Research presentation

Aim
This study aimed to examine the sociodemographic factors associated with mothers seeking infant and child feeding advice from health professionals (HPs).

Content
A cross-sectional analysis of data from two telephone surveys from linked randomised controlled trials was conducted. Mothers were asked which sources of infant and child feeding information they used when their child was six months and five years old. Logistic regression was conducted to examine associations between mothers’ sociodemographic characteristics and the use of information from HPs.

At six months, 947 out of 1155 mothers completed the survey. First-time mothers were more likely to seek advice from child and family health nurses (CFHNs) (Adjusted Odds Ratio (AOR)(95% CI)=1.79(1.34, 2.41)) and other HPs (AOR(95% CI)=1.42(1.09, 1.88)). Mothers who were not married or in a de-facto relationship were less likely to seek advice from other HPs (AOR(95% CI)=.58(.34, .99)). At five years, 405 out of 662 mothers completed the survey. Mothers with household income ≥$80,000 p.a. were less likely (AOR(95% CI)=.51(.30, .88)), while those born overseas were more likely (AOR(95% CI)=2.16(1.20, 3.90)) to seek information about food and drink choices for their child from a CFHN at five years. Mothers born overseas (AOR(95% CI)=2.32(1.48, 3.65)) and not in formal employment (AOR(95% CI)=1.72(1.11, 2.68)) were more likely to seek advice from their GP. First-time mothers were more likely to seek advice from a paediatrician (AOR(95% CI)=2.28(1.07, 4.86)) and were less likely to seek advice from other HPs (AOR(95% CI)=0.50(0.25, 0.98)).

Goals
By understanding the sociodemographic factors associated with mothers' seeking infant and child feeding advice from HPs, this work may inform future research and practice to improve the engagement of families in health promotion activities in primary healthcare.

1. Sociodemographic factors are associated with mothers’ use of infant and child feeding information from primary health professionals
2. Mothers' utilisation of infant and child feeding information from health professionals declines from six months to five years of age, and
3. Mothers seek infant and child feeding information from a variety of sources, making the provision of high-quality information in multiple formats a priority

Research presentation

Aim
Assessment of awareness, use of various forms of contraceptives to prevent pregnancy and knowledge about use of barrier methods in prevention against sexually transmitted infections (STIs) among married females in Punjab, Pakistan

Content
Following ethics approval this descriptive cross-sectional study was carried out using a questionnaire. A total of 385 participants will be included using purposive sampling.
292 responses have been obtained so far. Age range of female participants was between 17 to 49 years. Out of these 156 (53.4%) participants were in the age range of 17-33 years whereas 136 (46.5%) females were between 34-49 years. It was noted that 253/292 (86.6%) females had children which ranged between 0 to17 with an average of 3 children per participant.
The participation of rural, urban and semi-rural regions were 98/292 (30.4%), 57/292 (19.5%) and 146/292 (50%) respectively. In terms of level of education among women included in the study 122/292 (41.7%),70/292 (23.9%), 60/292 (20.5%) and 40/292 (13.6%) had college or university degree, secondary school education, primary school education and no education respectively. Regarding employment status, 89/292 (30.4%) were employed whereas 203/292 (69.5%) were unemployed.
The knowledge about condoms as a method of contraception and its proper use as contraceptive method was 231/292 (79.1%) and 107/292 (36.6%) respectively. Similarly, women’s knowledge about oral contraceptive pill and experience as users was 209/292 (71.5%) and 35/292 (11.9%) respectively. It was noted that 80/292 (27.3%) married women had used no form of contraception at all whereas 99/292 (33.9%) knew that condoms are a proven method for risk reduction of STIs.

Goals
This study will provide meaningful insights covering primarily level of awareness on use of contraception and also choice of method among reproductive age groups for better prevention from STIs.

1. In countries / regions with no well-organzied and functioning primary care system the family planning services remain underused and poorly understood.
2. Despite having knowledge about existence of commonly available contraceptives like condoms and oral pills their usage by married females remains low.
3. Less than one third (about 27%) study participants had not used any form of contraceptives in past or were currently using it. There is a need to promote acceptance and optimism towards use of contraceptives.

Research presentation

Background
Mastitis is common reason new mothers visit their general practitioner (GP). It is timely to examine how mastitis is managed in Australian general practice and explore GPs’ use of clinical guidelines (such as Therapeutic Guidelines: Antibiotic).

Aim of this presentation
To describe how GPs around Australia manage lactational mastitis.

Methods
A convergent mixed methods design integrated quantitative analysis of a general practice dataset, with analysis of interviews with GPs. Using the large-scale primary care database, MedicineInsight, (2011 to 2021), antibiotics prescribed and investigations ordered for mastitis encounters were extracted. Semi-structured interviews were conducted with 14 Australian GPs using Zoom in 2021-2022, and analysed thematically. The Pillar Integration Process was used to develop a joint display table; qualitative codes and themes were matched with the quantitative items to illustrate similarities or contrasts in findings.

Results
At the time of first mastitis encounter, 30,319 (88.4%) women received a prescription for an oral antibiotic; most commonly di/flucloxacillin (16,399 [47.8%]) or cefalexin (11,229 [32.7%]). Among those presenting with their first mastitis episode, a diagnostic breast ultrasound was ordered for 7.3%, FBE in 3.5%, breast milk or nipple swab cultures in approximately 1%. Despite being infrequent, the overall proportion of women receiving any clinical investigations doubled from 2011 to 2022.
Integration of quantitative and qualitative data identified the following themes regarding mastitis management:
- GPs support continued breastfeeding;
- Antibiotics are central to GPs' management;
- Antibiotics are mostly prescribed according to Therapeutic Guidelines;
- Analgesia is a gap in the Therapeutic Guidelines;
- Low use of milk culture.

Conclusions
Prescribing antibiotics for mastitis remains central to Australian GPs’ management of mastitis. Overall, GPs followed principles of antibiotic stewardship, but there is a need to educate GPs about when to consider ordering investigations.

1. Antibiotic prescribing is common in GP consultations with women with mastitis; interviews revealed that delayed prescribing is not uncommon.
2. Mostly antibiotic prescribing is consistent with recommendations in the Australian Therapeutic Guidelines: Antibiotics.
3. If mastitis does not start to improve within 48 hours or is severe, expressed breast milk should be collected for culture and sensitivity, yet this was rarely recorded in the GP database and most of the interviewed GPs were not familiar with this investigation.

Research presentation

Background
Positive and negative mood changes can occur with hormonal contraceptive use.

Objective
This study assessed self-reported mood during two phase-3 studies of a new oral contraceptive with estetrol (E4) 15 mg/drospirenone (DRSP) 3 mg (24-day hormone/4-day placebo regimen).

Methods
Healthy starters (no hormonal contraception in prior 3 months) and switchers (16−50 years) used E4/DRSP for up to 13 cycles. Participants completed a Menstrual Distress Questionnaire (MDQ), a validated inventory that helps clinicians to assess premenstrual and menstrual symptoms, at baseline and end-of-trial. Data were pooled from the two trials to evaluate changes in t-scores for the domain ‘Negative Affect’ (possible range 31−103) and compared using student’s t-test with p<0.05 considered statistically significant. The proportions of participants reporting no change, an improvement, or a worsening (intensity categories: none/mild/moderate/severe) for the symptoms ‘Feeling Sad/Blue’ and ‘Mood Swings’ within the ‘Negative Affect’ domain were also calculated.

Results
Of 3,417 treated participants, 2,707 (79.2%) completed baseline and end-of-trial MDQs; 1,207 (44.6%) were starters. Mean baseline t-scores were in the lower range (45−50). Starters reported significant improvement of premenstrual (-1.77, p<0.0001) and menstrual (-1.72, p<0.0001) ‘Negative Affect’ domain scores. At end-of-trial, the proportions of starters reporting no change in premenstrual(%)/menstrual(%) ‘Feeling Sad/Blue’ were 64.9%/65.0%, with 20.6%/19.8% reporting improvement and 14.4%/15.2% worsening. The proportions reporting no change in premenstrual/menstrual ‘Mood Swings’ were 47.0%/47.3% with 31.6%/31.2% reporting improvement and 21.5%/21.6% worsening. Overall, baseline and end-of-trial evaluations showed more starters reporting not ‘Feeling Sad/Blue’ (premenstrual 67.9% and 73.1%, respectively; menstrual 68.5% and 76.6%, respectively) and not having ‘Mood Swings’ (premenstrual 44.0% and 51.1%, respectively; menstrual 43.0% to 52.2%, respectively). Among switchers, only small changes were found in any assessed outcomes.

Conclusion
Most E4/DRSP users who had not recently used hormonal contraception reported an improvement or no change in negative affect symptoms. Switchers reported minimal changes.

1. The importance of considering the impact of hormonal contraceptives on women emotional wellbeing.
2. Users of hormonal contraceptives may experience fluctuations of menstruation symptoms, but the majority will not experience this or even benefits from their use.
3. In general, the new contraceptive E4/DRSP does not to disturb the emotional wellbeing of its users; improvements can be expected amongst starters.

Rapid impact presentation

Aims
This study explores Primary Care Staff’s experience of using the HPV testing pathway in the “Let’s test for HPV” study so that recommendations can be made to improve the testing process before nationwide roll-out in New Zealand during 2023.

Method
This is a sub study of a primary care intervention study - Let’s test for HPV (and prevent cervical cancer) designed to provide an evidence-base on which practical recommendations can be developed to guide the introduction of primary hrHPV testing for cervical screening in New Zealand.
39 individuals were interviewed across all 17 practices in the Capital and Coast, Canterbury and Whanganui region participating in the “Let’s Test For HPV” study. In total 19 semi-structured interviews took place. These interviews were recorded and transcribed. Template analysis was carried out on transcripts to aid in identifying themes.

Results
Three key themes, with additional subthemes, were identified. 1. Clinicians (and their patients) were strongly positive towards the pathway. More patients are screened (including those previously under screened), and the pathway in this study is less onerous for patients and clinicians. 2. There were some issues with the pathway, most difficulty encountered is because the pathway is new to clinicians. 3. There are educational requirements for clinicians (particularly regarding management of positive tests), and for patients to understand HPV and the new pathway.

Conclusion
Clinicians described the experience of using the HPV testing pathway positively. Clinicians desired continued support, practitioner education taking place online and a national advertising campaign to improve patient knowledge on HPV testing and follow up.

1. Introduction of new programs requires sector involvement / prework
2. This program will be beneficial to improve cervical screening in New Zealand
3. Real world testing has great potential to influence and improve program delivery

Rapid impact presentation

The clinical case discussion aims to discuss the approach to diagnosis and management of a patient with communicable and non-communicable co-morbidities and to apply patient-centred care in decision making for the appropriate preventive and curative care. It also aims to provide an avenue for healthy discourse in improving the quality of service for patients and their families through the practice of primary care.

This is about a 49-year-old female, known diabetic with cough and colds for seven months. She was seen in two different local clinics prior to consultation at the Family Practice Centre of a tertiary hospital in the Philippines. She had no prior COVID vaccination, no history of tuberculosis treatment, with 32-year history of second-hand smoke exposure and four-year history of biofuel smoke exposure. On physical examination, she had elevated blood pressure at 150/100 mmHg, right eye ptosis and down and out deviation of the eye, with clear breath sounds, and hyperpigmented lesions on bilateral legs; other findings were unremarkable. Her highest educational attainment is Grade 2 level, able to read and write basic words and limited financial capacity as a family. She also had an emotionally critical misperception regarding COVID vaccination. She was diagnosed with drug-sensitive pulmonary tuberculosis, bacteriologically confirmed, new, and metabolic syndrome that consisted of diabetes mellitus, type 2, non-obese, insulin-requiring, uncontrolled, with peripheral neuropathy, hypertension, newly-diagnosed, dyslipidaemia with an elevated total cholesterol, low-density lipoprotein, low high-density lipoprotein, central obesity, and a family diagnosis of nuclear family in the illness trajectory of reaction to diagnosis.

The goals of management were the identification the underlying cause of the patient’s cough and its related symptoms, control of co-morbidities and diagnose other co-existing conditions, and exploration of the family’s and the community’s resources for the double burden of communicable and non-communicable diseases.

1. The essence of patient-centered, family-focused, and community-oriented approach in primary care
2. The importance of the simultaneous management of both communicable and non-communicable diseases in a patient
3. The challenges in navigating the healthcare system of a developing country and how a primary care physician can help provide solutions

Rapid impact presentation

AIM: To raise awareness of the need to ensure clear referral pathways for bereaved parents who have lost their baby during pregnancy.

CONTENT: Pink Elephants can speak briefly and succinctly to the evidence around miscarriage being a traumatic event which if left unsupported can lead to poor mental health outcomes. We can speak to internal qualitative research where women shared what they want from their GP when experiencing the loss of their baby and subsequent pregnancy after loss.
Sam Payne our CEO can highlight top-level our support options, the evaluation of them, and the moderation of our circle of support.

GOAL: To increase knowledge of Pink Elephants as a clear referral pathway for patients suffering a pregnancy loss.

1. A deeper understanding of the wider issue of pregancy loss aside from medical management.
2. A clear knowledge of how Pink Elephants can support their patients
3. A clear referral pathway

Aim :
Education and development of in clinic strategies to increase patient uptake of cervical self-collection
Content :
Around 800 Australian women are diagnosed with cervical cancer each year. Up to 80% of these cases occur in women who have never been screened or were not up-to-date with their screening.
Strategies in general practice clinics such as reminders in software, recall of target groups, education of practice staff to assist in rollout, triage at reception to stratify collection and provision of private collection areas can improve uptake.
Education of providers that self collection is safe and reliable and to counsel patients appropriately.
Goals:
Improve Cervical Screening self collection uptake in minority and underserviced groups such as migrant women, Indigenous women and in regional areas.

1 Self collection is safe and reliable and recommend to patients
2 Providing private collection spaces facilitates uptake
3 Target and Recall minority groups and underserviced populations

Globally, nearly half of all pregnancies are unintended, with social, health, and economic implications for individuals, communities, and societies. Family Planning Australia (FPA), a non-government organisation, commenced abortion services in 2020, following New South Wales abortion decriminalisation.

Aims
This study aims to assess the experiences of clinic staff during the implementation of abortion services, which can inform the both the implementation and ongoing improvement of primary care abortion services.

Clinic staff (medical, allied health, administrative) involved in abortion services were invited to participate in 2 surveys from May 2020 to Apr 2021 with 1 follow-up interview after the 2nd survey to investigate their experiences of FPA abortion services.

Initial challenges reported included limited number of appointments available for abortion services, difficulties in ensuring recommended follow-up, and the complexity of steps required to organise appropriate abortion care with external service providers, especially during the COVID pandemic. Staff also reflected on factors which supported the adoption of this new scope of practice, including having a supportive team environment, the development of consultation support tools, engaging in regular feedback and quality improvement meetings and applying a multidisciplinary team management approach.

Feedback provided by FPA staff included a desire to continue working towards removing remaining barriers for women accessing abortion care, increase streamlining of abortion services and improve collaboration between other primary healthcare providers and tertiary services. FPA staff also expressed an interest in continuous training to manage complex cases and to learn counselling strategies to support women seeking abortions.

Goals:
To illustrate the experiences of clinic staff in the implementation of abortion services
To extrapolate learned experiences on the implementation of other primary health services.

• Support international primary healthcare clinicians to provide quality abortion services to women.
• Understand potential challenges and management strategies in the implementation of integrated sexual and reproductive health services.
• To inform efficient implementation strategies of quality services within sexual and reproductive health.