Sarah Louise LarkinsJames Cook University | JCU · School of Medicine and Dentistry
Sarah Louise Larkins
MBBS, BMedSci, MPH&TM, PhD, FRACGP, FARGP
About
185
Publications
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Introduction
I'm an academic General Practitioner, working as Professor of Health Systems Strengthening at the College of Medicine and Dentistry, James Cook University in Townsville, Australia. I am involved in a variety of reserach projects related to health services (with a a focus on primary care services for rural, remote and Indigenous populations), sexual and reproductive health, and social accountability in medical education.
Additional affiliations
August 2008 - present
Publications
Publications (185)
Background
A dramatic decline in mental health of people worldwide in the early COVID-19 pandemic years has not recovered. In rural and remote Australia, access to appropriate and timely mental health services has been identified as a major barrier to people seeking help for mental ill-health. From 2020 to 2021 a care navigation model, Navicare, wa...
Introduction Rural hospitals provide secondary care for much of the rural New Zealand population. Little is known about community perspectives of the health and social contribution. Aim This descriptive qualitative study aimed to explore community views on the role of their rural hospital in a low socioeconomic rural district with a high Māori and...
Introduction:
Despite universal health coverage and high life expectancy, Japan faces challenges in health care that include providing care for the world's oldest population, increasing healthcare costs, physician maldistribution and an entrenched medical workforce and training system. Primary health care has typically been practised by specialist...
e13539
Background: Efficient and streamlined referral of patients with suspected lung cancer is an integral part of providing optimal care for these patients. There is emerging evidence that use of online care pathways, such as HealthPathways is associated with improved referral quality from primary care, more timely access to secondary care and st...
Background: Access to clinical trials by rural, regional, and remote Australians is limited, adding to the current health inequity between rural and metropolitan populations. The Australasian Teletrial Model was developed to bring clinical trials ‘closer to home’. In 2020, the Australian Teletrial Program was funded to expand and support the uptake...
Objectives:
This research study aimed to discover how dementia affecting older people was perceived, experienced, and managed by stakeholders in the Pacific Island country of Fiji.
Method:
A transformational grounded theory approach was used. Semi-structured interviews and focus groups with key stakeholders in the major towns of Suva, Lautoka, a...
Introduction: Development and implementation of the Townsville Lung Cancer Referral Pathway [TLCRP] aims to reduce delays and improve referral patterns of people with suspected lung cancer in north Queensland, Australia. Reported in this paper is the experiences and perspectives of general practitioners [GPs] and specialists of the TLCRP. Methods:...
Objective
Timely access to primary care and supporting specialist care relative to need is essential for health equity. However, use of services can vary according to an individual’s socioeconomic circumstances or where they live. This study aimed to quantify individual socioeconomic variation in general practitioner (GP) and specialist use in New...
This protocol describes the methodology and methods for a collaborative project with eight Aboriginal and Torres Strait Islander primary health care (PHC) organisations, across three Australian states and one territory, to increase clinical service performance and access to preventive health and health promotion services for preventing, identifying...
Objective:
Knowledge is growing about cancer care and financial costs for Aboriginal and Torres Strait Islander people. However, much remains unknown about the true costs of cancer care, encompassing financial, emotional, and spiritual aspects. We aimed to explore and explain how non-financial costs affect the health-seeking behaviours of these cl...
Background
The translation of research into healthcare practice relies on effective communication between disciplines, however strategies to address the gap between information sharing and knowledge transfer are still under exploration. Communities of Practice (CoP) are informal networks of stakeholders with shared knowledge or endeavour and presen...
Understanding the health status of a population or community is crucial to equitable service planning. Among other uses, data on health status can help local and national planners and policy makers understand patterns and trends in current or emerging health and well-being, especially how disparities relating to geography, ethnicity, language and l...
Rationale, aims and objectives:
Ensuring equitable access to primary care (PC) contributes to reducing differences in health related to people's socioeconomic circumstances. However, there is limited data on system-level factors associated with equitable access to high-quality PC. We examine whether individual-level socioeconomic variation in gene...
Background:
Lung cancer referral pathways aim to reduce delays and improve referral patterns of people with suspected lung cancer. As part of implementing lung cancer referral pathway at a regional Australian hospital, this study aimed to explore the experiences and perceptions of people with lung cancer and their carers.
Methods:
In-depth inter...
Aboriginal and Torres Strait Islander peoples’ (hereafter respectfully referred to as Indigenous Australians) experiences of health care are shaped by historical, social and cultural factors, with cultural security critical to effective care provision and engagement between services and community. Positive patient experiences are associated with be...
Background
Academic health centres (AHCs) are organisations that aim to mobilise knowledge into practice by improving the responsiveness of health systems to emerging evidence. This study aims to explore the population health role of AHCs in Australia and England, where AHCs represent novel organisational forms.
Methods
A multiple-case study desig...
Background
There is limited data on system-level factors associated with equitable access to high-quality primary care. We examine whether individual-level socioeconomic variation in general practitioner (GP) quality-of-care varies by area-level organisation of primary healthcare (PHC) services.
Methods
Baseline data (2006–2009) from the Sax Insti...
Plain language Summary Globally, menarche is an important developmental milestone for females. Experiences of menarche and subsequent menstruation are embedded in socio-cultural norms and practices which can impact women’s ability to manage menstruation with dignity. This paper reviews social and cultural factors that affect the ability of women to...
Background:
Research is central to high functioning health services alongside clinical care and health professional training. The impact of embedded research includes delivery of high-quality care and improved patient outcomes. Evaluations of research impact help health service leadership ensure investments lead to the greatest healthcare benefits...
The COVID-19 pandemic has highlighted embedded inequities and fragmentation in our health systems. Traditionally, structural issues with health professional education perpetuate these.
COVID-19 has highlighted inequities, but may also be a disruptor, allowing positive responses and system redesign. Examples from health professional schools in high...
Background: Lung cancer referral pathways aim to reduce delays and improve referral patterns of people with suspected lung cancer. As part of implementing lung cancer referral pathway at a regional Australian hospital, this study aimed to explore the experiences and perceptions of people with lung cancer and their carers.
Methods: In-depth intervie...
Background
Timely access to primary healthcare and supporting specialist care relative to need is essential for health equity. However, use of services can vary according to an individuals' socioeconomic circumstances or where they live. This study aimed to quantify individual socioeconomic variation in GP and specialist use in New South Wales (NSW...
As life expectancy increases for Indigenous populations, so does the number of older adults with complex, chronic health conditions and age-related geriatric syndromes. Many of these conditions are associated with modifiable lifestyle factors that, if addressed, may improve the health and wellbeing of Indigenous peoples as they age. If models of he...
Background This systematic review was undertaken
to assist the implementation of the WOmen’s action
for Mums and Bubs (WOMB) project which explores
Aboriginal and Torres Strait Islander community women’s
group (WG) action to improve maternal and child health
(MCH) outcomes. There is now considerable international
evidence that WGs improve MCH outco...
Background
Australia has a universal healthcare system, yet organisation and delivery of primary healthcare (PHC) services varies across local areas. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effecti...
Background
Many indigenous people have died or been harmed because of inadequately monitored research. Strong regulations in Human Research Ethics (HRE) are required to address these injustices and to ensure that peoples’ participation in health research is safe. Indigenous peoples advocate that research that respects indigenous principles can cont...
The use of contraceptives for family planning improves women’s lives and may prevent maternal deaths. However, many women in low and middle-income countries, including the Pacific region, still die from pregnancy-related complications. While most health centres offer family planning services with some basic contraceptive methods, many people do not...
During the 2016-2017 Solomon Islands dengue outbreak, the National Referral Hospital (NRH) in Honiara was the epicenter for the national response. High-quality nursing care is critical for successful management and this study investigated the factors affecting the quality of nursing care for patients admitted to NRH with dengue. Data were collected...
Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at individual, organisational and broader system levels. For Aboriginal and Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge of community, and cultural awareness are critical. Continuous quality...
Background
A national accreditation policy for the Australian primary healthcare (PHC) system was initiated in 2008. While certification standards are mandatory, little is known about their effects on the efficiency and sustainability of organisations, particularly in the Aboriginal Community Controlled Health Service (ACCHS) sector.
Aim
The liter...
Setting:
Surveillance and response workforce in the Indo-Pacific region, including Papua New Guinea (PNG), Solomon Islands, Fiji, Eastern Indonesia and Timor-Leste.
Objective:
To evaluate the implementation of a modified WHO SORT IT research training programme which included a workplace-based research project. The training was designed for surve...
Background
Survivorship care plan (SCP) comprising a treatment summary and plan for follow-up care is recommended by various organizations to address long-term needs of an increasing number of breast cancer survivors. Although there have been previous systematic reviews of SCPs in cancer, none has focused on breast cancer exclusively. This systemat...
Background
Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextu...
Background
Menarche, the first menstruation, is a significant developmental milestone for females. In Papua New Guinea (PNG), menarche is an important socio-cultural event marking transition from girlhood to womanhood. PNG is a culturally and linguistically diverse nation, with wide-ranging socio-cultural beliefs and practices around menarche. This...
Objectives
To (1) apply the Framework to Assess the Impact from Translational health research (FAIT) to Lessons from the Best to Better the Rest (LFTB), (2) report on impacts from LFTB and (3) assess the feasibility and outcomes from a retrospective application of FAIT.
Setting
Three Indigenous primary healthcare (PHC) centres in the Northern Terr...
Background
Telehealth and teleradiology are increasingly used around the world to facilitate health care provision when the health care provider and clients are separated by distance. The BreastScreen Australia Remote Radiology Assessment Model (RRAM) is an initiative developed to address the challenges of inadequate access to a local radiological...
Background
A study was done to explore the attitudes of relevant health care professionals (HCP) towards the provision of intensive care for periviable and extremely premature babies.
Methods/design
Applying a constructivist grounded theory methodology, HCP were interviewed about their attitudes towards the provision of resuscitation and intensive...
Introduction
Breast cancer is the most commonly diagnosed cancer in Australian women. Given the diverse geography and populations within Australia, the ability to offer a telemedicine-supported breast screening and assessment service may increase access. The aim of this study was to assess clinical outcomes of a telemedicine-based remote radiology...
Breast cancer is the most commonly diagnosed cancer in Australian women. Providing timely diagnostic assessment services for screen-detected abnormalities is a core quality indicator of the population-based screening program provided by BreastScreen Australia. However, a shortage of local and locum radiologists with availability and appropriate exp...
Introduction:
Delivering health services and improving health outcomes of the 1.3 million people residing in northern Australia, a region spanning 3 million km2 across the three jurisdictions of Western Australia, Northern Territory and Queensland, presents specific challenges. This review addresses a need for systems level analysis of the issues...
Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the pr...
Objective: To understand the impact of alcohol consumption on the health utilisation of people with chronic diseases.
Methods: A retrospective chart audit was undertaken in two primary care settings in a regional Australian city. Three indicator conditions were selected: type 2 diabetes, chronic obstructive pulmonary disease and chronic kidney dise...
Objective:
To better understand the impact of alcohol consumption on the clinical management of chronic diseases in a regional general practice setting.
Methods:
A retrospective chart audit was undertaken of individual patient records at two large group general practices in Townsville, a regional Australian city. Three common indicator chronic d...
Objective:
The James Cook University (JCU) medical school has a mission to produce graduates committed to practising with underserved populations. This study explores the views of final-year students regarding the influence of the JCU medical curriculum on their self-reported commitment to socially-accountable practice, intentions for rural practi...
Objective:
Ageing is a time of change that might involve financial, health and social losses. To maintain well-being, older people need to engage a range of resources to cope with these losses. However, national policies mainly focus on financial resources. This study used Folkman and Lazarus's transactional theory to identify coping methods engag...
Introduction: Much of the existing work around implementation of cancer optimal care pathways (OCP) has either focused exclusively on the clinical elements of care or has targeted individual stages in the cancer trajectory, rather than using a patient-centred or service delivery lens to inform the integration of care across the continuum. This revi...
Health systems in the Asia-Pacific region are poorly prepared for pandemic threats, particularly in rural/provincial areas. Yet future emerging infectious diseases are highly likely to emerge in these rural/provincial areas, due to high levels of contact between animals and humans (domestically and through agricultural activities), over-stretched a...
Background: The use of family planning contraceptives helps improve women’s lives and prevent maternal deaths. Globally, maternal mortality has been significantly reduced between 1990 and 2015. However, the gains have not been evenly spread with the majority of deaths still occurring in low- and middle-income countries. Solomon Islands, a low-incom...
Chronic diseases are a major contributor to the burden of disease in Australia. Alcohol consumption is similar in people with chronic disease and the general public, and may contribute to management challenges. In regional Australia, there are limited options for the management of excess alcohol consumption, so most of this burden falls to general...
Background:
Extremely preterm babies are at risk of significant mortality and morbidity due to their physiological immaturity. At periviable gestations decisions may be made to either provide resuscitation and intensive care or palliation based on assessment of the outlook for the baby and the parental preferences. Health care professionals (HCP)...
Introduction: In Australia, there have been improvements in Aboriginal and Torres Strait Islander maternal health, however inequities remain. There is increasing international evidence illustrating the effectiveness of Participatory Women's Groups (PWGs) in improving Maternal and Child Health (MCH) outcomes. Using a non-randomized, cluster stepped-...
Background:
Health systems in Australia and worldwide are increasingly expected to conduct research and quality improvement activities in addition to delivering clinical care and training health professionals. This study aims to inform a research impact evaluation at a regional Australian Hospital and Health Service by developing a programme theor...
Introduction
Community-based Participatory Women’s Groups (PWGs) have proven to be an effective intervention to improve maternal and child health (MCH) outcomes in low/middle-income countries (LMICs). Less is known about how PWGs exert their effects in LMICs and virtually nothing is known about the contextual issues, processes and power relationshi...
Appropriate housing, education, access to healthy food and economic, physical and emotional security are all vital determinants of good health. However, access to appropriate health services, ideally close to home, is important in terms of delivering the required preventive and curative health care to maximise the potential of community members for...
Aim:
To quantify the direct out-of-pocket patient co-payments and time opportunity costs (length of hospital stay) incurred by Indigenous and non-Indigenous persons diagnosed with cancer during the first year postdiagnosis.
Methods:
CancerCostMod was used, which is a model of cancer costs based upon a whole-of-population data linkage. The base p...
Summary of abstract
What is the impact of research that learnt from high performing Indigenous primary healthcare centres to help striving centres improve their systems and performance?
Abstract Title
Impact evaluation of a strengths-based approach to improving the delivery of Indigenous primary healthcare
Background
Chronic disease management...
Objectives: Dementia is a growing health priority, particularly in less resourced countries and amongst indigenous populations. Understanding cultural meanings ascribed to dementia is an important aspect of policy development and the provision of culturally congruent care and support for people with dementia, their families and the caring professio...
Design
A qualitative study informed by grounded theory principles to explore the experiences of parents who had extremely preterm or babies with antenatally diagnosed life-threatening diagnoses who were cared for in a regional tertiary neonatal unit. The study was conducted when the child was old enough to be diagnosed with long-term neurodevelopme...
Objectives
Improving the quality of primary care is an important strategy to improve health outcomes. However, responses to continuous quality improvement (CQI) initiatives are variable, likely due in part to a mismatch between interventions and context. This project aimed to understand the successful implementation of CQI initiatives in Aboriginal...
Drawing from Australian Aboriginal and Torres Strait Islander perspectives, we conceptualize the association between community participation and continuous quality improvement (CQI) processes in Indigenous primary health care (PHC) services. Indigenous experiences of community participation were drawn from our study identifying contextual factors a...
Introduction:
Generalism in the health workforce has been established as an important strategy to address health workforce maldistribution. Thus, to best serve the medical needs of northern Australia, the James Cook University (JCU) College of Medicine and Dentistry has a mission to produce graduates who both practise in the region and have a gene...
Background
Indigenous Australians diagnosed with cancer have poorer survival compared to non-Indigenous Australians. We aim to: 1) identify differences by Indigenous status in out-of-pocket expenditure for the first three-years post-diagnosis; 2) identify differences in the quantity and cost of healthcare services accessed; and 3) estimate the numb...
This book examines the mechanisms and strategies farmers in North Australia adopt to manage the setbacks and challenges they face. This social research is based on farmers’ experiences, but also draws on the author’s own experience after his tropical fruit farm was destroyed by two Category 5 cyclones in five years.
Through historical analysis, the...
Background
Contemporary approaches to rural generalist medicine training and models of care are developing internationally as part of an integrated response to common challenges faced by rural and remote health services and policymakers (addressing health inequities, workforce shortages, service sustainability concerns). The aim of this study was t...
Background
Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the pra...
Aim
The Townsville Hospital cares for babies in a large geographical area, many of who are outborn, are of Aboriginal or Torres Strait Islander origin and have families who reside in areas of deprivation. This study examined the outcomes of babies born at all locations in North Queensland to assess the predictors of poor outcomes.
Methods
A retros...
(1) Background: Studies have shown that older people prefer to continue living in their own home and community as they age; however this is dependent upon available services and social support. In Australia about two thirds of people will age at home. The Australian Government provides home care packages to support ageing in place yet in rural area...
Background:
Medical workforce problems still dominate headlines despite considerable investment in education, training and other initiatives. There is little consensus about what Australia's general practice workforce should look like or what training outcomes should be reported.
Objective:
The aim of this paper was to explore a number of issues...