John Marley

University of Queensland, Brisbane, Queensland, Australia

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Publications (74)335.13 Total impact

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    Caroline Nicholson · Claire L Jackson · John E Marley

    Preview · Article · Jul 2014 · The Medical journal of Australia
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    Preview · Article · Jul 2014 · BMC Health Services Research
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    ABSTRACT: Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented. A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006-2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006-2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction. Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement - using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation. All examples of successful primary/secondary care integration reported in the literature have focused on a combination of some, if not all, of the ten elements described in this paper, and there appears to be agreement that multiple elements are required to ensure successful and sustained integration efforts. Whilst no one model fits all systems these elements provide a focus for setting up integration initiatives which need to be flexible for adapting to local conditions and settings.
    Full-text · Article · Dec 2013 · BMC Health Services Research
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    ABSTRACT: The parallel track model is one of the several models that are used in health promotion programmes that focus on community empowerment. It is unique in that it explicitly incorporates an empowerment approach with a top-down health programme. Since its development in 1999-2000 the model has been used in various health programmes in both developed and developing countries. The aim of this review is to examine the nature and extent of the application of this model and its contribution to promoting health. A review of the literature published between 2000 and 2011 was conducted. Nine results matched the inclusion criteria and revealed that the model has been mostly applied to disadvantaged communities to address health determinants, such as poverty and health literacy. This review found that the model had a positive impact on specific health outcomes such as health literacy and community capacity. We concluded that the parallel track model has the most potential for building capacity for community health promotion and appears to be the least useful for interventions focusing on health behaviour change within a limited time frame.
    Full-text · Article · Jan 2013 · Health & Social Care in the Community
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    ABSTRACT: This study explored the health needs, familial and social problems of Thai migrants in a local community in Brisbane, Australia. Five focus groups with Thai migrants were conducted. The qualitative data were examined using thematic content analysis that is specifically designed for focus group analysis. Four themes were identified: (1) positive experiences in Australia, (2) physical health problems, (3) mental health problems, and (4) familial and social health problems. This study revealed key health needs related to chronic disease and mental health, major barriers to health service use, such as language skills, and facilitating factors, such as the Thai Temple. We concluded that because the health needs, familial and social problems of Thai migrants were complex and culture bound, the development of health and community services for Thai migrants needs to take account of the ways in which Thai culture both negatively impacts health and offer positive solutions to problems.
    No preview · Article · Sep 2012 · Journal of Immigrant and Minority Health
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    ABSTRACT: Primary health care in Australia has undergone 2 decades of change. Starting with a vision for a national health strategy with general practice at its core, Australia established local meso-level primary health care organizations--Divisions of General Practice--moving from focus on individual practitioners to a professional collective local voice. The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional integration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system.
    No preview · Article · Mar 2012 · The Journal of the American Board of Family Medicine

  • No preview · Article · Dec 2011 · Australian and New Zealand Journal of Public Health
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    ABSTRACT: To study the effect of Baroque music in people with dementia. Patients in a multicultural dementia-specific aged care facility were subjected to Baroque music in a cross-over study. There were significantly more behavioural disturbances during the weeks when Baroque music was played compared to control periods (0.2 more episodes per week, P = 0.01), and more episodes in the afternoon shift compared to evening shift (1 more episode per week, P = 0.001). These results confirm that music can influence behaviour but is contrary to previous results.
    No preview · Article · Mar 2011 · Australasian Journal on Ageing

  • No preview · Article · Jan 2011
  • Julie Hepworth · John E Marley
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    ABSTRACT: Delivering integrated team care is a major priority for many countries. In Australia this is a component of the GP Super Clinic Program but it is also a focus of the broader primary care sector. Explicit consideration of human dynamics and team process is often absent from the move to integrated team care. To provide a practical framework that will inform the development and evaluation of integrated healthcare teams. The Team Focused and Clinical Content Framework is an approach to building integrated teams. This has the potential to be used to monitor and evaluate team development and functioning. Both the framework and clinical pathways provide practical tools for clinics to address the need to build integration into teams.
    No preview · Article · Dec 2010 · Australian family physician
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    ABSTRACT: To determine the effect of cardiac troponin I testing with a point-of-care (POC) device versus central laboratory on length of stay (LOS) in emergency department (ED) patients presenting with possible acute coronary syndromes (ACS). A 12-week randomised controlled trial at two metropolitan ED in eastern Australia with a combined annual census of 80,000. Participants were all patients presenting with possible ACS. Exclusions were a diagnosis of ACS before arrival, ST elevation and failure to wait for complete assessment. Randomisation was by week when POC was made available. Primary outcome was LOS from patient arrival to physical departure from the ED. The proportion of patients meeting a government target of less than 8 h stay was compared. Analysis was by intention to treat. Despite underutilisation of POC, LOS was shorter during weeks when it was available. The time savings translates into approximately 48 minutes (95% CI 12 to 84) per average LOS of almost 7 h, which did not reach statistical significance (p=0.063), or an absolute increase of 10% (95% CI 4.3 to 16.6) in the number of people discharged from the ED within the target LOS of less than 8 h, which did reach significance (p=0.007). These savings were more pronounced in the setting without 24 h central laboratory availability. POC testing for troponin in the ED tended to reduce the LOS for possible ACS patients. The degree of this benefit is likely to be markedly dependent on its acceptance and uptake by attending personnel, and on the ED setting in which it is used.
    No preview · Article · Mar 2010 · Emergency Medicine Journal
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    ABSTRACT: To determine the proportion of adverse events in patients discharged after ED assessment for possible acute coronary syndrome. Prospective observational cohort study enrolling consecutive patients presenting with symptoms suggestive of coronary syndrome. Main outcome was the proportion of adverse coronary events (defined a priori) within 30 days. Of 2627 patients, 1819 (69%) were discharged without a diagnosis of coronary syndrome and 808 (31%) were admitted for further investigation and treatment. Of these, 385 (14.7%) were given a final diagnosis of acute coronary syndrome. On 30 day follow up, 18 of the discharged patients were diagnosed with acute coronary syndrome (0.7%; 95% confidence intervals [CI] 0.4-1.1%), 10 with unstable angina (0.4%; 95% CI 0.2-0.7%) and 8 with non-ST elevation myocardial infarction (0.3%; 95% CI 0.2-0.6%). There were no cases of ST elevation infarction or death. The sensitivity for diagnosis of acute coronary syndromes was 95.5% (95% CI 92.9-97.3%). Average length of stay was 7 h for discharged patients. Forty-six per cent of patients with diabetes and 47% with a past history of coronary disease were discharged. Subsequent outpatient stress testing was performed in 13.6%. In a large Australian ED, less than 1% of patients presenting with symptoms suggestive of coronary syndrome were discharged and subsequently had a 30 day adverse event. Reducing this proportion by admitting patients with traditional risk factors would markedly increase hospital workload. Opportunities exist to improve both the safety and efficiency of chest pain assessment in the ED.
    No preview · Article · Dec 2009 · Emergency medicine Australasia: EMA
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    ABSTRACT: To validate the accuracy of a Point of care (POC) troponin device (Abbott i-Stat) in real life ED conditions. Design: A three-way comparison between troponin I results obtained by experienced POC operators, inexperienced ED staff and central laboratory criterion standard. Participants: Convenience sample of 332 patients presenting to the ED with possible coronary syndromes. Spearman correlation coefficient for experienced versus laboratory was 0.83 (95% CI 0.78-0.87), occasional users versus laboratory was 0.76 (95% CI 0.71-0.81), and experienced versus occasional users on POC was 0.82 (95% CI 0.76-0.87). Using local troponin cut-off of 0.1 ng/mL, kappa coefficient was 0.94 for occasional users versus laboratory, 0.91 for experienced versus laboratory and 0.94 for experienced versus occasional users. Bland-Altman plots showed good agreement across the range of measured values. The sensitivity of i-Stat (vs laboratory as criterion standard) was 92.2% (95% CI 83.8%-97.0%) with the local cut-off but only 70.1% (95% CI 60.5%-78.6%) using the lowest cut-off associated with acceptable reproducibility (10% coefficient of variation). The i-Stat POC device produces similar results in the hands of experienced and occasional operators in ED. There is good agreement between the POC and laboratory at levels used to diagnose infarction by older, more specific criteria. When compared using new lower cut-offs, the i-Stat had poor sensitivity.
    No preview · Article · Sep 2009 · Emergency medicine Australasia: EMA
  • P J Hay · J Marley · S Lemar
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    ABSTRACT: Aims: Beyond care to ensure there is no untoward inducement or coercion, rarely is consideration given to the reasons people participate in medical research. The present study aimed to explore this within a general practice based survey of eating disorders in women. Further aims were to assess the adequacy of the information provided to participants, and any perceived psychological impact from their involvement. Methods: The survey comprised two stages, first, the subject sample was screened for bulimic eating disorders by questionnaire, and second, likely cases were interviewed to confirm diagnosis and evaluate subject characteristics. A random sample of those who did not meet criteria for interview were interviewed. At the close of the interview respondents were asked a single qualitative question about their reasons for participation. Following the interview, respondents were asked to complete a confidential questionnaire regarding the adequacy of the information and any effects of the interview. This was returned by mail directly to the investigators (not the interviewer). Results: 510 women patients, mean age 36.8 years (SD 11.7, range 16–59 years) who were consecutive general practice attendees were screened by questionnaire and 73 were interviewed. At interview 26 had an eating disorder diagnosed, and subjects were offered follow-up advice and care provided by one of the investigators (PH). All respondents provided a reason for participation, 37 (51%) a single reason, 34 (47%) two reasons and two three reasons. The commonest reason was a general altruism, namely to help the survey, or to help people with eating disorders, or the like (n = 48, 64%). The next most common was to obtain some help for themselves (n = 25, 34%). Seven (all who had been selected randomly for interview) participated in order to specifically help someone they knew with an eating disorder. Seventeen participated out of general interest in the subject and one because she “didn't like to say no”. All of the 45 (62%) respondents who returned the questionnaire confirmed that the information they were told about the study reflected what they were asked to do. Thirty-five (48%) did not think the study made any difference to the way they felt about themselves or their life in general, 10 (14%) felt better, and no-one felt worse. Only 13 (18%) reported that the survey had changed their eating habits. Conclusions: In this study a general altruism was the commonest reason for participation. However, over a third took part in order to obtain some help specifically for themselves or for someone they knew. There were no reported general adverse psychological effects of the survey. Medical investigators should be aware that survey subjects in non-treatment studies, may be seeking specific help or treatment.
    No preview · Article · Jul 2009 · Australian and New Zealand Journal of Psychiatry
  • John E Marley

    No preview · Article · Apr 2009 · The Medical journal of Australia
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    Full-text · Article · May 2008 · The Medical journal of Australia
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    ABSTRACT: No Abstract available.
    No preview · Article · Jan 2008
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    Claire L Jackson · John E Marley
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    ABSTRACT: An innovative team approach and integration of care across sectors, including general practices, community health services, allied health professionals and hospitals, can deliver high-quality comprehensive care in disadvantaged areas while providing teaching and research opportunities and community service. Academic general practice departments are committed to supporting and evaluating such models. A governance infrastructure that encourages strong partnerships across health care sectors is essential. With broad health partnership support, bulk-billing is viable in an Australian general practice team model providing health care to the disadvantaged.
    Preview · Article · Aug 2007 · The Medical journal of Australia
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    ABSTRACT: Objectives We aimed to assess the feasibility of implementing, within Australian general practice, an innovative disease management program for hypertension. The central platform of this program is an information communication technology package for risk assessment and management, access to a dietitian commissioned by the program and a tailored set of audiovisual and written material. Methods We carried out a pilot cluster randomized controlled trial (stratified for rurality) of 67 general practices (including 371 patients) across two Australian states. Our primary hypothesis was that a disease management program would improve the cardiovascular risk score in patients with mild to moderate hypertension, compared with that of patients being treated according to current clinical practice. Analysis was by intention to treat. Results There was a borderline significant favorable treatment effect of the disease management program on the cardiovascular risk score of 4.6 percentage points (95% CI -9.7, 0.6) (theoretical range: 0–100%) at 6 months. At 12 months there was a non-statistically significant effect of approximately 2 percentage points. The proportion of patients achieving the target blood pressure of ≤130/85mm Hg was modest at between 20% and 30%. There was no treatment effect of the disease management program on this outcome at 6 months and a treatment effect favoring the control group was seen at 12 months (difference = −11.6%; 95% CI —21.1, −2.1). There was a modest short-term treatment effect in favour of the disease management program in terms of change in blood pressure from baseline. At 12 months follow-up, 70% of general practitioners were still accessing the program’s CD-ROM and improvements were noted for five of nine items measuring their satisfaction in relation to the provision of hypertension care. A treatment effect was found for 5 of 16 items on the patient satisfaction questionnaire at 6 months and 12 of 16 items at 12 months. Conclusions Disease management for hypertension incorporating information communication technologies is pragmatic in general practice and results in modest short-term health gains. More research is required to ensure feasibility over a longer period.
    No preview · Article · Jan 2006 · Disease Management and Health Outcomes
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    ABSTRACT: Objectives: We aimed to assess the feasibility of implementing, within Australian general practice, an innovative disease management program for hypertension. The central platform of this program is an information communication technology package for risk assessment and management, access to a dietitian commissioned by the program and a tailored set of audiovisual and written material. Methods: We carried out a pilot cluster randomized controlled trial (stratified for rurality) of 67 general practices (including 371 patients) across two Australian states. Our primary hypothesis was that a disease management program would improve the cardiovascular risk score in patients with mild to moderate hypertension, compared with that of patients being treated according to current clinical practice. Analysis was by intention to treat. Results: There was a borderline significant favorable treatment effect of the disease management program on the cardiovascular risk score of 4.6 percentage points (95% CI -9.7, 0.6) (theoretical range: 0-100%) at 6 months. At 12 months there was a non-statistically significant effect of approximately 2 percentage points. The proportion of patients achieving the target blood pressure of <=130/85mm Hg was modest at between 20% and 30%. There was no treatment effect of the disease management program on this outcome at 6 months and a treatment effect favoring the control group was seen at 12 months (difference = -11.6%; 95% CI -21.1, -2.1). There was a modest short-term treatment effect in favour of the disease management program in terms of change in blood pressure from baseline. At 12 months follow-up, 70% of general practitioners were still accessing the program's CD-ROM and improvements were noted for five of nine items measuring their satisfaction in relation to the provision of hypertension care. A treatment effect was found for 5 of 16 items on the patient satisfaction questionnaire at 6 months and 12 of 16 items at 12 months. Conclusions: Disease management for hypertension incorporating information communication technologies is pragmatic in general practice and results in modest short-term health gains. More research is required to ensure feasibility over a longer period.
    No preview · Article · Jan 2006 · Disease Management and Health Outcomes

Publication Stats

2k Citations
335.13 Total Impact Points

Institutions

  • 2005-2014
    • University of Queensland
      • • Faculty of Health Sciences
      • • Department of Medicine
      Brisbane, Queensland, Australia
  • 1995-2009
    • University of Adelaide
      • • Discipline of General Practice
      • • School of Medicine
      Tarndarnya, South Australia, Australia
  • 2008
    • Australian National University
      Canberra, Australian Capital Territory, Australia
  • 2003-2006
    • University of Newcastle
      Newcastle, New South Wales, Australia
  • 1997
    • Women`s and Children`s Hospital
      Tarndarnya, South Australia, Australia