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ABSTRACT: Aim This paper explores cultural and professional dynamics of HIV general practice nursing in Australia. It highlights specific contributions that HIV general practice nurses make to HIV medicine and considers how nurses' clinical practice has been shaped by past experiences of the AIDS crisis and subsequent developments in HIV medicine. BACKGROUND: In international contexts, nurses in HIV medicine commonly work as part of shared-care teams. In recent years, HIV general practice nursing has become a prioritised area for primary health care in Australia. METHODS: Data for this analysis were drawn from 45 in-depth, semi-structured interviews conducted with nurses and general practitioners (GPs) who provide HIV care in general practice, and key informants who work in policy, advocacy or education and training of the HIV general practice workforce. Findings Viewed through a socio-ecological framework of social capital, descriptive content analysis highlights a unique and strong HIV health professional identity, which emerged out of the adverse conditions experienced by nurses, GPs and allied health professionals during the 1980s AIDS crisis. Participants reported that today, HIV general practice nursing includes information provision, HIV treatment side-effect management, teaching patients methods to increase adherence to HIV treatments and capacity building with allied health professionals. Participants reported that HIV general practice nurses can reduce the clinical burden on GPs, ameliorate patients' exposure to HIV health care-related stigma and discrimination and facilitate the emergence of a comprehensive and personalised model of shared primary health care based on trust and rapport, which is desired by people with HIV. This study's findings support the future expansion of the role of HIV general practice nurses in Australia and internationally. General practice nursing will become increasingly important in the scaling up of HIV testing and in caring for increasing numbers of people living with HIV.
Primary Health Care Research & Development 03/2013;
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ABSTRACT: In Australia, primary healthcare is largely delivered through two parallel systems: Medicare supported primary care delivered by fee-for-service general practitioners, and state funded and managed community health services.
Semistructured interviews with 18 GPs to investigate the current links between GPs and local primary healthcare providers.
Barriers to links include: communication and information, access and availability of services, GP lack of awareness and understanding of services provided in the state funded sector, and lack of time to gain information. Discussion General practitioners reported dealing with more complex and challenging patients. However, this did not appear to increase their likelihood of engaging with state funded primary healthcare services in case management. Medicare Locals are a once-in-a-generation chance to establish a genuinely coordinated and multidisciplinary primary healthcare sector. To be successful, Medicare Locals will need to bring together two parallel systems of care and improve integration and coordination.
Australian family physician 12/2011; 40(12):995-9. · 0.73 Impact Factor
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ABSTRACT: This article identifies the roles that gay men with depression ascribe to their chosen general practitioner and considers how they might influence the dynamics of clinical interactions between gay men and their doctors.
Forty gay identified men with depression (recruited from high HIV caseload general practices in New South Wales and South Australia) took part in semistructured interviews that were analysed using the principles of thematic analysis. Seventeen men (aged 20-73 years) were HIV positive.
Five distinct roles were identified: GP as trusted confidant, gentle guide, provider of services, effective conduit, and community peer.
Gay men who have ongoing contact with their GP may expect them to intuitively understand which roles are expected and appropriate to perform in each consultation and over time. General practitioners should consider these changing roles, and take them into account (as appropriate) to achieve open and trusting relationships in the care of their gay male patients.
Australian family physician 09/2010; 39(9):667-71. · 0.73 Impact Factor
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ABSTRACT: This article explores qualitative descriptions of how a group of Australian general practitioners understand the relationship between depression, gender, and sexuality in their gay male patients, including gay men who are HIV negative and those who are HIV positive.
Thematic analysis of 16 semistructured qualitative interviews with GPs who prescribe s100 HIV medications in Sydney, Adelaide and a rural coastal town in New South Wales, Australia.
Recurrent themes regarding how depression affects the gay men these GPs see in their practices in comparison with heterosexual men included: differences in seeking help and accepting treatment; and similarities in emotional expression, overuse of alcohol and recreational drugs, and excessive time spent on work. Issues that complicated the management of depression in these populations included aging, sexual dysfunction, social isolation, loss of family and friendship networks, and poverty.
General practitioners with less experience in treating gay and HIV positive men can benefit from these insights to ensure that depression is accurately detected and effectively treated.
Australian family physician 09/2008; 37(8):678-80. · 0.73 Impact Factor
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ABSTRACT: Abstract
Background
This paper describes the experiences of Australian general practitioners (GPs) in managing problematic crystal methamphetamine (crystal meth) use among two groups of male patients: gay men and HIV positive men.
Methods
Semi-structured qualitative interviews with GPs with HIV medication prescribing rights were conducted in Sydney, Adelaide and a rural-coastal town in New South Wales between August and October 2006. Participants were recruited from practices with high caseloads of gay and HIV positive men.
Results
Sixteen GPs were recruited from seven practices to take part in interviews. Participants included 14 male GPs and two female GPs, and the number of years each had been working in HIV medicine ranged from two to 24. Eleven of the GPs who were based in Sydney raised the issue of problematic crystal meth use in these two patient populations. Five key themes were identified: an increasing problem; associations with depression; treatment challenges; health services and health care; workforce issues.
Conclusion
Despite study limitations, key implications can be identified. Health practitioners may benefit from broadening their understandings of how to anticipate and respond to problematic levels of crystal meth use in their patients. Early intervention can mitigate the impact of crystal meth use on co-morbid mental illness and other health issues. Management of the complex relationships between drug use, depression, sexuality and HIV can be addressed following a 'stepped care' approach. General practice guidelines for the management of crystal meth use problems should address specific issues associated with gay men and HIV positive men. GPs and other health practitioners must appreciate drug use as a social practice in order to build trust with gay men to encourage full disclosure of drug use. Education programs should train health practitioners in these issues, and increased resourcing provided to support the often difficult task of caring for people who use crystal meth. Greater resourcing of acute care and referral services can shift the burden away from primary care and community services. Further investigation should consider whether these findings are reproducible in other general practice settings, the relationship between depression, drug use and HIV medication, and challenges facing the HIV general practice workforce in Australia.
BMC Family Practice. 01/2008;
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Australian family physician 10/2004; 33(9):679. · 0.73 Impact Factor
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ABSTRACT: Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay men attending general medical practices. A secondary analysis was conducted on survey data collected from 531 gay men attending high-HIV-caseload general practices in Adelaide and Sydney, Australia. The survey contained demographic, social, behavioural and AOD variables. Participants were classified into those with ( n = 130) and without major depression ( n = 401) using the PHQ-9 screening tool. Although rates of drug use were very high in the sample, multivariate logistic regression analysis showed that the majority of variables independently associated with major depression were social and behavioural factors. Only one AOD variable was associated with major depression: the use of three or more drug types in the past 6 months. Attending to specific patterns of AOD use may assist in the identification of gay men most at risk of major depression.
International Journal of Mental Health and Addiction.
