from experts about a particular issue) was conducted between August 2002 and September 2003. GPs in six discussion groups were asked "What do you think is needed to achieve best outcomes for asthma care?" To augment analysis of the discussion, sessions were taped and transcribed. Forty-nine GPs were recruited: 34 from metropolitan and 15 from rural areas. All groups nominated asthma education for patients and continuing professional education for GPs as major priorities, but they also described educational and structural barriers to achieving these priorities. Other priorities were: medication adherence, facilitating regular patient review, negotiated treatment/management plans, making the correct diagnosis, ...

Research paper thumbnail of Back for more: a qualitative study of emergency department reattendance for asthma

The Medical journal of Australia, Jan 2, 2004

To explore the reasons why individuals recurrently present with asthma to hospital emergency depa... more To explore the reasons why individuals recurrently present with asthma to hospital emergency departments. A predominantly qualitative study in which participants were interviewed in-depth about their asthma. Data on medication use, respiratory health and asthma knowledge were also collected, and asthma severity was determined from medical records. A tertiary teaching hospital and a suburban hospital emergency department (ED) from 1 March to 30 April 2000, and a rural hospital ED from 1 July to 31 August 2000. The participation rate was 32% of an initial 195 ED attendees (183 of whom were eligible) aged 18-70 years: 32 had presented to an ED for asthma care on more than one occasion over the preceding 12 months (reattendees), and 29 were non-reattendees. Two-thirds (22/32) of reattendees had chronic severe asthma and presentation to ED was deemed appropriate for 18 of these, indicated by recurrent severe asthma attacks despite seeking prior medical intervention. Reasons for re-presen...

Research paper thumbnail of The prevention access and risk taking in young people (PARTY) project protocol: A cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice

BMC Public Health, 2012

Background: There are growing worldwide concerns about the ability of primary health care systems... more Background: There are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. Main outcomes: clinicians' detection of risk-taking and emotional distress, young people's intention to change and reduction of risk taking. Secondary outcomes: pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol.

Research paper thumbnail of Responding to Young People’s Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing

PLOS ONE, 2015

To evaluate the effectiveness of a complex intervention implementing best practice guidelines rec... more To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians' detection of health risks and patients' risk taking behaviour, compared to a didactic seminar on young people's health. Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. General practices in metropolitan and rural Victoria, Australia. General practices with at least one interested clinician (general practitioner or nurse) and their 14-24 year old patients. This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients' risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients' sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524…

Research paper thumbnail of Eating disorders in adolescents

Journal of Adolescent Health, 2003

Research paper thumbnail of Global burden of disease in young people aged 10–24 years – Authors' reply

Research paper thumbnail of Chronic illness and disability

BMJ (Clinical research ed.), Jan 26, 2005

Young people with chronic conditions often face more difficulties negotiating the tasks of adoles... more Young people with chronic conditions often face more difficulties negotiating the tasks of adolescence than their healthy peers. National, population based studies from Western countries show that 20-30% of teenagers have a chronic illness, defined as one that lasts longer than six months. However, 10-13% of teenagers report having a chronic condition that substantially limits their daily life or requires extended periods of care and supervision.

Research paper thumbnail of Barriers and facilitators to patient recruitment to a cluster randomized controlled trial in primary care: lessons for future trials

BMC medical research methodology, 2015

Primary-care based randomized controlled trials (RCTs) build an important evidence base for gener... more Primary-care based randomized controlled trials (RCTs) build an important evidence base for general practice but little evidence exists about barriers to recruitment which often hamper such trials. We investigated the issues that impeded and facilitated recruitment to a clinical trial in general practice. GPs participating in a cluster RCT that tested interventions for improving medication adherence and asthma control completed a survey comprising quantitative and free text questions about their recruitment experiences. We used backward regression to analyze quantitative data and coded free text responses into themes. 40/55 of enrolled GPs recruited patients, but only one-third reached the planned recruitment target (5 patients/GP). In univariate analyses, poor patient recruitment by GPs was significantly associated with longer time to first patient enrolment, GP-perceived poor access to eligible patients and GP working in a practice training medical students. In regression analysis...

Research paper thumbnail of Asthma control in Australia: a cross-sectional web-based survey in a nationally representative population

The Medical journal of Australia, Jan 18, 2015

To identify patterns of asthma control and treatment in Australian adults with asthma. Cross-sect... more To identify patterns of asthma control and treatment in Australian adults with asthma. Cross-sectional web-based survey, conducted 1-27 November 2012. Adults with current asthma, at least 16 years of age, drawn randomly from a web-based panel and weighted to reflect national population proportions for people with asthma. Asthma Control Test (ACT) scores; health care utilisation; medication use. 2686 participants completed the survey (57.1% female; median age group, 40-49 years). Mean ACT score was 19.2 (95% CI, 18.9-19.3), with asthma classified as "well controlled" for 54.4% of participants, "not well controlled" for 22.7% and "very poorly controlled" for 23.0%. 60.8% reported using preventer medication (mostly combined inhaled corticosteroid/long-acting β2-agonist) during the previous year. 23.4% had made at least one urgent visit to a general practitioner concerning their asthma, 10.0% at least one emergency department visit. Urgent consultations wer...