Abstracts of the Australasian Association for Academic Primary Care (AAAPC) Annual Research Conference

1. Difficult and shameful – a scoping review of menstruation experiences among women in prison

Penelope Abbott^A, Shalinie Senerathge^B, Alexandra Hawkey^A, Wendy Hu^A, Wasana Jayarathne^C

^ADepartment of General Practice, Western Sydney University

^BMinistry of Health, Sri Lanka

^CRural Clinical School, University of Queensland

Background: Menstruation remains a cultural taboo in many societies, which can manifest in silence and shame. The rate of incarceration of women continues to increase worldwide, and there is concern as to whether the gender-specific needs of women in prison are being met. Women in prison often face significant challenges, exacerbated by poorly resourced prison systems and infrastructure which was designed for men. Menstruation-related concerns rank among the commonest health presentations by women in prison. Aim/Objectives: To identify and map what is known about the experience of menstruation among people in prison. Methods: We undertook a scoping review following the Joanne Briggs Institute (JBI) methodology. We included peer reviewed articles on empirical studies published in English between 2000 to 2022, and in medical and sociological databases. We managed search results using Covidence software and undertook a content analysis of extracted data with coding of qualitative and quantitative data, followed by allocation into concepts and categories. Findings: Twenty-eight articles were eligible for final review. There was no literature on the experience of trans-men or non-binary people who experience menstruation, so our review focused only on the experiences of women. There were 16 studies undertaken in high income countries and 14 in low-income countries. Findings were categorised as lack of privacy and shame, menstruation changes, menstruation as difficult and hard to manage, prison health care, and women’s menstrual resistance and resilience in prison. Implications: Our findings suggest experiences of menstruation in prison aggravate the stress of incarceration. Challenges experienced by women related to menstruation are not adequately appreciated and managed within prison systems including by healthcare providers and custodial staff. This adversely impacts the physical health, quality of life and psychological wellbeing of women in prison.

2. Navigating pregnancy and beyond with gestational diabetes: South Asian women’s experiences in New Zealand

Sumera Akhtar^A, Sharon Leitch^A

^ADepartment of General Practice and Rural Health, University of Otago

Background: South Asian (SA) women are almost four times more likely to develop gestational diabetes (GDM) compared to other ethnicities. Women with gestational diabetes are seven times more likely to develop type 2 diabetes (T2DM) within five to ten years of first GDM diagnosis. Despite the higher rates of GDM among South Asians, there is a gap in our understanding of the knowledge and lived experiences of GDM management, which could inform and improve GDM care for NZ South Asian women. Aim: This study aims to investigate the lived experiences of SA women living in NZ who have been diagnosed with GDM. Method: Thirty SA women diagnosed with GDM within the past two to five years were recruited for in-depth, semi-structured telephone interviews. Four of these interviews were conducted in the participant’s first language. All interviews were transcribed verbatim. The data was analysed using inductive thematic analysis to identify emerging patterns and themes. Findings: Women diagnosed with GDM experienced anxiety and guilt, due to concerns about their baby’s health and the burden of lifestyle changes. Limited prior knowledge prompted many to seek self-directed education. Healthcare interactions were generally positive, particularly with diabetes nurses and midwives, although gaps existed in postpartum support. Dietary advice often conflicted with traditional South Asian eating habits. Frequent glucose monitoring and medication management posed significant challenges. Family and social support were critically important but shaped by cultural expectations, family dynamics and limited extended family presence in NZ. Experiencing GDM served as a catalyst for many women to increase awareness and adopt lasting health behaviour changes to prevent T2DM. Implications: Education, culturally tailored dietary and fitness resources, improved postpartum follow-up and mental health support would help SA women with GDM. Addressing these areas can enhance care experiences, empower women, and reduce the risk of future diabetes.

3. More than time: what makes longitudinal general practice placements impactful?

Rula Ali^A, Joel Rhee^A, Priya Pathak^B, Ben Harris-Roxas^C

^ASchool of Clinical Medicine, Discipline of General Practice, University of New South Wales

^BSchool of Clinical Medicine, University of New South Wales

^CSchool of Population Health, University of New South Wales

Background: Longitudinal placements in general practice (LPGP) have been associated with multiple benefits, including improved student attitudes toward general practice (GP), exposure to continuity of care, and their potential contribution to GP workforce sustainability. LPGP are distinct from other forms of work integrated learning. They typically focus on comprehensive patients’ care over time, continuing learning relationships with patients’ clinicians, while meeting most of the competencies across multiple disciplines simultaneously. While the advantages of LPGP have been well described, a growing body of literature is examining the contextual challenges encountered by students, supervisors, and institutions. Aim/Objectives: This review aimed to synthesise recent literature on the benefits and challenges of LPGP. It explored factors contributing to successful implementation, as well as challenges faced by students, supervisors and faculties, with a view to informing future program’s design and sustainability in Australia. Methods: A narrative literature review is currently being undertaken, focusing on peer-reviewed articles published in the past fifteen years. Inclusion criteria include studies exploring LPGP within undergraduate medical education, examining benefits, limitations, and implementation considerations. Findings: Analysis thus far reveals a diversity in LPGP implementation designs across different medical schools. Additionally, while LPGP are widely valued in literature, their success is reliant on many factors such as placement quality, institutional culture, and supervisors’ support play key roles. Reported challenges include students’ concerns regarding misalignment with summative assessments, supervisors’ potential increased workload, and faculties’ challenges with logistics, and uncertainty of cost-effectiveness and long-term sustainability. Implications: This review highlights that LPGP offer significant value but are shaped by complex structural, cultural, and educational factors. Recognising these dynamics is essential to maximising LPGP’s impact. The insights can inform educational policy, guide resource allocation, and support faculty strategies in Australia, while laying groundwork for future research into sustainable GP education models that aid workforce planning.

4. Avoidance of physical activity among patients with Chronic Obstructive Pulmonary Disease (COPD): an observational study

Dea Kejlberg Andelius^A,B, Julie Sandell Jacobsen^A,B,C, Freja Hauberg Hallen^A, Anders Loekke^D,E, Chris Barton^F, Rasmus Oestergaard Nielsen^A,B

^AResearch Unit for General Practice, Aarhus University

^BDepartment of Public Health, Aarhus University

^CVIA University College, Aarhus

^DLittle Belt Hospital, Vejle, Denmark

^EDepartment of Regional Health Research, University of Southern Denmark

^FDepartment of General Practice, Monash University

Background: Chronic Obstructive Pulmonary Disease (COPD) presents a significant challenge to both individuals and healthcare systems globally. While physical activity is recognized as an essential and sustainable component of COPD management, patients with COPD often exhibit lower levels of physical activity compared to their lung-healthy peers. Aim/Objective: The primary objective of our study was to describe the proportion of patients with COPD who report avoidance behavior related to physical activity. Methods: A questionnaire-based, observational study was conducted among patients with COPD, scheduled to attend a pulmonary rehabilitation program. Patients completed the COPD Anxiety Questionnaire (CAF-R), and functional tests were conducted prior to participation of the rehabilitation program. Findings: We included 90 patients (48 females, mean: age 70 ± 7.6 years, body mass index 25.5 ± 4.8, MRC dyspnoea scale 2.8 ± 1.0, 1-Minute-Sit-To-Stand-Test 18 ± 7.1). Findings revealed that 64 % (95% CI [54%–74%]) reported avoidance of physical exertion, 46 % (95% CI [36%–56%]) avoided activities causing breathlessness, and 36 % (95% CI [26%–48%]) tried to avoid any form of physical activity. Implications: The findings highlight that a substantial proportion of patients with COPD exhibit avoidance behaviors related to physical activity. These behaviors not only hinder physical health outcomes but also contribute to the increased reliance on medical interventions that are less sustainable. The results underscore the importance of investigating avoidance behavior in patients with COPD to better understand how to promote physical activity within this population. Future interventions designed to increase physical activity in patients with COPD should include identification of the extent of avoidance behavior and implementation of strategies to manage this, such as exposing individuals to physical activity within a secure environment.

5. Redefining integrating care to improve health outcomes for people with multimorbid chronic conditions in rural, remote, and very remote WA

Sayyida Anees^A,B, Sage Marie Consolatrice Ishimwe^A, Daniel Xu^A,B

^ACurtin School of Population Health, Curtin University

^BCurtin Medical School

Background: Multimorbidity, the coexistence of two or more chronic conditions, affects approximately 37% of the global adult population. In Australia, where 28% reside in rural and remote areas, multimorbidity management is hindered by limited healthcare infrastructure, personnel shortages, and socioeconomic disparities. Chronic disease care plans (CDCPs) are Medicare-funded programs focusing on multidisciplinary multimorbid chronic disease care, but are difficult to deliver to rural and regional patients. Telehealth models could be integrated to address this issue. Aim/Objectives: General: To investigate whether telehealth integration into CDCPs can improve health outcomes for multimorbid patients in rural and remote WA. Specific objectives: (1) to determine current telehealth and CDCPs utilization in multimorbidity management, (2) to explore enablers and barriers encountered by patients/clinicians in integrating telehealth into care plans and (3) implement an integrated CDCP-telehealth model for trial, developed based on beneficiaries’ feedback. Methods: This mixed-methods implementation study will collect data from electronic medical records to assess the current CDCPs uptake and telehealth usage. Semi-structured interviews with patients and clinicians will identify enablers and barriers to inform telehealth integration into CDCPs, followed by an implementation trial in up to 42 general practices. Adoption and effectiveness will be assessed, one- and two-year post-implementation. Quantitative data will be analyzed using descriptive and inferential statistics, while qualitative data will be examined through thematic analysis. Findings: Data collection is in progress. Preliminary results will be available mid-year. Implications: A co-designed, cost-effective telehealth model for rural practices will increase CDCPs uptake and telehealth use in multimorbidity management. Expected benefits include improved clinical outcomes (e.g., blood pressure, diabetes, kidney, heart disease, and weight management) and enhanced perceived quality of life.

6. Estimating the incremental direct healthcare cost of diabetes and related complications in Australia using linked administrative data

Bernard Asiamah-asare^A, Sean Randall^A, George Mnatzaganian^B, Richard Varhol^C, Crystal Lee^C, Kevin Chai^C, James Boyd^B, Sangita Shakya^A, Lan Gao^A, Suzanne Robinson^A

^ADeakin University

^BLa Trobe University

^CCurtin University

Introduction: Diabetes and its related complications impose a significant financial burden on healthcare systems. In Australia, existing cost estimates are prone to recall bias and selective participation. Objectives: This study aims to quantify the incremental direct healthcare costs associated with diabetes and related complications in Australia. Methods: In a matched retrospective cohort study, adults with prevalent diabetes (n = 18,937) and controls, identified from a linked administrative dataset (2000–2021) in Western Australia, were matched based on age, sex, remoteness, and body mass index status. Direct healthcare costs (including hospital admissions, emergency presentations, prescriptions, general practice visits, and pathology costs) were estimated for 2021, with costs expressed in 2024 Australian Dollars (AUD). For each diabetes case and complication (identified using combination of diagnostic records and ICD-10 codes), the average costs per patient and the incremental cost-difference between the costs of people with diabetes and those without diabetes-were computed. Results: Average annual healthcare costs per person with diabetes (AUD9,677) were 2.1 times higher than those without diabetes (AUD4,669). Incremental costs of diabetes (AUD5,008) were higher in people with type 2 diabetes (AUD5,135) than those with type 1 diabetes (AUD4,295). Total healthcare cost associated with diabetes in 2024 was estimated at AUD14.2 billion, and total incremental cost associated with diabetes was estimated at AUD7.3 billion. Complications accounted for about 20% of the total incremental costs of diabetes. Average annual costs attributable to people with diabetes having at least one complication was AUD4,778. Annual incremental costs were substantial in people with diabetes having macrovascular complications (AUD5,142), followed by metabolic (AUD4,841) and microvascular (AUD4,682) complications. Conclusions: Evidence could guide policymakers and health system managers and support the need for targeted health intervention.

7. Exploring the role of pharmacists in addressing and responding to gender-based violence: a scoping review

Kajol Babu^A,B, Susan Saldanha^A,B, Myat Phou Pwint San^A,B, Anna Barwick^C,D, Anisa Assifi^A,B

^ADepartment of General Practice, Monash University

^BNHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care (SPHERE)

^CUniversity of New England

^DUniversity of Queensland

Background: Gender-based violence (GBV) is a pervasive public health issue deeply rooted in systemic gender inequalities, with profound consequences on survivor health and wellbeing. Pharmacists, as generally accessible healthcare professionals are potentially well-positioned to provide support to people affected by GBV. However, little is known regarding pharmacists’ or survivors’ views on this, or how pharmacists might best support survivors. Aims/Objectives: This scoping review will examine: (1) pharmacists’ perspectives and capacity to assist GBV survivors and (2) women’s attitudes and perspectives on accessing GBV support through pharmacy practice. Methods: A systematic search of Scopus, CINAHL, EMBASE, Medline (Ovid), PsychInfo, Web of science, and grey literature was conducted to identify relevant peer-reviewed articles. Included articles’ references were also reviewed. Overall, 1612 articles were identified, 371 were excluded as duplicates and 1195 were excluded after screening title/abstracts. Of the remaining 46 articles 33 were excluded after full-text screening, leaving 13 eligible articles included in this review. Data was extracted and analysed thematically using Braun and Clarke’s framework. Findings: Findings suggest that pharmacist’s awareness and willingness to engage with GBV survivors is low, however, majority express interest in receiving training on GBV. Additionally, pharmacists exhibited minimal confidence and experience identifying warning signs of GBV, with many holding misconceptions about the profile of victims. Female consumers believed that GBV screening was an important activity for healthcare providers, but agreed less with the concept of screening in pharmacy settings. Additionally, there was low confidence in the belief that screening for GBV could assist individuals in leaving dangerous relationships. Implications: This review will contribute to informing pharmacy-led GBV support services. By understanding the gap between survivor needs and pharmacists’ capacity to respond, this study will inform the development of targeted training programs for pharmacists, to enhance their role as safe and accessible healthcare providers for survivors of GBV.

8. Heart failure readmissions: mixed methods research using linked population data

Margo Barr^A, Chang Leong^B, Dlamgir Kabir^B

^AInternational Centre for Future Health Systems, University of New South Wales

^BGeorge Institute, University of New South Wales

Background: Heart failure (HF) is a prevalent chronic condition characterised by compromised cardiac function. Despite medical advancements in diagnostics and treatments, HF continues to be a leading cause of hospital admissions, readmissions and deaths, posing a significant public health concern worldwide. Aim/Objectives: Estimate HF prevalence, 30-day HF readmission incidence rates, identify determinants influencing HF readmission and explore healthcare-associated events that occurred from index HF admission over a one-year period. Methods: This study was an explanatory sequential mixed-methods design, including a quantitative prospective cohort study and a qualitative linear sequence study to explore healthcare-associated events. We used data from the Sax Institute’s 45 and Up Study (Jan 2016 to Dec 2020) linked to hospitalisations, deaths, primary care and pharmaceutical data. Main outcome was HF readmission within 30 days. Kaplan-Meier Survival curves were plotted. Adjusted Cox proportional hazard regression model was used to determine HF readmission predictors. In the qualitative study the healthcare-associated events were retrieved and plotted as ‘string of pearls’ graphs by date. Findings: The prevalence of HF in the 45 and Up cohort was 3.2%. Our study identified 4,252 eligible participants; n = 409 had HF readmissions. The HF readmission incidence rate was 0.01 per 1,000 person-years. The adjusted hazard ratio (HR) was significant for adults aged ≥80 (HR = 1.30; 95%CI: 1.01–1.67); having one chronic condition, (HR = 2.49; 95%CI: 1.41–4.40) or two or more (HR =  1.75; 95%CI: 1.04–2.95); and, those who consumed alcohol above national guidelines, (HR = 1.45; 95% CI: 1.06–1.98). The ‘string of pearls’ graphs showed more healthcare-associated events for patients who had HF readmissions compared to those who did not. However, there were no specific patterns. Implications: This study highlights the importance of managing comorbidities and reducing alcohol intake to reduce the risk of HF readmission. Although we could not identify specific healthcare-associated patterns it allowed us to comprehensively examine patient interactions with the healthcare system and provide some insights.

9. The use of a validated competency framework to guide the implementation of integrated care into the curriculum and accreditation of health and care professionals in Australia

Frances Barraclough^A,B, Jennifer Smith-Merry^A, Sabrina Pit^A

^AUniversity of Sydney

^BUniversity Centre for Rural Health, Lismore

Background: There are overwhelming recommendations in the literature recommending training in integrated care for health and care workers. One underdeveloped area is how curriculum developers, accreditation bodies and policy makers are guided to implement the knowledge, skills and expertise required to practice integrated care. This study engaged discipline leads across Australia to ascertain if a validated global Framework developed by the authors can be used to guide the implementation of integrated care into the training of our health and care workforce. Aim/Objectives: This study explored curriculum developers’ current experience and knowledge of integrated care across both higher and vocational education settings. The study determined if and how the Framework can be used and what is needed to ensure the Framework can be applied to practice. Methods: This study involved semi structured interviews with eleven discipline leads across eleven higher education settings and one discipline lead from a vocational training setting. Findings: The findings of this study align with existing literature, highlighting a widespread lack of clarity regarding the concept of integrated care. Participants acknowledged they were still training their students in silos with ad hoc opportunities for interprofessional learning in the early years of training. We identified three major themes aimed at national workforce reform, curriculum transformation and leadership and culture. Implications: Our findings highlight the importance of the need for national reform in the way we train our health and care workforce. This study provides a Framework for accreditation bodies, higher education and vocational education settings as well as state and national government bodies to enable our health and care professionals in Australia to practice and implement the competencies required for integrated care.

10. What do we know about stigma in older adults living with asthma? A mixed methods scoping review of international peer reviewed literature

Austin Swamy^A, Sanduni Madawala^B, Evelyne Dharmawan^A, Chris Barton^A

^ADepartment of General Practice, Monash University

^BRespiratory Research @ Alfred, Alfred Hospital, Melbourne

Background: Asthma is often stereotyped and associated with negative attitudes, adversely affecting self-management and medication adherence. Research has tended to focus on younger people, especially children and adolescents, and there is limited knowledge about the impact of stigma on older adults with asthma. Aims/Objectives: We conducted a scoping review to map the breadth of research on stigma in asthma, identifying gaps and clarifying concepts, to inform future research with a focus on older adults with asthma. Methods: Following JBI methodology for scoping reviews, a systematic search was conducted across six databases (Medline OVID, Embase, Emcare, PsycInfo, Scopus, and Cinahl). Key domains included ‘asthma’, ‘stigma’, and ‘asthma medications and management’. Studies that did not include older adults, not in English language, or addressing chronic conditions other than asthma were excluded. Titles and abstracts were screened using COVIDENCE by two authors (AS and ED), followed by full-text review by AS. Data was extracted using a customised data extraction template. Findings: N = 1670 papers were screened and articles meeting inclusion criteria were retained for data extraction. Stigma was described across articles as a major obstacle for good health impacting how people seek care, use of medicines, and engagement in social activities. Preliminary review of these articles has found evidence of research addressing concepts such as discrimination, bias, and ageism, but a lack of studies on lived experiences. This suggests that the impact of stigma on older adults with asthma may be underexplored. Implications: The scoping review highlights a significant gap in the literature regarding the lived experiences of stigma among older adults with asthma. Further research is needed to explore various types of stigma, and intersectional impacts of discrimination and ageism, focusing on lived experiences to better understand and address these issues in asthma management.

11. A rural Longitudinal Integrated Clerkship’s influence on medical graduates’ general practice careers: a qualitative study

Jessica Beattie^A, Marley Binder^B, Hannah Beks^B, Lara Fuller^A

^ADeakin University, Colac

^BDeakin University, Warrnambool

Background: Australia faces a persistent maldistribution of medical professionals, with fewer doctors in rural areas and a shift toward sub-specialisation. Rural Longitudinal Integrated Clerkships (LICs) are more likely than other clerkships to produce graduates who enter General Practice and work in smaller rural communities. However, there is limited program-specific evidence explaining this phenomenon. Objective: To explore how the Deakin University comprehensive rural LIC program influenced graduates’ career decisions, particularly in rural general practice. Methods: A constructivist grounded theory methodology was employed, using qualitative interview responses to develop a conceptual framework depicting elements of the clerkship that were influential in career decision making. Findings: Thirty-nine graduates participated in qualitative interviews. The developed LIC Career Decision Making Framework postulates that the alignment of personal and program factors under the concept of ‘choosing to participate’ influences graduates’ geographic and vocational career decisions. A combination of learning in place and learning design affordance introduced and/or confirmed participants’ pursuit of rural general practice. Elements of the framework, in particular ‘compatibility’, ‘comfort’, and ‘community’, allowed the student to gain a realistic, authentic exposure to general practice, which they could compare with other specialities in real time. Implications: The framework identifies LIC elements that warrant alignment to influence general practice careers. A unique finding was that, regardless of graduates’ preferences for participating in the LIC, transformation was evident. This was particularly apparent concerning rural general practice, where pre-existing negative perceptions were challenged and reframed to become positive. As more medical graduates are needed in general practice, regardless of geographic setting, arguably, all medical students should be provided with longitudinal exposure to a general practice, enabling them to build authentic relationships with general practitioners, join a community of practice, and become active participants in patient care.

12. Canaries in the coal mine: a descriptive analysis of pathology investigations for paediatric diabetes using general practice electronic medical records

Chiara Beccia^A, Patty Chondros^A, Barbara Hunter^B, Mary White^A,C,D, Adrian Laughlin^A, Caroline McBride^A, Jo-Anne Manski-Nankervis^A,B

^AUniversity Of Melbourne

^BLee Kong Chian School of Medicine, Nanyang Technological University

^CRoyal Children’s Hospital, Parkville

^DMurdoch Children’s Research Institute, Parkville

Background: Pathology testing for paediatric type 1 diabetes can lengthen time to referral to emergency departments, exacerbating diabetic ketoacidosis. To target paediatric diabetes testing for quality improvement, a broader understanding of such practices in the general practice context is necessary. Aim: To investigate key patterns and drivers of diabetes pathology testing of children in the general practice context. Methods: We conducted a descriptive quantitative study involving 66 general practices contributing data from 2018 to 2023. For children (aged under 18) without a diabetes diagnosis: we determined the annual proportion of children with a diabetes test, used multi-level mixed effects logistic regression model to estimate the odds ratio for the effect of patient characteristics on whether a diabetes test was requested, and summarised the reason for visit. For children with a diabetes diagnosis we obtained: the number with diabetes test requests prior to diagnosis, and the reasons for visit during this encounter. Findings: We identified 14,155 patients (56.7% female, n = 8,023) with at least one diabetes test between 2018-2023, nineteen of which (0.1%) developed type 1 diabetes. The proportion of children with a diabetes test grew annually from 2.5% in 2018 to 4.9% in 2023. The following characteristics were associated with diabetes test requests: over 11 years old (adjusted odds ratio (aOR) =  4.3, 95% CI 4.0–4.6), highest socio-economic disadvantage (aOR = 2.1 95% CI 2.0–2.2), and adolescent girls (aOR  =  1.7, 95% CI 1.6–1.8). Reasons for visit when children developed type 1 diabetes indicated high suspicion. For children without diabetes, the top reasons for visit included: fatigue, abdominal pain, dizzy spells, and headaches. Implications: Replacing pathology tests with point-of-care tests for suspected type 1 diabetes may be an appropriate intervention. The increase in diabetes pathology requests over time may signal increased need for support in managing fatigue in adolescent girls with increased socioeconomic disadvantage.

13. Feasibility study for the Optimal Implementation of Antibiotic Stewardship in General Practice (OPTIMAS-GP) trial

Andrew Bonney^A

^AUniversity of Wollongong

Background: Antibiotics are frequently prescribed unnecessarily in Australian general practice settings for acute respiratory infections. The sustained use of antimicrobial stewardship (AMS) interventions can decrease unnecessary antibiotic prescriptions, but such interventions are not commonly used in Australian general practice. Aim/Objectives: To conduct a single-arm feasibility study, to inform a planned randomised controlled trial, to examine whether a redesigned workflow – the AMS Toolbox – is an acceptable, appropriate, and sustainable way to access AMS interventions in general practice settings. Secondary objectives included feasibility of recruitment, data collection, patient-reported experiences and outcomes. Methods: Data collected over three months in a single arm study. Participating GPs and practice staff were provided with an online AMS Toolbox containing shared decision-making, clinical decision support, and delayed antibiotic prescribing resources to promote AMS when treating patients with ARIs. The primary outcomes were acceptability and appropriateness of the AMS Toolbox to GPs assessed through the Intervention Appropriateness Measure and Acceptability of Intervention Measure and qualitative responses from focus groups. Secondary outcomes included recruitment and retention rates, resource use and antibiotic prescription rates. Findings: Participants were recruited from four GP practices in rural NSW and comprised ten GPs, two practice managers and two practice staff. Eight GPs and two practice managers completed the study. Quantitative and qualitative results found the AMS Toolbox to be an appropriate and acceptable way to deliver AMS interventions, but several improvements were suggested to increase the sustainability of using the Toolbox. Implications: Although the AMS Toolbox was an acceptable approach to providing interventions, additional implementation strategies are required to support and sustain the use of these interventions in Australian general practice. Future work will develop these strategies in partnerships with MedCast, local health districts, the Royal Australian College of General Practitioners, and the Australian Commission on Safety and Quality in Health Care.

14. Using routinely collected linked whole-of-population data for measuring and monitoring primary care access and quality in Australia. Implications for use in policy

Danielle Butler^A, Christine Phillips^A, Jennifer Welsh^A, Nina Lazarevic^A, Hsei-di Law^A, Sally Hall Dykgraaf^A, Grace Joshy^A, Emily Banks^A, Jane Desborough^A, Kirsty Douglas^A, Jason Agostino^A, Rosemary Korda^A, the ANU Telehealth in Primary Care Study Team^A

^AAustralian National University

Background: Ongoing measurement and monitoring of primary care access and quality is necessary to ensure the system sustainably meets the needs of the population. Now available whole-of-population linked datasets offer the opportunity to support this objective. Aim/Objectives: To describe novel and comprehensive applications of whole-of-population linked data for measuring primary care access and quality at the system-level, including in relation to policy changes. Methods: We used individual-level national primary care claims and dispensing data (2016–2022), linked to 2021 Census data and Death Registrations, accessed through the Person Level Integrated Data Asset (PLIDA), an Australian whole-of-population data asset. Qualitative data were collected via think-aloud interviews with clinicians and deliberative workshops with consumers. Existing international and national frameworks were reviewed, and indicators mapped to key domains of primary care access and quality. Thematic analysis of qualitative data and time-series and multivariable analyses of linked data were used to derive and quantify changes in proxy indicators of key primary care domains. Findings: Proxy indicators derived from claims data included use and out-of-pocket costs (access) and uptake and timeliness of chronic disease management, continuity-of-provider and medication continuity (quality). Indicators varied across population subgroups and over time, and in relation to policy changes. For example, the whole-population introduction of telehealth in 2020 was associated with sustained use of primary care during the pandemic, lower out-of-pocket costs and small positive changes in quality-related indicators of care, such as timely chronic disease management, continuity-of-provider, and medication continuity. However, we identified several quality domains that cannot be measured (e.g. patient-centredness, safety, acceptability). Important caveats when considering the domains that can be measured with these linked data will be discussed. Implications: Currently available linked whole-of-population data allows measurement of several key domains of primary care access and quality, with potential to inform primary care policy.

15. General Practitioners’ approaches to the use of privately-funded vaccines

Lucy Coles^A, Melissa Kang^A

^AUniversity of Sydney

Background: Immunisation is a cornerstone of preventive healthcare in general practice, and GPs deliver the majority of vaccines in Australia. The National Immunisation Program funds most vaccines recommended by the National Immunisation Handbook, however some vaccines are recommended but not publicly funded, so incur out-of-pocket costs for the patient. Examples are Meningococcal B vaccines (in many states) and RSV vaccines for older people. Aim/Objectives: This study aims to investigate GPs’ attitudes to recommending privately-funded vaccines and how they make day-to-day decisions in discussing these vaccines with their patients. Methods: This is a multi-methods study consisting of (1) a qualitative study using semi-structured interviews to explore GP perspectives, which will inform (2) a cross-sectional survey of a large number of GPs across Australia. The qualitative study will facilitate an in-depth exploration of GPs’ approaches and clinical decision-making, and the themes identified will be distilled into survey questions. The survey, which will be conducted as part of the HealthEd webinar series, will collect data from hundreds of GPs to allow for quantification of these themes and calculation of any association with sociodemographic and practice variables. Findings: It is anticipated that the study will be in the data collection stage at the time of the conference. Implications: Given the expansion of biomedical technologies, the number of approved vaccines is likely to increase, and calls for public funding are likely to exceed the available resources. Therefore, it is likely that privately-funded vaccines will remain an issue for Australian GPs. This research will explore equity implications of current funding models, and barriers and enablers to vaccine access. Further, it is hoped that the outcomes will contribute to the development of point-of-care resources to assist GPs in practice.

16. Supporting Australian general practitioners to engage in best practice chlamydia management through the provision of resources that integrate into clinic workflow

Jacqueline Coombe^A,E, Jane S Hocking^A, Zoie Alexiou^A,B, Helen Bittleston^A, Stephanie Munari^A,C, Meredith Temple-Smith^D, Lena Sanci^D, Jane L Goller^A

^AMelbourne School of Population and Global Health, The University of Melbourne

^BNational Institute for Public Health and the Environment, The Netherlands

^CBurnet Institute, Melbourne

^DDepartment of General Practice and Primary Care, The University of Melbourne

^EOn behalf of the Management of Chlamydia Cases in Australia (MoCCA) Study

Background: Chlamydia is the most diagnosed STI in Australia, with most diagnoses occurring in general practice. Effective case management is vital for reducing the risk of reproductive sequalae, however is not always undertaken optimally. Aim/Objectives: The Management of Chlamydia Cases in Australia (MoCCA) study designed an intervention to support best practice chlamydia care, including partner management, timely retesting for reinfection and early detection of pelvic inflammatory disease (PID). We aimed to support general practice to engage in best practice chlamydia management via the intervention. Methods: We conducted an implementation and feasibility trial to evaluate the use of MoCCA in 14 general practices across Victoria, New South Wales and Queensland. MoCCA included a website (www.mocca.org.au) which provides comprehensive chlamydia management information and resources, shortcut text for electronic medical software, prescription templates, patient factsheets, patient-delivered partner therapy resources, and published ‘how-to’ articles. Qualitative and quantitative data were analysed to understand adoption and impact on chlamydia management. Chlamydia retesting (2-4 months) and PID diagnoses were compared between a 12-month pre-intervention and intervention for patients 16–44 years. Findings: Clinicians (doctors = 40, nurses = 17) mostly indicated MoCCA integrated well with existing clinic workflows and was simple to set-up and use. Reported improvements in care included better quality, continuity and time-efficiency and patient communication. Chlamydia testing and positivity were similar pre-intervention [n = 7695/44847 (17.2%) tested, 4.6% = positive] and intervention [n = 9823/55333 (17.8%) tested, 5.0% = positive]. The retested proportion of patients with chlamydia increased (13.5% 95%CI 10.9–16.4 pre-intervention, 18.8% 95%CI 14.7%–23.5% intervention, difference = 5.4%, 95%CI 0.4–10.4). PID diagnoses remained similar (pre-intervention 0.97%, 95%CI 0.86–1.08, intervention 1.03% 95%CI 0.93%–1.13%, difference = 0.06%, 95%CI 0.09–0.20). Many clinicians wanted access to MoCCA resources post-study and suggested this be via organisations with STI-care responsibilities or practice software. Implications: MoCCA supported improved chlamydia management. MoCCA resources could be made routinely available via existing mechanisms and adapted to other STIs.

17. Women’s experience of postpartum care in general practice: a cross-sectional survey

Allyce Counsell^A, Katherine Vaclavek^B,C, Kate Cheney^B, Melissa Kang^A, Kirsten Black^D

^AGeneral Practice Clinical School, University of Sydney

^BSydney Nursing and Midwifery School, University of Sydney

^CDepartment of Women and Babies, Royal Prince Alfred Hospital

^DSpecialty of Obstetrics and Gynaecology, Sydney Medical School, University of Sydney

Background: The immediate postpartum period and the continuity of care in general practice is a critical window for reproductive life planning. Provision of comprehensive postpartum care and contraception advice by General Practitioners (GPs) can lead to improved maternal and foetal outcomes. Aim/Objectives: To describe postpartum contraception use, rates of breastfeeding and receipt of postpartum care and counselling by GPs at 12 weeks postpartum within Sydney, NSW, Australia. Methods: Pregnant adult women (>36 weeks’ gestation) were recruited from antenatal clinics at two hospitals within metropolitan Sydney. Those who experienced a still-birth were excluded. Data were collected via an e-survey (available in seven community languages) at 12–16 weeks postpartum; sociodemographic and obstetric data were extracted from hospital records. Primary outcomes were contraception use and breast-feeding. Secondary outcome was receipt of postpartum care by GP. Descriptive and logistic regression analyses were performed and looked for associations between these and sociodemographic and obstetric variables. Findings: 197 women consented; 112 surveys returned (57% response rate). 85% had seen a GP for their own care since delivery; 57% were satisfied with the care received. Topics most discussed with the GP included contraception (72.6%) and breast-feeding (56.8%); sexual and bladder function were discussed by less than a third. 55% were not using a method of contraception. Women were more likely to be using contraception if they had resumed intercourse, however 39% who had resumed intercourse were not. Condoms (46%) and breastfeeding (18%) were the most common methods of contraception used. 73% were fully breastfeeding. Further analyses will be available by August 2025. Implications: Most women are seeing a GP in the immediate postpartum period. However, a substantial minority of women were at risk of unplanned pregnancy. Improving information in the antenatal and postnatal periods and improving transition between hospital and primary care could lead to improved outcomes.

18. Online Pain Education Network (OPEN) – workforce sustainability through education and training

Simone De Morgan^A, Helen Slater^B, Duncan Sanders^C, Sue Bellino^D, Roger Goucke^E, Elizabeth Devonshire^C, Fiona Blyth^C, Michael Nicholas^C

^AGeneral Practice Clinical School, University of Sydney

^BFaculty of Health Sciences, Curtin University

^CFaculty of Medicine and Health, University of Sydney

^DConsultant

^EUniversity of Western Australia

Background: Chronic pain is a major public health issue and is increasing due to the aging population. However, many healthcare professionals practicing in primary care lack the knowledge, confidence and skills required to deliver pain management aligned to a biopsychosocial, person-centred and interdisciplinary team-based approach. Building workforce capacity in pain management is critical. Given the large numbers of healthcare professionals requiring this training, delivering it efficiently and effectively presents substantial challenges. Aim/Objectives: The National Pain Management Education Project aimed to build workforce capacity in pain management and address the need for accessibility, scalability and sustainability. The project was funded by the Australian Government and philanthropic partners. Methods: Methods include: (1) development of a Pain Care Priorities Framework (‘Listen to Me, Learn from me’) informed by the priorities of Australians living with pain, carers and health professionals; (2) development of self-directed interdisciplinary pain management training - Online Pain Education Network (OPEN) Clinical Pain Management (CPM) Training Program; (3) user testing by a multidisciplinary panel; (4) launch of OPEN in National Pain Week in July 2025; and (5) building partnerships with professional associations to disseminate the training through Continuing Professional Development. Findings: The OPEN Clinical Pain Management (CPM) Education Training Program includes 15 modules tiered over 4 levels. Training focuses on practical upskilling of healthcare professionals to reflect real world practices. The training is informed by the Pain Care Priorities Framework identifying 44 empirically derived pain care priorities and 9 target domains. OPEN was user-tested with a multidisciplinary panel (N = 23; across six jurisdictions). The panel provided constructive feedback on functionality, user engagement, visual design, content relevance, and feasibility. Implications: The OPEN Clinical Pain Management (CPM) Education Training Program has the potential to enhance workforce sustainability by providing the emerging, current and future health workforces with critical knowledge and skills in pain management.

19. Unfamiliar and unsupported: IMG GPs’ experiences with Centrelink medical certification in general practice

Parvin Delshad^A

^AUniversity of Queensland

Background: General Practitioners (GPs), particularly International Medical Graduate (IMG) GPs, are frequently tasked with completing Centrelink medical certificates for patients seeking financial assistance. However, many IMG GPs face challenges due to unfamiliarity with the process, lack of formal training, and concerns about legal implications, which can lead to significant stress and difficulty in decision-making. Aim/Objectives: This study explores the initial experiences of IMG GPs in writing Centrelink medical certificates, identifying key challenges they face and areas where support and training could be improved. Methods: A qualitative approach was employed, involving semi-structured interviews with 15 IMG GPs. Each interview lasted 30–45 minutes, was audio-recorded, transcribed, and analyzed using thematic analysis to identify recurring themes and concerns. Findings: Emerging themes include: (1) unfamiliarity with the process: many IMG GPs were unaware of Centrelink certificates before encountering them in practice; (2) frustration and confusion: participants expressed difficulty with unclear eligibility criteria and minimal guidance; (3) lack of structured support: most GPs sought advice from peers or independent resources due to the absence of formal support; and (4) legal concerns: fear of making incorrect assessments and facing medico-legal consequences caused hesitation in completing certificates. Implications: The findings suggest a need for targeted education and support for IMG GPs regarding Centrelink medical certificates. Addressing these gaps could reduce stress, improve the accuracy of assessments, and enhance patient care. Developing clear guidelines and training materials may build practitioner confidence and ensure fairer patient assessments.

20. The real price of health: a mixed methods study examining the influence of income on strategies used by people with chronic conditions to manage the out-of-pocket costs of health in Australia

Jane Desborough^A, Tergel Namsrai^A, Elisabeth Huynh^A, Anne Parkinson^A, Jillian Kingsford Smith^A, Andini Pramono^A, Danielle Butler^A, Kamania Butler^A, Fiona Hodson^B, Samar Ibrahim^A, Hsei Di Law^A, Julie Veitch^A, Leanne Watts^A

^AAustralian National University

^BChronic Pain Australia

Introduction: People living with chronic conditions face a disproportionate financial burden in managing their health. Despite Medicare’s aim to ensure equitable access to health care and medicines, people with chronic conditions face high out-of-pocket costs (OOPCs) and the burden is amplified by multimorbidity, which increases the frequency and range of health care needed. Aim: To investigate strategies people with chronic conditions use to manage the OOPC of health in relation to income and other demographic factors. Methods: A mixed methods study including: (1) semi-structured interviews (N = 57) and (2) a cross-sectional survey (N = 284) of people with chronic conditions exploring strategies used to manage the OOPC of health and comparing these across six income brackets: (1) $0–18,000, (2) $18,001–$45,000, (3) $45,001–$80,000, (4)$80,001–120,000, (5) $120,001–$180,000 and (6) >$180,000. Data were analysed using: (1) framework analysis and (2) comparative and multiple logistic regression models comparing income and adjusting for other demographics. Results: (1) Budgetary strategies, most often reported by people earning ≤$80,000, included foregoing basic necessities to afford health care, rationing medications or delaying care. (2) 82.5% of survey participants reported cutting back on health consultations due to OOPC, including GP, specialist, and allied health visits. Earning <$45,000/annum was significantly (5%) associated with making greater healthcare cutbacks compared to earning >$180,000. When comparing the effects of income and multimorbidity, multimorbidity had a larger impact on healthcare cutbacks (explaining 4.9% of the variance vs 2.3%), and when combined, they explained 10.9% of all healthcare cutbacks. Conclusion: These findings highlight the current burden of the OOPC of health care for people with chronic conditions in Australia. While income offers some buffers, it is insufficient in the face of growing multimorbidity and health care complexity. Policy responses must address groups affected by income and multimorbidity to address the cumulative burden experienced by people with chronic conditions.

21. The impact of income on people living with arthritis’ use of strategies to manage the out-of-pocket costs of healthcare and medicines in Australia

Aidan Hickey^A, Jane Desborough^A, Louise Hardy^B, Anne Parkinson^A, Jillian Kingsford Smith^A, Elisabeth Huynh^A, Tergel Namsrai^A, Danielle Butler^A, Kamania Butler^A, Fiona Hodson^C, Samar Ibrahim^A, Hsei Di Law^A, Andini Pramono^A, Julie Vetich^A, Leanne Watts^A

^AAustralian National University

^BArthritis Australia

^CChronic Pain Australia

Background: Australia’s universal healthcare scheme, Medicare, aims to optimise access to health care through reducing out-of-pocket costs (OOPC) for those who can least afford them. Arthritis, one of the most prevalent chronic conditions in Australia, is painful and disabling, one of the most costly to the health system and untreated it almost always deteriorates. Aim: To understand the strategies people living with arthritis use to manage OOPC and how these differ between income groups. Methods: A mixed methods study, including a cross-sectional survey (n = 760) and in-depth interviews (n = 16) with people living with arthritis, comparing the strategies they used to manage OOPC across six income brackets: (1) $0–18,000, (2) $18,001–$45,000, (3) $45,001–$80,000, (4) $80,001–120,000, (5) $120,001–$180,000 and (6) >$180,000. Data were analysed using: (1) multiple logistic regression models adjusting for income and other demographics and (2) framework analysis. Findings: Interview participants in the first three income brackets described a constant juggle between paying for health and everyday necessities such as heating and groceries, with many also reporting a substantial loss of social connectedness due to prioritising health costs. Compared with participants with incomes >$180,000, those with an income of $0–$18,000 had significantly (5%) greater odds of cutting back on medications, appointments with non-GP specialists, allied health services, dentists, and medical imaging; and those with an income <$45,000 had significantly (1%) greater odds of making the decision to pay for basic living expenses in lieu of paying for health care and the converse – the decision to pay for health care instead of basic living expenses. Implications: Our findings indicate that due to OOPCs, people in the lowest income brackets, the priority group for policies aimed at reducing OOPCs, are foregoing key aspects of care and some basic human necessities, highlighting policy gaps in achieving equity of health financing in Australia.

22. Does the anticipation of stigma predict stress and distress in people living with chronic obstructive pulmonary disease (COPD)?

Evelyne Dharmawan^A, Sanduni Madawala^B, Keya Bibikar^A, Chris Barton^A

^ADepartment of General Practice, Monash University

^BRespiratory Research @ Alfred, Alfred Hospital, Melbourne

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung condition causing breathing difficulty, disability and premature death. Stigma is a common experience of people living with COPD affecting healthcare access self-management, mental health and quality of life. Aims/Objectives: This study examined associations between ‘anticipated’ stigma in healthcare settings and psychological distress, depression, and anxiety, in people with COPD. Methods: This secondary analysis used data from a cross-sectional survey of community-dwelling adults with doctor-diagnosed COPD. Participants completed the Chronic Illness Anticipated Stigma Scale (CIASS) and Depression, Anxiety, Stress Scale (DASS-10). Pearson correlation and Hierarchical Regression were used to identify predictors psychological distress. Items for regression models were selected based on univariate associations and theoretical relevance. Findings: Responses from n = 123 adults with COPD were analysed. Respondents were aged 33–90 years, mostly women (63.4%), with mild to moderate symptoms (mMRC dyspnoea scale 0–2, 65.6%). Over half (56.1%) lived in areas of socio-economic disadvantage (SEIFA Decile 1–4) and nearly all reported a history of smoking (93.5%). A quarter (25.6%) had probable clinically relevant anxiety and 37.7% probable clinically relevant depression. A weak, but significant correlation was found between anticipated stigma and psychological distress (r = 0.251, p = 0.005), depression (r = 0.214, p = 0.018) and anxiety (r = 0.256, p = 0.005). This association was lost when social support and breathlessness were added to the multivariate analyses. Implications: This highlights the impact of stigma on mental health for people with COPD. Addressing stigma in healthcare and enhancing social support primary care providers can improve the overall management of COPD and mental wellbeing for COPD patients. Future research could explore biological underpinnings of stigma-related stress to inform effective interventions.

23. Access denied: how policy constructions of harms and risk place opioid pharmacotherapy beyond the usual business of primary care

Jessie Edwards^A, Idin Panahi^B, Tim Piatkowski^C, Emma Kill^D, Geoff Davey^E, Geoff Spurling^B

^ADiscipline of General Practice, University of Adelaide

^BGeneral Practice Unit, University of Queensland

^CSchool of Applied Psychology, Griffith University

^DQueensland Injectors Voice for Advocacy and Action

^EQueensland Injectors Health Network

Background: Opioid pharmacotherapy (OP) is highly cost-effective, halving mortality for people who use drugs. However, in 2022, fewer than 10% of Australian general practitioners (GPs) were authorised OP prescribers. The Australian National Drug Strategy (2017–2026) (NDS) prioritises improved access to OP under a harm minimisation approach, but OP is governed at both national and state levels by complex policy and regulatory frameworks that produce access barriers to OP in Australian primary care. Aim/Objectives: This study aims to describe how primary care opioid pharmacotherapy is problematised in the NDS, Queensland, New South Wales (NSW), and Victorian state policies, and the discursive and subjective effects that are produced. Methods: Relevant, current policy documents were collated and analysed using the ‘What is the problem represented to be?’ policy analysis method, drawing on Foucauldian theory to problematise the subjects and objects produced by policy texts. Reflexive annotation and memoing were used to collaboratively develop findings. Findings: Harms and risks are the two core “problems” of OP constructed by the policies studied. Policies address these problems through complex administrative and compliance requirements for GPs and patients, situating OP outside of the ‘usual business’ of primary care. Patients accessing OP are represented to be inherently chaotic and ‘full of harm’: harmful towards themselves and others, and harmed by drugs and disadvantage. OP patients are required to discipline themselves into non-risky, productive, socially responsible selves to receive access to less-burdensome prescription regimen s. Throughout, OP drugs are produced as uniquely risky objects requiring a high level of GP and pharmacist oversight and control. These harms and risks are constructed and managed differently across states, resulting in unequal distribution of access and burdens. Implications: Reorienting policy away from harm and risk, and towards access and integration within ‘usual business’, could improve access to OP in Australian primary care.

24. Cancer survivorship care in general practice: a national survey

Carolyn Ee^A, Kylie Vuong^B, Joel Rhee^C, Elysia Thornton-Benko^D, Julien Vos^E, Rose Fok^F, Divya Babu^G, Chad Han^A, Larissa Nekhlyudov^H

^AFlinders University

^BUniversity of Melbourne

^CUniversity of New South Wales

^DBondi Road Doctors

^EAmsterdam University Medical Center

^FNational University of Singapore

^GGriffith University, Gold Coast

^HHarvard Medical School, Boston

Background: There is increasing demand for greater involvement of GPs in cancer survivorship. This is the first quantitative study to evaluate GPs’ comfort in providing survivorship care in Australia. Aims/Objectives: This study aims to evaluate Australian GPs’ comfort in providing survivorship care to adult cancer survivors and assess knowledge barriers and educational needs. Methods: An anonymous cross-sectional online survey was distributed to GPs/GPs in training practising in Australia from July – December 2024 via professional networks and social media. The survey was developed by the research team through an iterative process to assess GP overall comfort in caring for adult cancer survivors across five domains of quality survivorship care (surveillance, health promotion/disease prevention, and management of physical effects, psychosocial effects and comorbid chronic conditions) and comfort in providing care in five clinical scenarios with varying levels of risk. Barriers to optimal survivorship care, resource access and training opportunities were also assessed. Logistic regression was used to identify differences in comfort levels between scenarios and between domains. Findings: 217 GPs/GPs in training responded to the survey invitation and 157 completed the survey. For surveillance, GPs were less comfortable in the three high risk scenarios compared to the baseline low-risk scenario (postmenopausal breast cancer). For managing physical effects, GPs were less comfortable in the medium and high risk scenarios compared to the baseline scenario. GPs were more comfortable in scenario 2 (medium risk survivor of Hodgkin’s lymphoma) compared to baseline. There were no differences in comfort levels with health promotion and disease prevention. For managing chronic conditions, GPs were less comfortable with the medium risk scenario, and the high risk scenario of an adult survivor of childhood neuroblastoma. Implications: GP-specific guidance and systems-level change should be prioritised in order to enhance provision of survivorship care in general practice.

25. Working with whānau pounamu: exploring relationships enacted in a non government organisation supporting the chronically homeless in Hastings Aoteaoroa

Kyle Eggleton^A, Alice Mills^A, Kate Te Pou^B

^AUniversity of Auckland

^BHealth New Zealand, Hastings

Introduction: Kuhu Mai is an award winning non government organisation established to provide wrap around services to the chronically homeless community in Hastings, Aotearoa New Zealand. Service users (whānau pounamu) are often disengaged from iwi, government agencies and health services. They experience high rates of mental health issues and drug and alcohol abuse. Previous evaluations have shown that service users have improvements in housing, mental and physical health, increased employment, reduced offending and reduced addiction. Aim: The aim of this project was to evaluate the forms of relationships enacted at Kuhu Mai in order to better understand how other organisations can replicate its success. Methods: This study utilised a participatory action research methodology. Observations were undertaken of interactions within Kuhu Mai by an insider research assistant. 12 interviews with service users occurred using participatory visual methods where participants drew pictures of their ‘journey’ into Kuhu Mai and then the forms of relationships that occurred within Kuhu Mai. Semi structured interviews also occurred with external partners and agencies. A thematic analysis was undertaken to offer an explanatory model of how relationships improved wellbeing. Findings: Participants discussed how they entered Kuhu Mai at a dark time in their lives. It took time for trust to develop with staff. Key to developing trust were relationships centred around kindness, consistency, boundaries, acceptance and meeting people where they are. These forms of relationships were noted by visiting agencies and replicated. Implications: Developing meaningful, trusting relationships with vulnerable populations takes time. For organisations working with vulnerable populations a key factor to improved outcomes is genuine relationship building. This may require a culture shift for organisations, a pivot away from viewing vulnerability within a deficit framing, and a change to how funders measure success.

26. Pilot implementation of comprehensive screening and preconception care in Indonesian primary care

Fitriana Ekawati^A, Tritia Widiantara^B, Phyllis Lau^C, Siti Marlina^D, Shinta Prawitasari^E, Detty Siti Nurdiati^E

^ADepartment of Family and Community Medicine, Universitas Gadjah Mada

^BPanembahan Senopati Hospital

^CDepartment of General Practice, Western Sydney University

^DBantul Local Health Office

^EDepartment of Obstetrics and Gynaecology, Universitas Gadjah Mada

Background: Preconception care aims to optimise women’s health before pregnancy. In Indonesia, such care in primary care is currently limited into the preparation of premarital examination, typically focusing on nutrition and infectious disease. Aim: Building on prior work that developed a more comprehensive preconception screening and care package, this study piloted its implementation and evaluated its feasibility in the Bantul district, an area with relatively high maternal mortality rates in the Yogyakarta province. Methods: The study adopted an implementation science approach and was conducted between August 2024 and January 2025 in three primary care centres (Puskesmas) in Bantul. The intervention involved general practitioners, midwives, nurses, and women of reproductive age participating in the preconception screening. Evaluation methods included a fidelity survey, women’s screening profiles and focus group discussions (FGDs) with healthcare providers and service users. Quantitative data from the surveys were analysed descriptively, while qualitative data from FGDs were thematically analysed. Findings: A total of 30 healthcare providers and 104 women participated in the program. Survey findings indicated high levels of adherence and positive responses across implementation domains, including tool usage (90%), intervention complexity (80%), facilitation (85%), process fidelity (80%), participant engagement (85%), and support systems (80%), and a few women (1–10) already with health risks before pregnancy. Thematic analysis of FGDs identified three key themes: (1) acceptance and perceived feasibility of the program in routine practice, (2) active and meaningful participation of women, and (3) the need to address challenges of diagnostic supplies and enhancing counselling competencies among primary care providers. Implications: The pilot demonstrated the potential for broader adoption of comprehensive preconception care in Yogyakarta’s primary care system. For sustainable integration, attention must be given to maintaining supply chains for tests, strengthening provider counselling capacity, and ensuring continuity of care between primary and referral services.

27. Temporal trends in opioid prescribing by GP registrars: a longitudinal analysis within the Registrar Clinical Encounters in Training (ReCEnT) study

Celine Farkash^A,B, Parker Magin^A,B,C, Hester HK Wilson^B,D,E, Amanda Tapley^A,C, Elizabeth Holliday^C, Andrew Davey^A,C, Jason Dizon^F, Michael Tran^B

^ARoyal Australian College of General Practitioners

^BUniversity of New South Wales

^CUniversity of Newcastle

^DSouth East Sydney Local Health District

^ENSW Ministry of Health

^FHunter Medical Research Institute

Background: Pharmaceutical opioid use has increased substantially in Australia over recent decades, associated with significant harms including fatal and non-fatal overdose, motor vehicle accidents, falls, and dependence. In 2018, opioids contributed to three drug-induced deaths per day. Legislative measures—including real-time prescription monitoring, codeine up-scheduling to prescription-only, and PBS restrictions—have aimed to curb inappropriate prescribing. While PBS-subsidised opioid dispensing has declined since 2017, private opioid dispensing has increased. Many Australians continue to use opioids for chronic non-cancer pain, contrary to guideline recommendations, with GPs being their main source of prescriptions. No longitudinal studies have examined opioid prescribing trends among GP registrars, who make up 15% of the GP workforce and are influenced by senior colleagues. Understanding their prescribing patterns is crucial for shaping future opioid prescribing behaviours. Aims/Objectives: To analyse temporal trends in GP registrar opioid prescribing between 2010 and 2024. Methods: We are conducting a longitudinal analysis using data from the Registrar Clinical Encounters in Training (ReCEnT) study, comprising approximately 1.5 million problems recorded across 1 million GP registrar consultations. An expert panel will review the opioids (identified using Anatomical Therapeutic Chemical codes) and associated presenting problems to define the outcome measure: opioid prescription for non-cancer, non-palliative care problems. Segmented multivariable mixed-effects logistic regression will compare prescribing trends before and after the 2018 codeine up-scheduling. Additional analyses will assess prescribing in relation to the rollout of real-time prescription monitoring. Findings: We hypothesise an overall decline in opioid prescribing associated with policy interventions, though a transient increase may have occurred following codeine up-scheduling in 2018. Preliminary findings will be available for the conference. Implications: Findings may inform educational strategies, practice policies, and government initiatives to support appropriate opioid prescribing by GP registrars, ultimately aiming to reduce opioid-related harms in Australia.

28. General practitioners’ perspectives on cervical screening test self-collection

Tali Feiglin^A, Allyce Counsell^A, Melissa Kang^A

^AUniversity of Sydney

Background: Cervical screening tests (CST) are a key preventative health activity in primary care. Eligibility criteria for HPV self-collection in the National Cervical Screening Program were significantly broadened in July 2022 to include most people due for screening. This change aimed to increase engagement amongst under-screened priority groups. Self-collected samples have equal sensitivity as clinician collected samples for HPV detection as well as cervical intraepithelial neoplasia 2+ and adenocarcinoma in-situ. Research into general practitioners’ (GP) views of self-collection around the time of introduction showed that while many GPs acknowledged the benefits of self-collection there was still hesitancy amongst some practitioners. More recently a further public health campaign has commenced to raise awareness about self-collection. Aim/Objectives: To explore GPs current attitudes towards, experiences and clinical practices of self-collected CSTs. Methods: This is a cross-sectional, qualitative study. Semi-structured one-on-one interviews with Australian GP fellows will occur via Zoom. A small amount of demographic data will be collected, aiming to interview a heterogenous sample. Open-ended questions will investigate GPs’ perspective on self-collection including perceived advantages and disadvantages, their attitude changes over time and influences on their patients’ attitudes. Interview data will be de-identified, transcribed and analysed in stages using thematic analysis with QSR NVivo software. An application to the Human Research Ethics Committee at the University of Sydney has been submitted. Findings: We anticipate preliminary findings will be available in late 2025. Implications: The research will provide a current perspective on Australian GPs’ attitudes towards and experiences providing HPV self-collection now that it has been in place for over 2 years and is being publicly promoted. We hope it will encourage participating GPs and those who read the research to consider how they can increase engagement in their clinical practice and guide further research into the area.

29. Improving primary care vaccination rates in underserved and medically vulnerable populations: a rapid review of strategies used in Australia and Aotearoa New Zealand

Georgia Fisher^A, Bianca Forreste^A,B,C, Tina Vickery^A, Nadia A Charania^D, Samantha Spanos^A, Lisa Pagano^A, Kate Churruca^A, Louise Ellis^A, Jeffrey Braithwaite^A

^AAustralian Institute of Health Innovation, Macquarie University

^BWestern Victoria Primary Health Network, Geelong

^CUniversity of Melbourne

^DAuckland University of Technology

Background: Despite excellent evidence for effectiveness of vaccines and their inclusion within multiple clinical guidelines, vaccination coverage remains sub-optimal and inequitable in both Australia and Aotearoa New Zealand. Primary care plays a central role in interventions that aim to improve vaccination coverage in these health systems. Aims/Objectives: We had three aims, each related to medically vulnerable and underserved populations in Australia and Aotearoa New Zealand. We aimed to: (1) describe barriers and enablers to increasing vaccination coverage in these populations in primary care, (2) to review primary care-based interventions for improving vaccination coverage in these populations and (3) to compare the identified barriers and enablers with the identified intervention strategies and thus describe gaps that should be addressed. Methods: A rapid review of the literature published the last ten years. Findings: Of the 42 included articles, 37 described barriers and enablers, and 13 described an intervention to improve vaccination coverage. Barriers and enablers were identified at three levels: consumer; practitioner/practice; and healthcare system. Consumer-level factors included mistrust and hesitancy (barriers), and high perceived benefit of vaccination (enabler). Practitioner/practice-level factors included competing demands (barrier) and positive attitudes towards population-health interventions (enabler). System-level factors included a lack of culturally informed services and information technology issues (barriers), and policy-level support for the development of equitable, co-designed, patient-centred, and culturally informed vaccination care pathways (enabler). Most interventions attempted to provide culturally informed services; however, barriers and enablers were rarely addressed at all levels. Instead, many interventions took simpler approaches, including personalised vaccination calendars, SMS-reminder programs, and structured health assessments, and achieved small to moderate positive impacts. Implications: Future primary-care based interventions in Australia and Aotearoa New Zealand should be tailored to meet the needs of medically vulnerable and underserved populations to achieve more equitable rates of vaccination coverage.

30. Uniting depression care through generalism. A primary care response to the Lancet-World Psychiatric Commission’s call for united action on depression: a review informed by a realist synthesis approach

Alison Flehr^A, Christopher Dowrick^B, Catherine Kaylor-Hughes^A, Jane Gunn^A

^ADepartment of General Practice and Primary Care, University of Melbourne

^BDepartment of Primary Care and Mental Health, Institute of Population Health, University of Liverpool

Background: The 2022 The Lancet-World Psychiatric Association Commission report called for ‘united action on depression’, advocating greater understanding and improved implementation of depression care strategies at all levels. Objective: To respond to the Lancet Commission’s call with a review informed by a realist approach of observational cohort studies of depression in the primary care setting. Aim: To bring primary and psychiatric knowledge together with insights and recommendations for united action on depression. Methods: We conducted a systematic search of MEDLINE, CINAHL, and PsycInfo for the following articles: (i) observational cohort studies, (ii) adult primary care attendees, (iii) recruited via primary care, (iv) administered a depression assessment at screening/inclusion and (v) followed up for at least 12 months. Additional articles were identified via citation searches. What works for whom, and in what context was then evaluated. Findings: Of the 2095 record retrieved, 76 articles were retained and 109 more were identified from secondary sources. In total, 185 articles from 16 cohorts, representing 53 cumulative years of observation of over 26,000 participants from 26 countries, were included. Personal resilience and reductions in social burden were powerful predictors of improved depression outcomes. Prediction of depression severity trajectory, the complexity of the depressive experience, and the need for tailored yet holistic depression care plans were recurring themes across the cohorts. Implications: Our refined program theory consists of seven primary care focussed IF-THEN insights and recommendations to guide united action on depression. The recommendations advocate a generalist model of depression care and the building of primary care capacity in depression needs prediction and care navigation support. We believe the recommendations provide tools and pathways to better support GPs deliver depression care to people presenting to general practice and for how primary care might contribute to the broader goal of a reduced global burden of depression.

31. Learning from quality, safety, and performance indicators in primary care: a systematic review of barriers and facilitators to implementation

Bianca Forrester^A,B,C, Georgia Fisher^A, Louise Ellis^A, Samantha Spanos^A, Samran Sheriff^A, Maree Saba^A, Jeffrey Braithwaite^A

^AAIHI, Macquarie University

^BDepartment of General Practice and Primary Care, University of Melbourne

^CWestern Victoria Primary Health Network, Geelong

Background: Policymakers worldwide are prioritising primary care reforms to enhance health system resilience, sustainability, and performance in response to increasing complexity and demands. Quality Improvement (QI) and its associated quality indicators will be key to these reforms, enabling measurement and feedback to be embedded in routine care. Aim/Objective: This review aimed to examine how quality, safety, or performance indicators are implemented in primary care, and to analyse the factors that influence their use. Methods: Empirical investigations of the implementation of quality, safety, and performance indicators in primary care, published in Medline, EMBASE, and Scopus, were included in this review. Data from included studies were thematically analysed in two ways: (1) implementation strategies were deductively mapped to the People, Process, Technology (PPT) framework and (2) barriers and facilitators were inductively analysed. Findings: Twenty-three studies were included, conducted in diverse primary care settings, focused on a range of improvement approaches. They predominantly used mixed or qualitative methods. Indicator implementation frequently leveraged electronic health record data (18/78.3%) and digital tools for automated data extraction (n = 15/65.2%), analysis (n = 13/56.5%), and feedback (16/69.6%). Commonly reported feedback strategies included performance benchmarking (8/34.8%), audit and feedback (n = 16/69.6%), and cohort risk identification with clinical decision support (n = 17/73.9%). Specific to barriers and facilitators, six key themes emerged: alignment with value at all levels, incentivisation for participation and outcomes, collaborative leadership and culture, practice infrastructure and capacity, self-generating clinical improvement cycles, and digital enablement. Implications: Multiple sets of interrelated factors drive the successful use of quality, safety and performance indicators in primary care settings. Given the increasing reliance on digital technologies to enhance data capture and feedback, the PPT framework may offer a particularly useful lens through which to view, navigate and enhance implementation efforts. These findings may be used to guide the resourcing and selection of implementation strategies for data-driven learning and improvement in primary care.

32. Where are you now? Medium term outcomes and impacts of the 2017–2023 RACGP Academic Post program

Georgia Franklin^A, Christopher Barton^B, Nancy Sturman^C

^ARoyal Australian College of General Practitioners

^BMonash University

^CUniversity of Queensland

Background: The Academic Post program engages Australian General Practice Training registrars in research and medical education in academic general practice environments. The program aims to build the academic workforce, and General Practitioner research and teaching skills. Aim/Objectives: We assessed academic outputs, and other research and teaching outcomes, of the 2017–2023 RACGP Academic Post cohort, to better understand the impact of the program. Methods: An electronic survey was distributed to RACGP Academic Post recipients (n = 134) between 2017 and 2023. The survey included questions about academic outputs, research higher degree studies, subsequent academic employment, and research, teaching or other leadership roles. Findings: Sixty-four participants responded to the survey (48% response rate), with 55 (41%) providing complete responses. Most (55/62 88%) currently worked in clinical General Practice and had Medical Education (36/62 58%) and/or Research (34/62 53%) roles. The majority (47/59 80%) maintained a university affiliation, including 17/59 (29%) with academic or adjunct titles, and 30/59 (51%) with University appointments (casual, fixed term, continuing or conjoint). Of 59 respondents, 6 had completed a PhD, three were currently undertaking PhD studies and 13 were considering PhD enrolment. Research outputs from their post were reported by 48/55 (87%) respondents, including conference presentations or posters, and 45/55 (82%) had published at least one peer-reviewed journal article or had a first publication pending. Free text comments emphasised the importance of the Academic Post in respondents’ subsequent academic careers. Implications: The survey had a good response rate for general practitioner surveys. Further analysis of respondent demographics is underway to assess respondent representativeness in comparison with the overall alumnus cohort. Results suggest a strong impact of the program in building and sustaining general practice academic, research and medical education skills and workforces. A subsequent interview study is planned to further understand subsequent alumnus opportunities and careers.

33. Outcomes of heart failure diagnosis in the community compared to acute care settings: insights using big data

Eliot Frymire^A,C, Michael Green^A,B,C, Hannah Willms^C, Alex Van^A, Aws Almufleh^A

^AQueens University, Kingston

^BNorthern Ontario School of Medicine, Thunder Bay

^CInstitute for Clinical Evaluative Sciences

Background: A heart failure (HF) diagnosis has been associated with worse outcomes when made in acute care settings (emergency department [ED] or during hospital admission) compared to ambulatory care settings (the community). Little is known about this correlation in Canada which has a comprehensive primary care system. Aims/Objectives: This study aims to evaluate the rate, predictors, and outcomes of HF diagnosis when made in acute care settings compared to the community in Ontario. Methods: This is a retrospective cohort study utilizing administrative databases in Ontario, Canada from 2010 to 2022. We estimated HF diagnosis rates, patient/provider characteristics, and clinical outcomes (all-cause mortality, hospital admissions, and ED visits for HF) in each setting. Findings: 597,025 patients with new HF diagnosis were identified; 220,560 (36.9%) patients were diagnosed in acute care settings. Patients with multiple comorbidities, without a primary care provider (PCP), or those of lower income were more likely to be diagnosed in acute care settings (p < 0.0001). Patients diagnosed in acute care settings had an increased risk of all-cause mortality, hospital admissions for HF, and ED visits for HF (rate ratios: 1.82 [1.80, 1.83]; 2.80 [2.75, 2.85]); 2.68 [2.61, 2.75], respectively; adjusted for age, sex, and comorbidities). Implications: Over a third of HF diagnoses in Ontario are made in acute care settings; particularly in comorbid patients, those of lower socioeconomic status, and patients without a PCP. Acute care diagnosis was associated with increased mortality and hospital admissions. These findings highlight the important role of primary care in the diagnosis and management of HF.

34. Ontario’s centralized waitlist 2009–2020: addressing access issues to primary care

Michael Green^A,B,G, Eliot Frymire^A,B, Richard Glazier^B,D, Liisa Jaakkimainen^B, Shahriar Khan^A,B, Imaan Bayoumi^A,B, Kamila Premji^B,C, Tara Kiran^B,D, Emily Marshal^F, Mylaine Breton^E

^AQueens University, Kingston, Canada

^BInstitute for Clinical Evaluative Sciences

^CUniversity of Ottawa

^DUniversity of Toronto

^EUniversity of Sherbrooke

^FDalhousie University, Halifax

^GNorthern Ontario School of Medicine, Thunder Bay

Background: This study explores the effectiveness of a centralized waiting list in Ontario (Health Care Connect – HCC) connecting patients, self-identified as unattached, with a primary care provider. Universal health care coverage applies in all parts of Canada. This study is the Ontario component of a larger three province study including Quebec and Nova Scotia. Aims/Objectives: Determine the effectiveness of the centralized wait list in Ontario Canada in attaching patients to a primary care provider- as well as attachment stability following attachment. Methods: Time trends in the number of patients registered with HCC in Ontario and attachment rates were calculated. Measures of HCC effectiveness of attachment including the stability of attachment were also examined. HCC registrants in comparison to non-HCC registrants are 14.9 times more likely to be continuously attached and 7.6 times more likely to be irregularly attached relative to those who were never attached. This difference in maintaining attachment is an order of magnitude that is noteworthy. Findings/Implication: This first of its kind data linkage of the wait list in Ontario found that a small percentage (10%) of patients without a regular source of primary care use the HCC wait list. HCC is very effective in attaching patients to a primary care provider and keeping them attached. For those patients who lose attachment, HCC is effective in ensuring the patients are re attached to a primary care provider. HCC is an important effect tool in increasing access to primary care over this 10 year period.

35. Learning in place: the creation of a community-based Rural Training Stream to grow a local health professional workforce in Western Victoria

Lara Fuller^A, Jessica Beattie^A, Matthew McGrail^B, Vincent Versace^C, Gary Rogers^D

^ARural Community Clinical School, Deakin University, Colac

^BRural Clinical School, University of Queensland

^CDeakin Rural Health, Warrnambool

^DSchool of Medicine, Deakin University, Waurn Ponds

Background: Rural Western Victoria suffers from a medical workforce maldistribution impacting healthcare access for rural communities. Since 2010, Deakin University’s rural clinical schools (RCS) have trained students in the region, yet a study of Deakin’s graduate workforce outcomes in 2019 found that only 16.2% of graduates were working rurally. Objective: To present a case study demonstrating the evidence-based design of a place-based Rural Training Stream (RTS) in Deakin’s Doctor of Medicine (MD) course in Western Victoria, to widen access for students from Deakin’s rural footprint and enable them to complete end-to-end rural training. Methods: Variables associated with graduate rural practice informed the RTS design, prioritising 30 places annually for students from Deakin’s rural footprint. The footprint was formally defined and admission changes focused on the recruitment of students with connections to a local rural community. Two new rural learning campuses were established, in Ararat and Warrnambool, to deliver the face-to-face component of a blended learning program for the two pre-clinical years. Clinical years are completed at one of the RCS. Findings: Since rural delivery of the entire MD course was first offered in 2024, the RTS has been filled with students from the footprint. Mapping the footprint enabled the evaluation of Deakin’s graduate workforce outcomes for this region. In 2024, 120 graduates were working in the rural footprint. Significant associations (p < 0.001) with working in the footprint were: post-graduate years 1–3 (OR 7.2), rural longitudinal integrated clerkship (LIC) and RCS training (OR 6.8); RCS training (OR 4.1), General Practice vocation (OR 4.7) and rural background (OR 3.02). Implications: This case study demonstrates a model for the development of a sustainable, home-grown rural workforce and provides baseline data for future evaluation of whether the RTS objectives for Western Victorian rural communities are realized.

36. Incident cancer and its effect on health-related quality of life trajectories among Australian older adults

Svetla Gadzhanova^A

^ADiscipline of General Practice, University of Adelaide

Background: Health-related quality of life (HRQoL) is a subjective measure on how health impact different domains of people’s daily life. Few studies have investigated the long-term effect of cancer diagnosis on HRQoL trajectories using large-scale population-based data. Aim: To investigate the long-term effect of incident cancer on HRQoL trajectories among healthy older people. Methods: Longitudinal data from the Aspirin in Reducing Events in the Elderly (ASPREE) trial was utilized to identify people with an incident (first-ever) (1) non-metastatic or (2) metastatic cancer diagnosis between 2010 and 2022. SF-12v2 was used annually to collect information on the physical (PCS) and mental (MCS) component scores of HRQoL. Group-based trajectory modelling was applied to investigate the effect of the incident cancer on (1) “acute” HRQoL changes and (2) HRQoL trajectories (high, intermediate, low trajectories). Findings: Out of 19,106 older people, 2,852 had an incident cancer diagnosis (mean age 76 ± 4.6 years, 46% females). Of these, 22% had metastatic cancer. Except for those in the lowest PCS trajectory group, metastatic cancer led to a significant “acute” decline in PCS (effect size ranging from –3.4 to –7.4 points), with a further decline of –0.23 points/year among those in the low-intermediate PCS trajectory group. The trajectory remained steady over time for those in the high PCS group. Metastatic cancer also led to an “acute” decline in MCS only in the low (–2.1 points) and intermediate MCS groups (–3.4 points). Still, it did not affect the MCS trajectory slope after that. The effect of non-metastatic cancer on “acute” PCS or MCS changes was less evident, and individuals returned to their corresponding non-cancer trajectories over time. Implications: Non-metastatic cancer had a lesser effect on HRQoL trajectories than metastatic cancer. Older people with intermediate PCS and MCS are more likely to suffer the impact of metastatic cancer.

37. Australian general practitioners’ experiences with providing climate-sensitive health counselling (CSHC): a study looking at enablers, barriers and how we can build capacity of general practitioners to provide such counselling

Aharani Ganeshamoorthy^A, Phoebe Holdenson Kimura^A, Melissa Kang^A

^AUniversity of Sydney

Background: The effects of climate change on morbidity and mortality are becoming increasingly prevalent. Such effects include exposure to hazardous levels of air pollution, heat stroke, increased transmission of vector-borne diseases and increased mental health presentations. The Australian Department of Health released a National Health and Climate Strategy, which identifies the key role of primary care in addressing the impacts of climate on health. Carbon-reducing behaviours such as plant-based diets and active transport have also demonstrated benefits to health with secondary benefits for the environment. The Lancet Planetary Health released a study in 2023 that proposed a term climate-sensitive health counselling (CSHC) to describe the integration of climate change into health counselling. Despite this there is no empirical literature from Australia exploring GPs’ experiences of integrating this type of counselling into clinical practice. Aim/Objectives: To look at the experiences, attitudes, knowledge, enablers, barriers, and perceived capacity building factors of climate-sensitive health counselling in general practice. Methods: A purposive sampling strategy will be utilised to recruit GPs with a variety of background characteristics. Background sociodemographic and practise information will be collected and reported descriptively. Semi-structured interviews with Australian GPs will be conducted to explore the above aims. Data will be analysed inductively using thematic analysis facilitated by coding with NVivo software. Findings: This study is currently awaiting ethics approval. Preliminary findings for this study are expected by August of 2025. Implications: We hope to address a gap in empirical literature on this topic in an Australian setting. We hope that the data will help inform larger survey type studies into enablers, barriers and capacity building needs as well as assist with the creation of resources to integrate CSHC into clinical practice. The goal is to enhance patient care and help protect against the health effects of a changing climate.

38. Vaping in the Australian primary care setting: surveying current practice

Sam Gerami^A, Marguerite Tracey^A, Christopher Harrison^B, Julie Gordon^A, Ramesh Manocha^A, Joan Henderson^B, Melissa Kang^A

^AGeneral Practice Clinical School, University of Sydney

^BSchool of Public Health, University of Sydney

Background: Use of e-cigarettes (vaping) has risen rapidly over the last decade. The 2023 National Drug Strategy Household Survey found 7% of the population (1.5 million Australians) were current users, and 19.8% had used at least once. Vaping causes a range of short and long-term harms, but uncertainty remains around harms and benefits, therapeutic use, and strategies to help patients quit. Current Australian GP guidelines for primary care are based on early and interim evidence, as well as available evidence on smoking. Aim/Objectives: (1) To find out what Australian GPs current practice regarding vaping is and (2) to compare how much vaping related care is provided by GPs relative to a snapshot undertaken in March 2024 using the same platform. Methods: A 7-question anonymous survey will be undertaken utilising the HealthEd platform among currently practicing Australian GPs (2000–3000 GPs expected), using Likert or multiple-choice answers. The choices are based on current vaping/smoking guidelines, with “other” choice allowing comment. This will capture mostly quantitative data as well as some qualitative data through comments. The first 5 questions ascertain whether GPs ask patients about vaping, whether/how they assess vaping dependence, whether/how they quantify vaping, whether they use vaping as a harm minimisation tool or smoking cessation aid, and whether/how they provide vaping cessation care. The last 2 questions are repeats of 2024 questions asking how many vaping-related consults GPs have had in the last 2 weeks, and how many with patients under 18 years old specifically. Findings: Descriptive statistics and confidence intervals will be reported. If there are adequate qualitative data, results of inductive thematic analysis will be reported. Implications: We expect findings to point out current areas of uncertainty in practice, reveal level of concordance between practice and guidelines, and inform structure and usability of future guidelines and their dissemination.

39. The Readiness Program: a mixed methods evaluation of a national domestic and family violence training program for primary care

Fiona Giles^A, Simone Gleeson^A, Rachel Komen^A, Kitty Novy^A, Jacqueline Kuruppu^A,B, Kelsey Hegarty^A,C

^ADepartment of General Practice and Primary Care, University of Melbourne

^BLa Trobe Rural Health School, La Trobe University, Bendigo

^CThe Royal Women’s Hospital, Parkville

Background: Domestic and family violence (DFV) is a chronic social condition that leads to complex chronic health conditions. DFV is the leading cause of disability and death for women of childbearing age. General practitioners (GPs) are among the most trusted professionals for disclosures of DFV. However, primary care health professionals often perceive they lack the skills to appropriately respond. The Safer Families Centre and its partners developed and delivered a comprehensive primary care training program (‘the Readiness Program’) to build capacity to respond to DFV. Training formats included workshops, webinars, e-learning and virtual-practice-centred learning. Aim/Objectives: To conduct an evaluation of the Readiness Program 2020–2024 to assess whether the Program was: feasible to deliver; acceptable to participants; effective in improving participants’ readiness to address DFV; and effective in increasing participants’ confidence and capacity to identify and respond to DFV. Methods: A mixed methods evaluation was conducted using data collected from registrations, pre-/post- surveys and interviews. Data were analysed using descriptive statistics (quantitative) and thematic analysis (qualitative). Data were then synthesized across all formats to develop whole-of-program themes. Findings: Overall, 5,056 users accessed the Program. Findings show the Program was successful in building capacity and systems that improved the knowledge, skills, comfort and confidence of primary care to respond to DFV. Findings also show it met participants’ expectations of content and delivery. Key elements of program success were the strong leadership and governance, the flexible whole-of-practice approach and partnering with the specialist DFV sector. Implications: Flexible, whole-of-practice training delivered across multiple formats is effective in reaching a large cohort of primary care providers to better support patients experiencing DFV. Ongoing support for training is needed to ensure every primary care provider has access to the tools, resources and training to equip them with the readiness and confidence to address DFV.

40. PATHS – providing accessible treatment for higher education students

Iris Q Gu^A, Chris Barton^A, Susan Kotwas^B, Kim Turudia^B, Ines Rio^B, Grant Russell^A

^ADepartment of General Practice, Monash University

^BUniversity Health Service, Monash University

Background: University campuses are an important setting for the provision of health care to young adults and students. Little is known about how these services are organised to provide accessible care for university students, in particular international students. Aim/Objectives: To explore how a University Health Service (UHS) organises itself to optimise access to primary care services for university students. Methods: We will use a rapid ethnographic study design informed by the Levesque model of healthcare access. Set in a UHS situated on the Monash University Clayton campus, data collection will comprise non-participant observations of clinic activities and interviews with key staff and stakeholders of the health service. Observations will be organised using the ULTRA tool to describe detailed interactions within the clinic, combined with an observer-completed reflexive journal. Semi-structured interviews will be conducted with clinic leadership and practice managers, administrative staff, and clinicians (doctors, nurses, counsellors and allied health professionals). The data will be analysed using an inductive thematic analysis. Preliminary interpretations will be shared and refined with clinic leadership and staff. Findings: Preliminary results will be presented illustrating the ways the University Health Service organises itself to provide better access to primary health care services for university students. Implications: It is anticipated that this study will provide rich insights into the organisation of university healthcare systems from the provider’s point of view; and lay the foundations to enhance healthcare accessibility for students and young people across Australian higher education providers in the future.

41. Stroke prevention using oral anticoagulants among patients with atrial fibrillation: a survey of Australian general practitioners

Omar Hamed^A, Solomon Wright^A, Katrina Giskes^B, Nicole Lowres^C, Ben Freedman^C, Charlotte Hespe^B

^ASchool of Medicine, University of Notre Dame

^BDepartment of General Practice, School of Medicine, University of Notre Dame

^CHeart Research Institute, Sydney

Background: Patients with atrial fibrillation (AF) are at an increased risk of thromboembolic complications, such as transient ischaemic attacks and ischaemic stroke. As such, the use of oral anticoagulants (OACs) is an essential component of managing patients with AF. Aims/Objectives: To examine Australian General Practitioner’s (GP) confidence in the initiation of OACs and practices for monitoring treatment adherence among patients with AF. Methods: GPs were recruited by promotion through professional development education, social media platforms and GP networks. An online questionnaire was used to collect data on GPs’ prescribing and monitoring of OACs, and demographic data, including years of practice and geographic remoteness. Findings: 1765 GPs completed the questionnaire; 82.2% had practiced >10 years and 31.6% worked in regional/rural areas. Overall, 48.6% reported being very confident with initiating OACs among high-risk patients. Confidence prescribing OAC was directly associated with years of practice: >10 years (50.1%), 5–10 years (43.6%) and <5 years (42.2%) (p < 0.01). Confidence prescribing OAC was also significantly associated with location: 71.2% in remote, 55.6% regional and 44.9% in metropolitan areas (p < 0.01). Only 72.7% of GPs reported monitoring adherence and/or persistence of OAC treatment. Monitoring of adherence/persistence was higher for Registrars (80.6%) compared to GPs (73.0%) (p < 0.01); and higher in remote areas (76.5%) compared to metropolitan areas (71.9%) (p < 0.01). GPs reported low health literacy as the leading cause for poor adherence (53.7%), and >40% identified medication concerns, cognitive impairment and being unaware of stroke risk as barriers to adherence. Implications: Improving GP’s confidence in initiating and monitoring adherence to OAC treatment may reduce potentially avoidable strokes. Less experienced and metropolitan GPs would benefit from strategies to improve their confidence in initiating OACs, and metropolitan GPs could improve their monitoring of patient adherence to OACs.

42. CAC-GP: understanding the use of Coronary Artery Calcium scoring by Australian general practitioners

Shaddy Hanna^A, Liliana Laranjo^A, Clara Chow^A, Melissa Kang^A

^AGeneral Practice Clinical School, University of Sydney

Background: General Practitioners (GPs) have a pivotal role in primary prevention of cardiovascular disease (CVD). Recent guidelines on CVD risk assessment introduced recommendations on the use of Coronary Artery Calcium (CAC) scoring by GPs as a tool to improve risk assessment in situations where traditional risk calculators may underestimate risk. CAC scoring involves the use of a computed tomography scan of the heart to measure the amount of calcium in the coronary arteries. Higher scores correlate with increased CVD risk and can be used to improve CVD risk prediction accuracy for patients with low-intermediate CVD risk. It is highly specific, non-invasive, widely available in Australia, and relatively low in radiation dose. However, the current utilisation of CAC scoring by Australian GPs is not well understood. Aims: To better understand how Australian GPs make decisions about utilising CAC scoring in CVD risk assessment. Methods: Semi-structured interviews with Australian GPs working in NSW were conducted from September 2024 to January 2025. A diverse sample was selected using purposive sampling. Interviews were conducted via phone, video, or in-person, with audio recordings de-identified, transcribed, and analysed inductively using thematic analysis with QSR NVivo software. Findings: Thirteen GPs were interviewed. Preliminary findings of the data analysed suggest that the barriers and facilitators for GPs making use of CAC Scoring in daily practice are complex and include: the direct financial cost of the investigation to the patient, the complexity of counselling required to refer and explain results with patients, and the sparsity of accessible and reliable resources to guide clinical use of CAC Scoring in routine practice. Implications: This study addresses a significant gap in the literature about GP perspectives on the use of CAC scoring in CVD risk assessment. We expect these findings will inform future guidelines around the use of CAC scoring in CVD risk assessment within general practice.

43. The PARTNER Network: creating enduring infrastructure for primary care research in rural, regional and remote communities

Suzanne Harte^A, Paris Panozzo^A, Hannah Lushington^A, Lena Sanci^A, Jon Emery^A

^AUniversity of Melbourne

Background: Australians in outer metro areas face poorer health outcomes and limited access to clinical trials. Improving equity in research access can help address these disparities. Funded by the Medical Research Future Fund and administered by Queensland Health, the PARTNER Network program supports the Australian Teletrial Program (ATP) in delivering primary care telehealth trial sites by 2027. Aims: The PARTNER Network aims to: (1) establish a national rural practice-based research network (PBRN) of 90 general practices to enhance access to primary care clinical trials for underrepresented Australians in rural, regional and remote communities and (2) establish a database of 15 clinical trials for participant access and enrolment in rural, regional and remote communities. Methods: A collaboration between The University of Melbourne, University of Tasmania, University of Queensland, University of Western Australia, University of Adelaide, and the Royal Flying Doctor Service formed the PARTNER Network. Academic leaders and state coordinators alongside a national stakeholder and community advisory group, guided network infrastructure project development, identified opportunities, and worked towards building a sustainable clinical trials pipeline. Findings: PARTNER Network state coordinators have recruited 83 primary care clinics across five states and one territory, targeting MMM2-MMM7 regions categorised by the Modified Monash Model. A REDCap database has been developed supporting 20 clinical trials approved for recruitment in the PARTNER Network. Key opportunities included collaboration with state rural medical schools, integration with other PBRNs, consistent governance, and GP education. Challenges such as geographic distance, electronic medical record compatibility, workforce shortages, and privacy legislation compliance were identified. Implications: By leveraging an integrated, interconnected clinical trials database management system in partnership with the ATP, the PARTNER Network provides a sustainable model to enhance rural primary care research. This initiative will support equitable healthcare access and improve the health outcomes of the seven million Australians residing outside metropolitan areas.

44. Clindamycin and bacterial load reduction as prophylaxis for surgical site infection after below-knee flap and graft procedures

Clare Heal^A, Leanne Hall^A, Helena Rosengren^A

^ARural Clinical School, James Cook University

Background: Management of skin cancer comprises a substantial proportion of general practitioner (GP) workload in Australia. Flap and graft procedures below the knee have an increased risk of infection. Antibiotic resistance is a threat to global health, and any decision about antibiotic prophylaxis must balance adverse outcomes of antibiotic use with patient morbidity. Aim/Objective: To determine the effectiveness of two interventions to prevent surgical site infection (SSI) after below-knee surgery: (1) 450 mg of clindamycin pre- and post-operatively and (2) pre-operative chlorhexidine wash. Methods: Prospective randomised controlled trial was conducted across three skin cancer clinics over 12 months, with 44 participants. Consecutive patients presenting for below-knee flap and graft procedures were eligible to participate. The primary outcome was superficial SSI in the first 30 days following excision. Secondary outcomes included adverse effects (anaphylaxis, skin irritation, foreign body reaction) and patterns of antibiotic resistance. Findings: SSI occurred in 14/44 (31.8%) of cases overall, comprising 2/14 (14.3%) of clindamycin, 5/15 (33.3%) of chlorhexidine and 7/15 (46.7%) of control participants. Absolute reduction in SSI in the clindamycin group compared with control was 32.4% (95% CI 1.2, 63.6), which approached significance (p = 0.06). In sub-analysis of flaps versus graft procedures, infections occurred in 11/39 (28.2%) of flaps and 3/5 (60%) of grafts. In the flap group, the absolute difference in infection rate in clindamycin compared with control in was 46.2% (95% CI 19.1, 73.3) (p < 0.05). There were no adverse symptoms that could be attributed to high dose antibiotic administration, and no patterns of antibiotic resistance (p = 1). Number needed to benefit (NNTB) was 3.1 overall and 2.2 in flap procedures. Implications: A 450 mg dose of clindamycin given before and after below knee dermatologic closure reduced SSI compared with no treatment control. The effect was more pronounced in graft procedures. Low NNTB could implicate change in practice.

45. GP attitudes towards the potential utility of an AI-augmented clinical decision support tool for hypertension – a cross-country qualitative study

Elizabeth Hoon^A,B, Jessie Edwards^A, Basharat Hussain^C, David Gonzalez-Chica^A,B, Barbara Lyen^D, Nigel Stocks^A

^ADiscipline of General Practice, Adelaide Medical School, University of Adelaide

^BAdelaide Rural Clinical School, University of Adelaide

^CNottingham University Business School, The University of Nottingham

^DCentre for Academic Primary Care, The University of Nottingham

Background: Given the importance of hypertension as a risk factor for cardiovascular disease (CVD), its prevalence in the community, our failure to achieve blood pressure targets for many patients, and the emergence of artificial intelligence (AI)-augmented health technologies, primary care may represent an ideal setting for implementing innovative technologies to blood pressure management. Aim/Objectives: Using hypertension as a case study, we aimed to explore GPs’ attitudes to the opportunities and challenges of using AI-augmented clinical tools for managing hypertension. Methods: This qualitative exploratory study used purposive sampling to promote diversity across Australia and UK. Semi-structured interviews were conducted with 22 GPs, recruited through existing research and teaching networks. The interview included discussions of two scenarios of potential AI-augmented clinical decision support (CDS) for managing hypertension. A thematic analysis approach assessed their acceptability of such tools. Findings: GP attitudes towards opportunities and challenges of AI in primary care reflected their pragmatic, patient-centred approach to hypertension management generally. GPs in both countries considered the proposed AI tool broadly acceptable and trustworthy if endorsed by trusted clinical associations and free of vested interests. However, GPs also highlighted that utility of AI CDS for hypertension would be limited if it could not offer efficiencies to the GPs in the distinctive complexities of chronic condition management for specific patients. There were clear country differences in this theme reflecting a more ‘protocolised’ approach in UK. Desired efficiencies included seamless integration into clinical software, and synthesis of patient data in relation to clinical recommendations. Scepticism towards the quality and local applicability of electronic patient records in an AI-dataset was also expressed by some, especially Australian GPs. Implications: To be taken up, AI CDS technology in primary care needs to address the practical needs of GPs and facilitate the real-time, locally appropriate care of individual patients.

46. How well do hospitals prepare the GPs of the future? Insights from the CREATE Project

Elsa Daniela Ibanez Prada^A, Tamara Nguyen Le^A, Riki Lane^A, Chris Barton^A, Caroline Johnson^B, Lena Sanci^B, Grant Russell^A

^AMonash University

^BMelbourne University

Background: In Australia, all general practitioners begin their clinical careers in teaching hospitals. However, in recent years, reduced working hours, abbreviated admissions, and wide moves towards sub-specialisation have limited generalist experiences for junior doctors hoping to move to a career in General Practice (GP). Objective: To explore perceptions of junior doctors’ preparedness for GPT1 across GP and hospital settings in Eastern Melbourne. Methods: We conducted 15 semi-structured interviews with participants in GP clinics and hospital settings across Eastern Melbourne. Thematic analysis was used to identify patterns in preparedness and training gaps to guide targeted solutions. Findings: Hospital terms were highly valued for developing acute care and communication skills. However, limited exposure to primary care and the lack of GP role models impacted confidence in chronic disease management, professional identity, and GP advocacy. Additionally, while high levels of supervision in hospitals were supportive, they limit opportunities for independent decision-making, making the transition to GP settings more challenging, abrupt, and daunting. Existing support networks (involving meetings with training providers, GP liaison officers, and mentors) were either hard to access or ineffective, particularly for those retrospectively accrediting their hospital year. Despite these challenges, participants who had prior exposure to GP or received active mentorship reported feeling more confident and better equipped to transition into GPT1. Some even adopted informal strategies such as viewing hospital patients “through a GP lens” to bridge the gap themselves. Implications: Our findings highlight the need for better integration of hospital and GP training experiences. Opportunities include earlier exposure to GP contexts, improved availability and accessibility of mentorship by GPs, and incorporation of GP supervisors or educators as educational contributors in hospital settings. Addressing these gaps may ease the transition to GPT1 and enhance registrar confidence.

47. A multi-sectoral scoping review of co-design theoretical models

Jessica Jaja^A, Penelope Abbott^A, Phyllis Lau^A

^AWestern Sydney University

Background: Co-design is the involvement of end-users in program, service, or product development, and ensures they are suitable for the communities they are intended for. Co-design can be underpinned by diverse theoretical frameworks, or ‘models’. Objective: The objective of this scoping review was to map evidence relating to how and where co-design models have been used, with the guiding questions: ’What are the co-design models described in the literature?’, ‘How are they implemented?’ and ‘What are their outcomes?’. Methods: The JBI methodology for evidence synthesis: Scoping Reviews protocol guided this review. A search of CINAHL, MedLine, SCOPUS, and ERIC databases was conducted, and supplementary searching of grey and peer-reviewed literature via the CLUES method. Findings: Co-design models in the included studies derived from healthcare, education, public/community, and marketing/economic settings. Overall, 26 different co-design models were identified. Though co-design models offer a structured approach, their suitability can differ according to the context of application, and may need to be adapted to specific research settings. Implications: Co-design seeks to create programs that better align with the needs, expectations, and preferences of those who will ultimately use them. Using co-design models in primary care can ensure that program development is evidence-based, and ensures positive outcomes for patients and consumers. Relating to sustainability in primary care, co-design can be utilised in primary care settings to address complex challenges in practices, by facilitating discussions and amongst patients, staff, and care providers to create cohesive solutions. This review provides guidance for researchers seeking to use a co-design model which will best support their research.

48. Impacts of healthcare hubs on managing chronic disease in the community: a scoping review

Shivjot Sharma^A, Nethmi Kariyawasam^A, Ania Luczewic^B,C, Kali-Renata Bergin^B, Jaspreet Saini^B, Penny Abbott^A, Wendy Hu^A, Phyllis Lau^A

^ASchool of Medicine, Western Sydney University

^BHealthiCare, Rooty Hill

^CGeneral Practice Clinical School, University of Sydney

Background: South Western Sydney faces a significant chronic disease burden, where about 49% of the population live with at least one chronic disease. Preventable hospital admissions are approximately three times higher than in wealthier areas. HealthiCare, a neighbourhood-based healthcare hub in Rooty Hill, was introduced to this region to integrate primary care, allied health services, local General Practitioners (GPs) and community health services. Aim/Objectives: This scoping review aims to explore the real-world impacts of healthcare hubs on chronic disease management in the community, to inform the future development of HealthiCare. Methods: The scoping review is currently being conducted. Embase, PubMed, and CINAHL were searched for studies published in the past 20 years evaluating primary care-led healthcare hubs. Of 1672 articles identified, over 600 titles and abstracts have been screened by two reviewers using the Covidence software. Full-text screening and data extraction are underway using a structured data extraction tool designed to capture key elements, including model type, intervention characteristics, outcome domains, evaluation methods, and the alignment with HealthiCare. Title, abstract and full-text screening is currently ongoing. Findings: Initial results indicate that healthcare hubs may improve chronic disease outcomes, reduce emergency department and urgent care visits, and enhance continuity and integration of care. Benefits include better management of multimorbidity, greater patient engagement, improved provider satisfaction, stronger system accountability, and cost-effectiveness. They also appear to enhance access to care, continuity of services, and integration of home-based and team-based care models. Evaluation methodologies across studies were heterogeneous making comparison of models challenging. Implications: This scoping review lays a foundation for future evaluation of HealthiCare. The preliminary findings reveal the potential effectiveness of healthcare hubs in chronic disease management and highlight the need for standardised evaluation frameworks. Future research should build on these findings and continue with stakeholder engagement for improving real-world implementation.

49. How GPs identify and prioritise clinical problems: a systematic review

Adele Kincses^A, Shaun Prentice^A, Andrew Killcross^B, Parker Magin^C, Carolyn Semmler^D

^AGP Training Research, Royal Australian College of General Practitioners

^BAdelaide Medical School, University of Adelaide

^CSchool of Medicine and Public Health, University of Newcastle

^DSchool of Psychology, Faculty of Health and Medical Sciences, University of Adelaide

Background: Everyday, General Practitioners (GPs) draw upon varied information sources to analyse patient information and decide on the best course of action. These cognitive processes comprise ‘clinical reasoning’. In this domain, diagnostic and therapeutic reasoning are well characterised, but little is known about how GPs first recognise and prioritise problems. Aim/Objectives: This systematic review aimed to elicit how GPs identify, and then prioritise, clinically significant problems. Methods: The systematic review is registered via PROSPERO (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024555709). MEDLINE, Embase, PsycINFO, ProQuest Central, ERIC and Scopus databases were searched from inception to July 2024 for primary studies and dissertations. Studies were included if their sample predominantly comprised GP/family physicians/trainees who were working in a primary care setting, and the data focussed on problem identification or prioritisation. Findings: 29 studies were included in the review. How GPs identify problems is influenced by the interplay between patient, doctor and contextual factors. These include doctor and patient static characteristics (age, gender, race), the patient’s health context (historical and current) and psychology (e.g., patient’s understanding of their presentation, help-seeking behaviours), the doctors’ familiarity with such presentations (knowledge and experience), the doctor-patient relationship, and the practice setting (e.g., country, time pressure). There is a heavy reliance on heuristics to interpret presentations (consistent with the dual processes model of cognition), and symptoms are interpreted within patient-specific contexts. Some of these factors also influence problem prioritisation, but this construct has received less attention. Implications: GPs’ clinical reasoning is shaped by interactions between patient, doctor and contextual factors. This reinforces the importance of trainee exposure to a diverse patient case mix in a variety of settings during training. The factors identified may support GPs to reflect on their own heuristics to maximise the use of evidence-based practice and when instructing trainees. Further research is required to address how GPs prioritise problems.

50. Inter-practice variability in registrar experience of Continuity of Care

Adele Kincses^A, Amanda Tapley^A, Andrew Davey^B, Elizabeth Holliday^B, Jason Dizon^C, Parker Magin^B

^AGP Training Research, Royal Australian College of General Practitioners

^BSchool of Medicine and Public Health, University of Newcastle

^CData Sciences, Hunter Medical Research Institute (HMRI)

Background: Continuity of care, whereby patients have an ongoing relationship with ’their’ GP, is a defining feature of general practice, with strong evidence for improved patient outcomes. Globally, rates of continuity in general practice are decreasing. Variability in practices’ rates of continuity could markedly influence registrars’ learning experience. Continuity of care may be ‘upstream’ (registrar has previously seen the patient) or ‘downstream’ (a follow-up appointment arranged between the registrar and patient). Previous research found ‘upstream’ continuity of 43% and ‘downstream’ continuity of 49% in Australian GP registrars. Aim/Objectives: To assess inter-practice variability in registrar experience of continuity of care. Methods: Cross-sectional analysis (2010–2023) from the ReCEnT study of GP registrars’ in-consultation clinical experiences. Outcome factors in our analyses were ‘upstream’ and ‘downstream’ continuity. Inter-practice variability was assessed using Median Odds Ratios (MORs). Outcome variance attributable to practice was estimated within the Bayesian modelling framework using a mixed-effects logistic regression with cross-classified random effects for registrar and practice. Findings: 42.5% (289,426) of registrar consults involved ‘upstream’ continuity and 45.5% (313,295) of registrar consults involved ‘downstream’ continuity. The MOR values were 1.47 (Credible Interval (CrI)[1.44,1.50]) and 1.40 (CrI[1.38,1.43]), respectively, in a model with random effects for practice and registrar; and, adjusted for time/registrar/patient/consultation/consultation outcome/practice variables, 1.35 (CrI[1.32,1.37]) and 1.38 (CrI[1.36,1.41]), respectively. Implications: In Australia, registrar rates of ‘upstream’ continuity are steady, whilst rates of ‘downstream’ continuity are decreasing. By a registrar randomly changing practice, the median odds ‘upstream’ continuity increases by 47% (or decreases by 32%), whilst odds of ‘downstream’ continuity increases by 40% (or decreases by 29%). This has implications for registrars’ learning opportunities, particularly in chronic disease management - essential in the context of an aging population. Strategies to improve registrars’ continuity of care in practices with lower rates of continuity should be considered.

51. Applying theory models to understand relationships in co-design for developing sustainable primary care outcomes

Alicia King^A, Jennifer Bibb^A, Elise Dettman^A, Candice Peart^A, Victoria Palmer^A

^AUniversity of Melbourne

Background: Experience-based co-design brings people receiving and delivering healthcare together to co-create innovations. Applied purposefully, co-design can ensure resources are directed to their greatest effect. This workshop will improve participants’ understanding of the role of relationships in promoting positive co-design outcomes. Objectives: Participants will Learn about the explanatory theoretical model of change for codesign and coproduction in healthcare improvement and research. Develop an understanding of how this model can be used to prepare for and reflect upon experiences of relationships in co-design processes. Set a goal to further develop their own research practice using what they have learnt in the workshop. Format: The workshop will include: Interactive activities using online tools to understand people’s experiences with applying co-design. A presentation on the explanatory theoretical model of change for codesign and coproduction in healthcare improvement (see Content). An individual reflective activity in which participants reflect upon an experience of codesign (their own or a written example provided), using the model. Questions will prompt participants to consider the relational shifts and associated mechanisms of change present or absent and their implications for the co-design process. A small group discussion in which participants will break into groups and brainstorm suggestions for supporting each relational transition. An individual goal setting exercise in which participants will write a goal for their research practice on a postcard which they can take with them or have posted to them following the workshop (see post workshop survey). Post workshop survey (optional): Participants will have the option to be sent a follow up survey checking-in with their progress toward their individual goal. Amendment to Living Labs ethics approval will be sought from University of Melbourne for the post workshop survey and findings shared via the ALIVE National website, social media and in a peer reviewed publication or other research forums. Content: The workshop content will be derived from an explanatory theoretical model of change for codesign and coproduction in healthcare improvement which has been proposed in previous research implementing experience-based co-design [1]. The model describes four theoretical frames to explore relational shifts that occur in co-design processes which interact with and influence eight mechanisms of change: ‘I’—‘Them’ which relates to narrative theory and epistemic justice and the mechanism of recognition; ‘Them’—‘I’—‘You’ which relates to dialogical ethics and narrative contract and the mechanism of dialogue; ‘You’—‘Us’ which relates to cooperative theory and the mechanisms of cooperation, accountability and mobilisation; and ‘Us’—‘We’ which relates to empowerment and design theories and the mechanisms of enactment, creativity and attainment. Presenting authors and workshop participants will also share their own experiences with experience-based co-design in support of the workshop objectives. Audience: This workshop is best suited to clinician researchers and academics with an experience or interest in research co-design. Maximum 40 participants.

52. Artificial intelligence (AI) usage in Australian GP training: educators’ perspectives

Linda Klein^A, Dave Runciman^A, Lyndon Walker^A, Beth Turnbull^A

^ARoyal Australian College of General Practitioners

Background: Artificial Intelligence (AI) technology offers transformative opportunities for primary care practice and education. However, little is known about GP educators’ AI use or their opinions regarding AI use in GP training. Aim/Objectives: To assess supervisors’ and medical educators’ (ME) use of AI, their perspectives on AI use in GP training and their awareness of registrar AI use. Methods: Separate online surveys utilising Likert scale, dichotomous and open-ended questions were emailed to 3546 Australian GP supervisors and MEs in May 2024. Response rates were 12.6% (n = 406) for supervisors and 20.6% (n = 64) for MEs. Supervisor and ME responses were combined where survey questions were identical and responses between supervisors and MEs were not significantly different. Findings: A majority of educators reported never having used AI in the clinic (59%), or to support registrar training (80%), while 93% had received minimal to no training in use of AI tools in general practice. Importantly, most supervisors and MEs were unaware of the extent of registrars’ AI use. Despite lack of personal experience with AI, educators generally thought AI would improve registrar education and clinical practice (e.g., 63% reported it would improve/substantially improve administrative workload and 73% agreed/strongly agreed that use of AI should be included in GP training). However, most educators expressed concerns about ethical/legal aspects of registrars using AI to support their training (e.g. 93% were concerned about legal liability for medical errors resulting from AI use). Implications: GP supervisors and MEs indicated AI tools have the potential to benefit GP training, and that AI education should be part of the training program, while expressing caution regarding ethical/legal aspects of AI use. The results mirror those from a survey of registrars run concurrently. Training providers should consider the merits of delivering AI training to registrars and their educators.

53. Building capacity to translate research into practice

Riki Lane^A, Lena Sanci^B, Grant Russell^A, Taryn Elliott^C, Elizabeth Kennedy^D, Cath Kaylor-Hughes^B

^ADepartment of General Practice, Monash University

^BDepartment of General Practice and Primary Care, University of Melbourne

^CRoyal Australian College of General Practitioners, Adelaide

^DRoyal Australian College of General Practitioners, Melbourne

Aim and intended outcome/Educational objectives: Translating research findings into improved primary health care has been difficult. A key failure has been establishing ongoing community-based partnerships in primary care (PC) settings. Research has traditionally had minimal community input and community stakeholders feel their needs differ from researchers. Sustainability plans are rare and knowledge is translated to peers rather than community. This workshop aims to increase participants’ awareness of challenges in building research capacity and develop skills. Implementing effective health services research capacity building requires systemic strategies at varied levels: Individual; Team; Organization and Networks. Cooke et al. (2008) identify key activities – Prioritisation and consensus from stakeholders; Mentoring; Leadership; and Facilitation for those with limited research experience. The workshop will be presented by researchers and staff from TROPHI (Translating Research Outcomes into the Primary Health Interface), a key partnership of the RACGP and the General Practice Departments of Melbourne and Monash Universities. TROPHI was instrumental in achieving MRFF funding for TRANSFORM, aiming to transform the healthcare journey of people with chronic illness from fragmentation to integration. TROPHI brings clinicians, researchers, decision makers and community together to drive implementation and translational research to improve PC delivery and patient outcomes. This includes: (1) formalising relationships, mapping regional needs; consultation and priority setting; (2) capacity building supporting research translation (research fellowships, mentoring, bursaries etc); and (3) evaluating the partnership, contribution to translational research capacity, and sustainability. This workshop will give participants skills in dealing with problems faced in implementation research conducted with clinicians, policy makers and members of vulnerable communities. Format: After a brief recap of the history, design and evolution of TROPHI and presentation of a case example, participants will divide into small groups. Then, facilitated by TROPHI investigators and staff, participants will assume the roles of research team members in which they will remain for the rest of the workshop. Roles (outlined on a script) may include PC researcher; PC clinician; PHN staff; hospital staff; community leader. Each group will seek a consensus solution to a regional health care challenge emerging from a hypothetical implementation research project: details will be released at the workshop. It will require collaborative solutions between different stakeholders and relate to the needs of a vulnerable population. Content: Step 1 (5 min): Introduction to TROPHI. Step 2 (10 min): Presentation of a case example of projects translating research into practice in primary care. The identified issue will be used as a focus for workshop activities. Step 3 (30 min) Break into 4–5 breakout groups facilitated by TROPHI members, to discuss approaches to the case example. Step 4 (15 min): Breakout groups report back to whole audience and discussion of approaches. Intended audience: (include a maximum number of participants if you wish) All conference delegates in particular those interested in research translation. A maximum of 25 participants would allow for everyone to participate actively.

54. Avoiding the perils and pitfalls of stakeholder engagement and research priority setting

Sharon Leitch^A, Anna C Williams^A, Tim Stokes^A

^ADepartment of General Practice & Rural Health, University of Otago

Background: Stakeholder engagement in research priority setting leads to relevant, high-impact research that has a clear mandate, meets health needs and improves health equity. Stakeholder engagement can enhance trust and understanding between researchers and stakeholders. The Southern Primary Care Research Network (PCRN) is based in Southern Aotearoa New Zealand. It facilitates the use of routinely collected primary care clinical and administrative data for research, to improve health equity and health outcomes in the region. There are three key stakeholder groups in the Southern PCRN: patients, clinicians, and researchers. Different methods were chosen to engage with these stakeholder groups. Regional focus groups were held with Māori, Pasifika and other communities with specific health needs, such as migrant and tāngata whaikaha (disabled) people. Purposive sampling allowed the voices of these different patient groups to be heard, however it was more difficult to elicit their research needs. The Delphi survey method was used to identify the research priorities of primary care clinicians and academics. Participants were asked which research areas and research questions were the most important for improving health equity in the region. This activity generated a large range of areas and questions, but this meant it was difficult to establish consensus. Combining the priorities of all stakeholders may be possible by using a prioritisation matrix method. This will allow priority ranking by feasibility, relevance and impact on health equity. Aim and intended outcome/Educational objectives: This experiential workshop aims to provide participants with an understanding of how to engage with stakeholders, and different methods of undertaking research prioritisation. Attendees will gain practical knowledge to conduct their own stakeholder engagement and research prioritisation exercises. Format: The workshop will start with a 20-minute presentation outlining different ways to engage with stakeholders. Different methods of research prioritisation will be described, including the Delphi survey method and focus groups. The advantages, disadvantages and lessons learnt from these methods will be discussed. The interactive component of the workshop will consist of a 25-minute research prioritisation exercise. Participants will work in small groups to rate the research questions generated from the Southern PCRN Delphi survey and focus group interviews. Participants will use the prioritisation matrix method to rate the research questions against predetermined criteria. Results will be collated in real time. A structured 15-minute discussion period will allow participant groups to share their decision-making experiences. Any outstanding participant queries will be addressed. Content: The workshop will provide an in-depth insight into three different methods for prioritising research questions with stakeholders. Participants will have the opportunity to ask questions, share their experiences, and engage in a prioritisation exercise to gain firsthand experience of the prioritisation matrix method. Supplementary reading materials will be supplied to attendees. Intended audience: The session is aimed at students and researchers interested in learning practical methods to engage with stakeholders and conduct research prioritisation exercises.

55. Empowering GP registrars as near-peer educators: a co-designed intervention to foster teaching skills and sustainable workforce development

Hok Lim^A, Daniela Ramirez-Duran^A, Anneliese Willems^A, Rebecca Starkie^A, Caroline Johnson^A

^AUniversity of Melbourne

Background: As demand for sustainable primary care grows, leveraging underutilised workforce assets become important. GP registrars are well positioned to contribute to the teaching workforce. While many GP registrars informally contribute to the clinical teaching, it is often ad hoc, variable and irregular. Near-peer teaching, where registrars teach medical students, enhances student learning, strengthens general practice as a career choice, and supports professional development. Strengthening registrars’ role as an educator could improve sustainable workforce development. Aims/Objectives: This study co-designed an intervention to equip GP registrars with the skills and support to teach medical students within a clinical setting. We sought to evaluate the intervention’s impact on registrar confidence and teaching readiness. The study also examined feedback from medical students and GP supervisors on the feasibility of this approach. Given the known benefits of near-peer teaching, the ultimate aim was to create a model that is easily scalable within the current RACGP AGPT curriculum. Findings: The study was conducted in two phases. Phase 1 was a codesigned pilot intervention with 8 GP registrars. The intervention included teacher training and self-organised teaching opportunities within the clinical setting. Phase 2 involved 18 GP registrars to evaluate the revised model. Data from focus groups and surveys of GP registrars, supervisors, and learners was analysed using reflexive thematic analysis and descriptive statistics. Registrars reported increased confidence and competence in teaching roles. Supervisors recognised registrars as valuable educators and a reduction their own teaching burden. Medical students valued the relatability and enthusiasm of registrar-led teaching. However, time constraints and remuneration concerns remained barriers for GP registrars. Implications: Integrating teaching skills into GP registrar training could support a sustainable primary care workforce by cultivating dual-skilled clinicians and educators. Scaling near-peer teaching requires partnership, collaboration, institutional support, clear remuneration structures, and recognition of teaching skills as integral to GP training.

56. Uptake of patient enrolment in primary care and associated factors: a systematic review and meta-analysis

Jialing Lin^A, Shona Bates^A, Luke Allen^A, Michael Wright^A, Rafal Chomik^A, Chris Dietz^A, Michael Kidd^A,B

^AUniversity of New South Wales

^BUniversity of Oxford

Background: Patient enrolment in primary care is expected to enhance continuity and coordination of care. However, limited information exists on the uptake of patient enrolment and its associated characteristics. Aim: To estimate the uptake of patient enrolment in primary care and examine factors associated with decisions around enrolment. Methods: Eight electronic databases (PubMed, Cochrane Register of Systematic Reviews, Embase, CINAHL, PsycINFO, PAIS, Web of Science, and Scopus) were searched for peer-reviewed articles published from January 2014 to July 2024. Findings from included studies were extracted and synthesised, with uptake estimated through meta-analysis and factors associated with enrolment summarised narratively. Review registration: PROSPERO CRD42024597078. Results: Ten studies across nine publications were included. Of these, eight studies with 27,919,216 participants were included in the meta-analysis. The results showed a pooled patient enrolment uptake rate of 71.4% (95% Confidence Interval [CI]: 13.6–97.5%). There was no significant difference in enrolment rates between population-wide and program-based enrolment (72.4% vs. 73.5%; p = 0.980). Women showed higher enrolment rates than men (adjusted odds ratio [aOR] = 1.07, 95% CI: 1.07–1.08), while recently arrived immigrants in a country had lower enrolment rates than the established population (aOR = 0.40, 95% CI: 0.40–0.41). Patients living in small urban/suburban/rural areas had higher enrolment rates than those in large urban/metropolitan regions (aORs: 1.17–2.18). Higher socioeconomic level was associated with increased rates of enrolment. Patients with some specific chronic health conditions, such as those with diagnosed mental illness or substance use disorders, had lower enrolment rates. Conclusions: The findings reveal that more than two-thirds of patients were enrolled with a primary care provider or practice; enrolment was influenced by demographic, geographic, socioeconomic, and clinical factors. Addressing disparities in patient enrolment is essential to promote equitable access and enhance opportunities for continuity and coordination of primary care.

57. ‘If all is well, no one will touch it’: an interview study to understand rising antidepressant use in Australian residential aged care

Chengjun Liu^A, Piumika Sooriyaarachchi^B, Maria Donald^A, Katharine Wallis^A

^AGeneral Practice Clinical Unit, Medical School, University of Queensland

^BSchool of Public Health, Faculty of Health, Medicine and Behavioural Science, University of Queensland

Background: Antidepressant use in residential aged care is rising, with around 59% of residents taking antidepressants. Older people (aged 65 and older) are at a higher risk of antidepressant-related harms due to higher levels of comorbidity, age related physiological changes, and polypharmacy. There is little empirical evidence showing the benefit of continued antidepressant therapy in this population. Deprescribing medication in residential aged care is challenging. Antidepressant withdrawal symptoms pose an additional barrier to stopping although slow tapering to reduce dose may help. Aim: To explore stakeholders’ perspectives on antidepressant use in residential aged care and to identify the barriers and enablers to deprescribing antidepressants in this setting. Methods: Qualitative research using semi-structured interviews with stakeholders recruited via four aged care facilities in southeast Queensland, Australia. Interviews were conducted via phone or in person, audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Findings: Twenty-four interviews were conducted including with residential aged care facility managers (n = 3), nursing staff (n = 6), pharmacists (n = 4), general practitioners (n = 3), and residents and/or their family (n = 8). Three main findings were revealed. First, most participants perceived antidepressants to be beneficial in residential aged care and were either unaware of or overlooked the harms. Second, decision-making to decrease or stop antidepressants was described as complex, with challenges such as conflicting interests among multiple parties and difficulties in accessing timely healthcare advice. Third, enablers to support tapering were identified as clear step-by-step instructions, ready access to mini doses, and medication administration aids. Implications: To curtail rising antidepressant use, it is necessary to empower and enable residents and their family to make informed decisions about antidepressant use, and to provide sustainable practical tools to guide nursing staff in the tapering process.

58. CRISP-C – Making a Colorectal Cancer Risk Prediction (CRISP) Tool available to the public: what needs to be done to make it usable?

Madeline Luke^A, Jennifer McIntosh^A, Sibel Saya^A, Sandra Sursock^A, Adrian Bickerstaffe^A, Alfie Punnoose^A, Finlay Macrae^B, Jon Emery^A

^AUniversity of Melbourne

^BRoyal Melbourne Hospital

Background: Many Australians are not completing the correct bowel cancer screening for their risk. The CRISP tool is a web-based tool that calculates an individual’s risk of developing bowel cancer using lifestyle factors and cancer family history and provides an associated report with screening recommendations. To ensure maximum reach and impact, the CRISP tool could be made publicly available. This would also enhance the tool’s sustainability, as patients can independently use it, reducing the demand on general practice time. Previous research has indicated that changes to the tool are required to increase its accessibility and usability. Aim: This qualitative project aimed to explore perspectives on the usability and acceptability of the CRISP tool as a public-facing tool in individuals aged 50–74 years. Methods: Semi-structured interviews were conducted on Zoom with participants aged 50–74. Recordings were transcribed; deductive content and thematic analysis were conducted. Results: Nine participants (5 females, 4 males, mean (SD) age: 67 (±5) years) were interviewed. Deductive content analysis identified specific suggestions for improvement, including rewording diet-related questions for clarity, providing clear directions for accessing additional clarification, and restructuring risk presentation in reports. Thematic analysis showed overall positive responses to the tool and reports. However, emotional reactions to them varied widely, with some participants finding the reports scary and others thinking they might convey a false sense of reassurance or complacency. The positive influence of the reports and other factors on completing bowel cancer screening was also explored, with participants saying that receiving the report would encourage them to do the screening recommended. Implications for practice: These findings will inform changes to the CRISP tool prior to broader acceptability and feasibility testing in a larger cohort to assist in the implementation of CRISP as the first publicly available online bowel cancer risk prediction tool in Australia.

59. The effect of part time training on GP registrars: a sessional approach

Jenna Lyttle^A, Talia Follett^A,B, Parker Magin^B, Angelo D’Amore^B, Dave Runciman^B

^ADeakin University, Geelong

^BRoyal Australian College of General Practitioners

Background: Many GP registrars train part-time (PT), yet little research has explored their training experiences. Our previous work suggests considerable registrar- and practice-related differences between full time (FT) and PT registrars, but with little difference in their in-consultation training experience, except for some decrease in continuity of care. PT vs FT could, however, be thought a rather crude measure of in-training clinical workload. Aim: To examine associations between the number of clinical sessions GP registrars work per week and registrar, practice, patient, consultation, consultation outcome, and clinical case-load (ICPC-2 chapter) related factors. Methods: We utilised ReCEnT data from Term 1–3 registrars (2016–2024), collected via registrar questionnaires and case report forms for 60 consecutive consultations per training term. Poisson regression within a generalised estimating equations framework (accounting for repeated measures) was conducted, with number of sessions worked per week as the outcome. Final multivariable models were generated via augmented backwards model reduction. Effects were expressed as rate ratios (RR) with 95% CI. Findings: Data from 4587 registrars were analysed. Overall mean sessions per week was 7.97 (95% CI: 7.93–8.00). Female gender (RR = 0.92, CI: 0.91–0.93), older age (RR = 0.99, CI: 0.99–1.0), later training term (RR = 0.95, CI: 0.94–0.96), and concurrent other medical work (RR = 0.86, CI: 0.85–0.88) were associated with working fewer clinical sessions (p < 0.001 for all). Smaller practice size and rurality were modestly associated with working more sessions. No substantive associations were found between number of sessions worked and types of clinical problems managed, consultation outcomes, or patient characteristics. Implications: Part-time training was not associated with reduced exposure to clinical conditions managed, consultation outcomes, or patient factors. Registrar demographics and work context, rather than clinical factors, were primarily associated with sessional commitment. These findings suggest training flexibility (via part-time training options) may not compromise educational utility.

60. Does culturally and linguistically diverse background influence registrars’ use of telehealth consultations?

Parker Magin^A, Srividya Kota^C, Angelo D’Amore^C, Andrew Davey^A, Elizabeth Holliday^A, Jason Dizon^D, Benjamin Mundy^C, Amanda Tapley^A, Irena Patsan^A, Hemi Robinson-Kingi^C

^AUniversity of Newcastle

^BUniversity of New South Wales

^CRoyal Australian College of General Practitioners, GP Training Research Unit, Newcastle

^DHunter Medical Research Institute, Newcastle

Background: Culturally and linguistically diverse (CALD) registrars constitute a sizable proportion of the Australian GP registrar population (21% of NSW/ACT/Victorian/Tasmanian registrars) and have particular clinical and training needs. Uptake of telehealth consultations was rapid during the COVID-19 pandemic and is now well-established. Our previous work has demonstrated considerable implications of this uptake of telehealth for GP registrars who are negotiating the difficult transition from hospital practice to the very different structure and conduct of the general practice consultation. It is plausible that telehealth consultations could be singularly problematic for registrars coming from non-English linguistic backgrounds. Aim/Objectives: To estimate the prevalence of telehealth consultations in CALD and non-CALD registrars’ practice. We hypothesized CALD registrars would be less likely to conduct telehealth consultations. Methods: Nested within the ReCEnT ongoing inception cohort study of GP registrars’ in-consultation experience (2020–2023). In ReCEnT, registrars provide demographic information (including CALD status) and record details of 60 consecutive consultations. We used multivariable logistic regression, with outcome factor consultation modality (telehealth versus face-to-face). The study factor was CALD status. Multiple relevant ReCEnT-collected covariates were included in the multivariable models. Findings: Of 320,672 consultations (443 registrars), 19.7% were telehealth-conducted. 17.2% of CALD registrar consultations were telehealth. For non-CALD registrars, 20.4%. On univariable analysis, telehealth consultation modality was significantly negatively associated with registrar CALD background – odds ratio (OR) 0.83 (95%CI: 0.75, 0.92); p < .001. On multivariable analysis, however, the lesser odds were not statistically significant – OR 0.91 (95%CI: 0.81, 1.03); p = 0.14. Implications: While there are reasons to believe CALD registrars may find telehealth consultations clinically and educationally challenging, we found them not to be statistically significantly less likely to conduct consultations via telehealth. Whether this could be due to adequate CALD registrar clinical confidence/competence or to structural factors within training practices is a topic for further research.

61. Management of concussion by general practitioners – a survey study

Adam Mckay^A, Harishan Tharmarajah^A, Alicia Tran^A, Narelle Warren^A, Michael Takagi^A

^AMonash University

Background: General practitioners (GPs) are at the forefront of diagnosis and management of concussion although few studies have explored their approach to concussion care. Aim/Objectives: This collaborative study involving concussion and GP experts used a survey to explore GP practices in regards to concussion management, knowledge of relevant guidelines, and confidence in care provided. Methods: A cross-sectional online survey design was used. The survey was developed with GP input and was disseminated to Australian GPs via websites and email lists for the Australian College of General Practitioners and local GP networks primarily based in Victoria. Descriptive statistics were used to explore survey findings. Findings: The survey was completed by 33 Australian GPs with an average of 12 years of experience. The majority were based in metropolitan settings and saw 4–6 patients for concussion in the past 12 months, with sports being the most frequent injury mechanism. Over 90% of GPs reported moderate or high levels of confidence in diagnosing concussions and in providing initial advice and management, compared to 40% confidence in managing patients who are slow to recover from concussion. About 70% reported using clinical guidelines as a main source for guiding their concussion care, although half recommended rest until patients were asymptomatic which differed from current recommendations. GPs primarily used clinical interview and neurological examination to assess for a suspected concussion, with specific physical or cognitive assessments used less often. The majority of participants believed having a concussion was likely to cause longer term brain issues. All participants indicated a desire for further training and education on concussion. Implications: Delayed recovery after concussion was identified as a key challenge for GPs and there is a desire for further training. Future work will use interviews to unpack these findings and to guide educational and support needs for GPs.

62. Early commencement of physical therapy is associated with a shorter duration of work disability: findings from a retrospective cohort study of occupational low back pain

Tesfaye Mekonnen^A,B, Luke R. Sheehan^A, Michael Di Donato^A, Alex Collie^A, Grant Russell^A

^AMonash University

^BUniversity of Gondar, Ethiopia

Background: Early physical therapy for workers reporting low back pain (LBP) may reduce disability and facilitate rapid return to work. Workers’ compensation schemes provide income support and fund healthcare, including physical therapy, and therefore have an opportunity to influence the timing of physical therapy and potentially facilitate return to work. Objectives: This study aimed to investigate the relationship between the timing of physical therapy commencement and the duration of work disability following compensable LBP onset. Methods: This was a retrospective cohort study. We examined administrative datasets comprising accepted workers’ compensation claims for LBP in South Australia and Western Australia. An accelerated failure time (AFT) model was used to investigate the relationship between physical therapy timing and the duration of work disability. We used time ratio estimates (TR) to determine the associations between the timing of physical therapy commencement and the duration of work disability, with a TR>1 indicating a longer duration of disability. Findings: A total of 9160 LBP cases were examined. Workers who had not seen a physical therapist had the shortest duration of disability (median, 4.1; Interquartile range, 3.0–9.4) weeks. In those who received physical therapy, disability duration increased with delayed initiation—median duration of 8.0 weeks and 34.7 weeks for therapy commenced within 7 days and > 30 days after injury, respectively. Our adjusted model demonstrated that delaying physical therapy to >30 days post-injury was associated with disability durations 4.51 times as long as those commencing therapy within 7 days (TR 4.51; 95 % CI (4.06, 5.02)). Implications: In workers with work-related LBP undertaking physical therapy, early commencement of physical therapy was associated with a significantly shorter duration of disability. Our findings suggest that programs targeting earlier treatment initiation may assist in reducing prolonged work incapacity in injured workers receiving physical therapy for LBP.

63. A qualitative study on co-located models of care and women’s health services in community pharmacy

Kimberley Moss^A,B, Anisa Assifi^A,B, Sharon James^A,B

^ADepartment of General Practice, Monash University

^BSPHERE NHMRC Centre of Research Excellence, Monash University

Background: Community pharmacies play a pivotal role in women’s healthcare due to their accessibility and potential for collaboration with various healthcare professionals. While co-location of health services is common in settings like hospitals, its application within community pharmacy requires deeper exploration to identify care gaps, improve workforce sustainability, and strengthen interprofessional partnerships for enhanced service provision. Aim: To investigate the acceptability and feasibility of co-located health services, specifically examining women’s health service provision in community pharmacy without an onsite doctor. Methods: This qualitative descriptive study used purposive, convenience, and snowball sampling techniques to recruit community pharmacists (CPs), nurses, general practitioners (GPs), and allied health professionals with experience in co-located health services within community pharmacy settings. We conducted one-on-one semi-structured interviews and transcribed these verbatim. We then conducted inductive reflexive thematic data analysis. The theoretical frameworks of acceptability and feasibility informed the study’s development. Findings: A total of 20 participants (CPs (n = 13); nurses (n = 5); midwife (n = 1); GP (n = 1)) shared their experiences about co-locating women’s health services in community pharmacies. Many reported positive outcomes, highlighting enhanced patient accessibility and collaboration amongst healthcare professionals. Participants emphasised that co-location supported patient-centred care, with effective communication and teamwork identified as key factors. Participants reported challenges including staffing shortages, the need for specialised interprofessional training, and insufficient funding to sustain this model of care. Despite these barriers, participants were optimistic about this model’s potential to address gaps in healthcare provision and improve patient outcomes. Implications: Co-locating women’s health services in community pharmacies is a promising approach to improving patient access and outcomes. Implementing and sustaining this model will require addressing the system and professional challenges associated with practice change. With the rise of multidisciplinary teams and pharmacist-led initiatives, such as contraceptive prescribing pilots, policy support and collaboration will be key for model integration into primary healthcare.

64. Exploring examinations conducted by registrars during telehealth consultations

Ben Mundy^A, Angelo D’Amore^A,B, Amanda Tapley^A,C, Andrew Davey^A,C, Irena Patsan^A, Hemi Robinson-Kingi^A, Adele Kincses^A, Parker Magin^A,C

^ARoyal Australian College of General Practitioners, GP Training Research Unit, Newcastle

^BSchool of Rural Health, Monash University

^CSchool of Medicine and Public Health, University of Newcastle

Background: Since becoming a remunerable service in 2020 (in response to the COVID-19 pandemic) telehealth consultations have become a regular part of GP registrar practice: approximately 21% of registrar consultations are telehealth-delivered and, of these, 97% are by telephone and 3% by videoconferencing. An educational as well as clinical limitation of telehealth consultations is proposed to be inherent barriers to performing physical examination. Aims/Objectives: To estimate the frequency and type(s) of physical examinations performed during registrars’ telehealth consultations in both telephone and video modalities. Methods: A cross-sectional analysis nested within the Registrar Clinical Encounters in Training (ReCEnT) project, within which registrars record information on 60 consecutive office-based consultations in each of their three general practice training terms. Descriptive statistics were used to determine the prevalence of 16 categories of physical examinations performed during registrars’ telehealth consultations (both by telephone and by videoconference). Findings: Of 34,745 problems/diagnoses (during 28,234 telehealth consultations conducted by 1,718 registrars), 1.1% (n = 370) involved a physical examination, compared to 45.8% (n = 144,942) during face-to-face consultations. Of 16 recorded physical examination categories during telehealth consultations, respiratory examinations (0.40%, n = 138), ear/nose/throat examinations (0.30%, n = 103), and skin examinations (0.24%, n = 84) were the most prevalent. 3.8% (n = 37) of problems/diagnoses during video consultations involved physical examination, compared to 1% (n = 324) of telephone consultations. Implications: Registrars conduct physical examinations remotely via telehealth very infrequently but including in circumstances where there is no visual contact with the patient (telephone examinations). The implications for clinical practice, including diagnostic accuracy and patient safety, of diagnosis in the absence of physical examination (or when examination reliability may be compromised) requires further study. Also, further investigation into effects on the development of examination skills for registrars who use Telehealth in a substantive proportion of their consultations is merited.

65. Assessing the effect of COVID-19 related lockdowns in Australia on GP registrar telehealth use

Ben Mundy^A, Angelo D’Amore^A,B, Amanda Tapley^A,C, Andrew Davey^A,C, Irena Patsan^A, Hemi Robinson-Kingi^A, Adele Kincses^A, Parker Magin^A,C

^ARoyal Australian College of General Practitioners, GP Training Research Unit, Newcastle

^BSchool of Rural Health, Monash University

^CSchool of Medicine and Public Health, University of Newcastle

Background: In response to the COVID-19 pandemic MBS remuneration for telehealth consultations was introduced and, since, has continued in general practice. A previous ReCEnT (Registrar Clinical Encounters in Training) study explored the prevalence and associations of GP) registrar telehealth use. While establishing important information about the nature of registrar telehealth use, confounding introduced by the pandemic itself was not adjusted for in the analyses. Aim/Objectives: To determine what effect Australian COVID lockdowns had on registrar use of telehealth during the pandemic. Methods: This was a cross-sectional study nested within the ongoing ReCEnT project. Publicly available information was used to document pandemic-induced lockdowns in Australia and construct a dichotomous variable. This variable was included in analyses as a measure of practices undergoing lockdown at the time of the consultation. Multivariable logistic regression was used to assess the effect of covid lockdowns on registrar telehealth consultations. Findings: ReCEnT data from 30th March 2020–18th October 2021 were analysed. Of 141,641 consultations, 24% were conducted by telehealth. Of the telehealth consultations 18% occurred in a practice during lockdown. For face-to-face consultations, 8% occurred during a lockdown. The temporal pattern of the prevalence of telehealth consultations and lockdowns will be presented. The odds of a registrar conducting a consultation by telehealth were significantly higher if the consultation was conducted in a practice that was currently in lockdown, though, perhaps, somewhat less than may have been anticipated (aOR: 1.26, p = .003, 95%CI: (1.08, 1.46)). Implications: Analyses of general practice-related outcomes conducted using data collected during the pandemic may be biased by confounding introduced by factors related to the pandemic. While our findings are of relatively modest association, use of a ‘lockdown’ variable in analyses of practice (including telehealth) during the pandemic years could attenuate confounding due to the pandemic environment.

66. Speaking up: men’s perspectives on engaging with general practice

Ruth Mursa^A, Christopher Patterson^A, Gemma McErlean^A, Elizabeth Halcomb^A

^AUniversity of Wollongong

Background: Men are less likely to seek healthcare from general practice when compared to women. Men have shorter consultations and present when a concern is in its later stages, reducing the potential for early diagnosis and intervention. Not much is known about why men are less engaged and what impacts their engagement and interaction with general practice. Aim/Objectives: To explore men’s experiences of engagement with general practice. Methods: Seventeen semi-structured interviews were conducted using a qualitative descriptive approach with men from the New South Wales Rural Fire Service about their experiences of engaging with general practice. Findings: Five sub-themes were identified. ‘Reasons for engagement’ highlighted men’s motivation to help-seeking. ‘Seeking validation’ explained how social influences impacted healthcare engagement. The ‘importance of relationships’ identified the value that men have with the healthcare team and the impact this has on healthcare engagement. ‘Interpersonal communication’ highlighted the need for authentic communication. Finally, ‘barriers to engagement’ identified the challenges in accessing care in general practice. Implications: The findings have elucidated men’s barriers and facilitators to engaging with general practice for healthcare. Understanding men’s experiences can assist in informing strategies to enhance healthcare delivery, improve engagement and health outcomes.

67. From guidelines to practice: co-designing a practical checklist for managing multiple chronic diseases in primary care

Amna Mushtaq^A, Marie Consolatrice Sage Ishimwe^A, Dan Xu^A,B

^ACurtin School of Population Health, Faculty of Health Sciences, Curtin University

^BCurtin Medical School, Faculty of Health Sciences, Curtin University

Background: Chronic diseases present a major healthcare challenge in Australia, with 81% of adults living with at least one chronic condition and 38% (9.7 million people) experiencing multimorbidity (two or more chronic conditions). Managing patients with multiple chronic conditions is a growing challenge in primary care. Existing disease-specific guidelines are often impractical for patients with multimorbidity in time-limited real-world practice, leading to fragmented care, implementation gaps, and practitioner fatigue. Aim: To bridge the gap between clinical guidelines and everyday practice by co-designing a concise, user-friendly checklist of key management indicators for five common chronic conditions: obesity, hypertension, cardiovascular disease, type 2 diabetes, and chronic kidney disease. This innovative tool aims to integrate guidelines for single chronic diseases into a simplified, peer-led protocol for management of multimorbid chronic conditions. Methods: A comprehensive review of national primary care guidelines was conducted to develop the initial management indicators for the selected chronic conditions. These indicators are grouped into three categories: biophysical markers, lifestyle modifications, and pharmacological management. In iterative Delphi survey rounds, General Practitioners across Western Australia will assess the clarity and clinical relevance of these indicators, thereby contributing to the systematic development of the checklist. Descriptive statistics will be used to analyse survey results. Findings: Data collection for the first round of the Delphi survey, administered via red cap is currently underway. Data from round one and the development of the preliminary checklist are expected to be completed by mid-year. Implications: This co-designed checklist will offer a practical tool for everyday practice, aligned with real-world multimorbidity management, to reduce the cognitive and workload burden for GPs. It will promote consistent, integrated care for multimorbidity, thereby enabling sustainability and enhancing patient outcomes. It may also inform future training resources and support streamlined, sustainable multimorbidity guideline development.

68. Acceptability of an integrated care program to identify patients at risk of advanced chronic liver disease in Australian primary care settings

Cathy O’Callaghan^A, Margaret Williamson^A, Jane Miller^B, David Prince^C, Alenda Dwiadila Matra Putra^A, Margo Barr^A

^AInternational Centre for Future Health Systems, University of New South Wales

^BCentral and Eastern Sydney Primary Health Network

^CAW Morrow Gastroenterology and Liver Centre, RPA Hospital, Sydney

Background: The prevalence of advanced chronic liver disease (ACLD) is increasing, and is becoming a significant burden on individuals and health systems internationally. General practice is in a unique position to identify patients at higher risk of chronic liver disease, refer them for further assessment and help coordinate appropriate management. However, many general practitioners are unclear about the best diagnostic tests to use, do not have access to or training in the use of non-invasive tests and are uncertain of their role in the management of these patients. Objectives: An Integrated Liver Toolkit (LTK) program in Sydney, Australia aimed to: (1) test an early detection program for patients with advanced liver disease in general practice with support from liver specialist hospital staff; and (2) enhance the management of patients with ACLD through referral to specialist hospital-based liver clinics. Methods: To understand the acceptability of the LTK program with staff from general practice and hospital-based liver clinics, a qualitative study design was used consisting of semi-structured interviews. Findings: A thematic analysis of the interviews found that there was varied levels of acceptability of using the LTK. Attitudes ranged from seeing merit in the effectiveness and importance of the program to viewing the program as having low operational coherence and general practice self-efficacy. Implications: The results indicate that while there was moderate agreement with the benefits of the LTK in identifying and managing patients at risk of ACLD, further development is required before the LTK could be expanded throughout general practice. Improvements include greater design specificity, reduced number of indicators and enhancing the primary care skills to screen patients without relying on hospital staff. With targeted refinements, and sustainable implementation, the LTK program holds promise in being an effective tool for improving early detection and management of ACLD in primary care.

69. Exploring the early adoption of artificial intelligence by general practice trainees: a qualitative study

Irena Patsan^A,B, Linda Klein^A,B, Beth Turnbull^B, Lyndon Walker^B

^AUniversity of Newcastle, College of Health, Medicine and Wellbeing, School of Medicine and Public Health

^BRoyal Australian College of General Practitioners

Background: Artificial intelligence (AI) technologies are rapidly being adopted within healthcare, including general practice. Emerging AI technologies, including large language models (e.g. ChatGPT) and voice-to-text scribes (e.g. Lyrebird, Heidi), may provide novel opportunities and assistance for practitioners. However, there is a paucity of research regarding the early adoption of AI among registrars undergoing vocational general practice training. Aim/Objectives: We aimed to investigate the early adoption of AI by registrars in Australian GP vocational training, focusing on its use in clinical and educational practice. Methods: Semi-structured interviews were conducted with Royal Australian College of General Practitioners (RACGP) registrars by video conference between July-October 2024. Interviews were undertaken following a quantitative survey sent to RACGP registrars which explored AI use during training. Registrars who completed the survey and indicated AI use during training were invited to participate. We purposively selected 15 registrars to participate in an interview. Findings: We will focus on qualitative findings in this presentation and will present information on three key themes: (1) supporting (not replacing) practitioners, (2) reducing the time/cost to healthcare, and (3) cautiously adopting new technology. Registrars described using AI to support clinical and educational practice (e.g. brainstorming, differential diagnosis, clarifying own thoughts, consolidating information), but emphasised that clinician knowledge is crucial for determining accuracy of AI output. Participants highlighted that AI streamlined in-consultation administrative tasks (e.g. note-taking, referral letters), resulting in improved workflow, enhanced patient-centred care, and improved work-life balance. While AI shows promise for enhancing career satisfaction/sustainability, registrars were cautious about AI regarding privacy/ethical issues and the need for comprehensive training and guidance by training providers. Implications: A deeper understanding of how ‘early adopter’ registrars are using AI in their clinical and educational practice is essential for informing how AI training is best embedded within the vocational general practice training model in the future.

70. Outcomes of implementing healthcare professional training to reduce barriers to accessing dementia rehabilitation

Den-Ching A. Lee^A,B, Catherine Devanny^B,C, Taya Collyer^B, Keith Hill^A,B, Kate Swaffer^D, Natasha Layton^A,B, Grant Russell^E, Lee-Fay Low^F, Monica Cations^G, Helen Skouteris^H, Claire M C O’Connor^I,J,K, Marianne Piano^B,C, Barbara Barbosa Neves^L, Nadine Andrew^B,C, Terry Haines^B,M, Velandai K Srikanth^A,B,N, Alan Petersen^O, Michele L Callisaya^A,B,P

^ARehabilitation and Independent Living (RAIL) Research Centre, Monash University

^BNational Centre for Healthy Ageing, Frankston

^CPeninsula Clinical School, School of Translational Medicine, Monash University

^DUniversity of South Australia, Adelaide

^EDepartment of General Practice, School of Public Health and Preventive Medicine, Monash University

^FFaculty of Medicine and Health, University of Sydney

^GCollege of Education, Psychology and Social Work, Flinders University

^HHealth and Social Care Unit, School of Public Health and Preventive Medicine, Monash University

^ISchool of Psychology, University of New South Wales

^JHammondCare, Centre for Positive Ageing, Sydney

^KNeuroscience Research Australia, Sydney

^LSydney Centre for Healthy Societies, University of Sydney, Sydney, Australia,

^MSchool of Public and Allied Health Care, Monash University

^NPeninsula Health, Melbourne

^OSociology, School of Social Sciences, Monash University

^PMenzies Institute for Medical Research, Hobart

Background: People living with dementia are less likely to receive rehabilitation services from allied health professionals due to experiencing stigma, therapeutic nihilism and other barriers. A series of initiatives to reduce access barriers to dementia rehabilitation were co-designed with people living with dementia, care partners and healthcare professionals, including general practitioners and primary care nurses. Aims/Objectives: This study aimed to evaluate one initiative: dementia rehabilitation training for healthcare professionals, including a community of practice to engage and inspire change agents to advocate for dementia rehabilitation within their services. Methods: Outcomes were evaluated through a mixed methods approach considering dementia knowledge, attitudes/confidence and practice, respectively evaluated using validated scales (Dementia Knowledge Assessment Scale, Dementia Attitudes Scale) and a custom survey (understanding of allied health roles in dementia care, confidence in providing rehabilitation). Linear mixed modelling explored change in these measures from baseline, immediately post-course and at 10 months. Findings: 366 participants took part from a variety of settings e.g. hospital, community, private practice; 103 also participated in the community of practice. Post-course, dementia knowledge was unchanged from a high baseline, but participants displayed more positive attitudes about dementia (regression co-efficient = 10.4, p < 0.001), felt more confident delivering rehabilitation (regression co-efficient = 3.2. p < 0.001) and gained knowledge regarding interprofessional care (regression co-efficient = 3.3. p < 0.001). For a subset (n = 67) followed up at 10 months, gains from baseline were sustained. Implications: Widespread, accessible workforce training about dementia rehabilitation increases confidence in rehabilitation provision, and knowledge of roles/contributions by other allied health professions to support multidisciplinary team working. National scale/spread of such training would nurture and develop a sustainable, dementia-informed, multidisciplinary rehabilitation workforce. This in turn enables a role for primary care practitioners as key referrers for dementia rehabilitation.

71. Creating a sustainable dementia eyecare pathway for residential aged care

Marianne Piano^A, Lisa Keay^B,C, Lynette Joubert^D, Anita Goh^E

^ANational Centre for Healthy Ageing, Monash University

^BSchool of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales

^CThe George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales

^DDepartment of Social Work, University of Melbourne

^ENational Ageing Research Institute, Melbourne

Background: Seeing well matters to people living with dementia, supporting activity participation and maintaining independence. Everyone with dementia should be able to access person-centred eyecare, wherever they reside. However, avoidable vision loss is common in people residing in long-term care, potentially related to accessibility challenges and changes in cognition/communication affecting assessment. Some individuals may miss out on vision assessments, or timely treatment for eye problems affecting vision. Aims/Objectives: To break down barriers to accessing dementia-friendly eyecare, this research aims to create a dementia eyecare pathway for integration into dementia care models in aged care. Methods: To create the pathway and an implementation plan, this comprehensive program of work is structured around the Consolidated Framework for Implementation Research. Planned activities are an observational case study in an aged care facility, accompanying documentary analysis of care plans and organisation/state/federal-level policies or standards, shadowing aged care optometrists, and a literature review of existing domiciliary eyecare models/interventions. Results: We will present key research around dementia-friendly eyecare, and evidence-based practice from around the world, alongside pilot data from our case study. Our findings will be reviewed by an expert reference group uniting hospital, community and long-term care perspectives on eyecare, and a project advisory group comprising people living with dementia and past/present carers. The pathway will be refined in consultation with the public, aged care sector professionals/leaders, eyecare professionals and medical specialists (e.g. geriatricians, general practitioners). From these activities, final outputs will be a dementia eyecare pathway and implementation plan. Conclusion: Extensive stakeholder engagement, together with a theory-informed methodology using a recognised implementation framework, allows barriers to pathway adoption/sustainability to be identified and addressed during pathway design and implementation. Results of this project are steps towards a future where individuals with dementia receive high-quality, accessible, and person-centered eye care to see well, and live well.

72. Using continuous glucose monitoring and Shared Medical Appointments in pregnant women with type 2 or gestational diabetes: protocol for a case study in Central Australia

Valerie Quah^A

^ACongress Clinic Alice Springs

Background: Type 2 diabetes is a significant health concern for First Nation Australians, particularly among pregnant women with Type-2 or gestational diabetes. The significant impact of type 2 diabetes on pregnancy outcomes highlights the need for effective interventions in general practice that can address the challenges faced by these women. Lifestyle factors, limited engagement with clinicians as well as low rates of blood sugar monitoring are key factors contributing to suboptimal glyceemic control during pregnancy. Aim: The objective of this study is to explore if a new model of care using continuous glucose monitoring (CGM) and Shared Medical Appointments can improve the experiences and glycaemic control of pregnant women with type 2 or gestational diabetes who are enrolled in Congress antenatal services before 28 weeks of gestation. Methods: A case study will be conducted at Alukura, the Congress antenatal clinic in Alice Springs, NT. The lead researcher, a general practitioner, will be embedded within the clinic to collect data from multiple sources during a three-month period. Quantitative data collected will include HbA1c levels, utilization of the CGM monitors and attendance rates. Qualitative data to be collected will include interviews with 10 pregnant women and 5 antenatal clinic staff. Findings: The protocol of a study aiming to understand if this new model of care improves pregnant women’s experiences, HbA1c levels and attendance rates. Implications: If successful, this model can be implemented in antenatal care settings to improve the engagement and pregnancy associated risks for First Nation Australians.

73. Prolotherapy in the American Academy: results of a cross-sectional mixed methods survey

David Rabago^A, Jared Dubey^A, Nathan Jones^A, Jane Evered^A, Rachel Grob^A, Joseph Andrie^A

^APennsylvania State University, Hershey

Background: Prolotherapy (PrT) is a non-opioid injection-based therapy for chronic pain with a growing evidence base. PrT has historically been taught in mentored clinical and conference settings rather than academic training programs. Anecdotally, the use and teaching of PrT is growing; this trend is unassessed, limiting understanding of its use and rationale for further research. Aims/Objectives: We conducted a survey to identify the rate and characteristics of academic PrT use and teaching in the U.S., and the rationales for adopting or not adopting PrT. Methods: Mixed methods cross-sectional survey. A 21-item survey was developed by co-authors and mailed in three waves to program directors of the Accreditation Council for Graduate Medical Education (ACGME) resident and fellowship programs in 11 specialties (including Family Medicine and Sports Medicine) in the US treating chronic pain. Primary outcomes were rate and rationale of PrT use and teaching. Secondary outcomes were indications for PrT use and rate of ultrasound guidance. Findings: We received 854 responses from 1792 mailed surveys (47.6%). 24.7% (211) of programs reported PrT use; 13.9% (119) reported PrT teaching. Osteopathic programs were most likely to include PrT training (73.3%; 11), followed by PM&R residencies (40.0%; 18) and Sports Medicine fellowships (31.5%; 45). 8.5% (31) of Family Medicine programs reported including PrT in residency training. The top 3 anatomical regions treated were: knee (79.1%; 91), shoulder (74.8%; 86), and elbow (69.6%; 80). 81.5% (97) of PrT-teach programs use ultrasound guidance. Qualitative analysis revealed mixed perceptions of the evidence base, effectiveness, and resource limitations associated with use and non-use of PrT. Implications: For the first time, a substantial minority of academic training centers reported using and teaching PrT. Adopters reported that PrT is an effective, evidence-based treatment for chronic pain. Non-adopters cited concerns about evidence and effectiveness, resource restrictions, and limited awareness.

74. Prolotherapy for chronic ankle instability improves postural balance and reduces recurrent sprains: results of a 1-year RCT

David Rabago^A, Regina Sit^A, K Dean Reeves^A

^APennsylvania State University, Hershey

Background: Chronic ankle instability (CAI) is common in primary care; up to 43% patients report residual instability, and 21% report recurrent sprains, after conservative care. Better non-surgical care is needed. Objective: We evaluated the efficacy of dextrose prolotherapy (DPT), an emerging non-opioid pain procedure, compared with control normal saline (NS) injections. Methods: Blinded RCT; analysis by intention-to-treat and generalized estimating equations. Participants met CAI criteria (International Ankle Consortium Position Statement), ultrasound evidence of anterior talofibular ligament (ATFL) laxity, at least one ankle sprain within 12 months, and Cumberland Ankle Instability Tool (CAIT) score ≤24. They received ultrasound-guided DPT or NS injections to the anterior talofibular ligament (ATFL) attachment on the talus and fibula at 0, 4, 8, and 16 weeks. The primary outcome was the CAIT (0-30 points); secondary outcomes included the Star Excursion Balance Test (SEBT), number of ankle re-sprains, and satisfaction. Assessment was at 0,16, 26, and 52 weeks. Findings: Randomization produced two balanced 57-participant groups (57 % female; 49.9 ± 14.8 years). DPT and NS injections resulted in clinically meaningful improvements in the CAIT at 26 and 52 weeks without difference between groups. However, DPT participants had improved SEBT compared to control, with a difference-in-difference estimate of 4.46 points ([CI] –0.51 to 8.41, P = 0.027) at 26 weeks, and 4.27 points (CI 0.26 to 8.29, P = 0.037) at 52 weeks. DPT participants had fewer re-sprains compared with control (adjusted odds ratio 2.88 (CI 1.21 to 6.89, P = 0.017). Satisfaction with DPT was high; no adverse events were reported. Implications: Participants with CAI receiving DPT injections to the ATFL improved self-reported ankle stability compared to baseline status; they improved objectively-assessed performance in SEBT at 26 and 52 weeks, and experienced fewer re-sprains at 52 weeks, compared with those receiving saline injections.

75. Increasing primary care research workforce and output through primary care fellowship training

David Rabago^A, Aleksandra Zgierska^A, Holly Carver^A

^APennsylvania State University, Hershey

Background: Primary care (PC; family medicine, academic general pediatrics, general internal medicine) is well-positioned to lead rapidly evolving research priorities including team science, informatics, and dissemination and implementation science. Research training is rate-limiting. Numerous funding opportunities for pre- and post-doctoral training exist worldwide. Most PC departments are not substantively involved in such programs. Aim/Objective: To describe the framework and outcomes of a USA-based National Research Service Award (HRSA-21-013) from inception (July 1, 2021) to the end of year three (June 30, 2024). Methods: The 2-year Primary Care Research Fellowship is guided by 3 curricular tenets: (1) justice, equity diversity, and inclusion; (2) translational team science; and (3) actively mentored research. Post-doctoral trainees with terminal degree in health care or related field in an academic medical center receive culturally competent, high-quality training via coursework, seminars/workshops, and individually-mentored research. Primary outcome: (1) A stable fellowship as assessed by fellow satisfaction and meeting institutional/administative guidelines and (2) the proportion of fellows who graduate to careers with a PC research focus. Secondary outcomes are fellows’ research output as assessed by conference abstracts, peer reviewed publications, and grants. Findings: We have trained seven fellows. Administrative, guidelines are met; fellows rate seminars, coursework, and mentorship relationships highly; research areas include women and children’s health, obesity, substance use disorders, depression, traumatic brain injury/concussion, and musculoskeletal injury. Our first graduate was hired as an assistant research; six fellows have graduated into clinician-scientist training programs. Fellows have: published 50 peer-reviewed papers; presented 44 conference abstracts; and received three internal and one external grants, including one NIH Loan Repayment award. Implications: Research training is accessible to PC departments. The current fellowship is well-positioned to respond to the next funding notice from this funder, expected in November 2025.

76. Comparing the healthcare burden of dialysis versus conservative care in the final years as an aid to clinical care decision-making

Jan Radford^A, Kim Jose^A, Georgia McGrath^A, Rajesh Raj^A, Tim Saunder^A, Alex Kitsos^A, Matthew Jose^A

^AUniversity of Tasmania, Hobart

Background: for the first time, the CKD.TASlink study has identified, for Tasmanian patients with renal failure, the proportion of time spent in contact with the healthcare system in the years preceding death according to treatment pathway: dialysis or conservative care. Aims: This study investigated the role of information about the health care burden during the years before death to see: (1) if it was useful for consumers with renal failure and (2) how it was best shared with them as they decided between dialysis and supportive care treatment pathways. Methods: This two-part study first extracted information about healthcare system interactions in adults with eGFR < 15 mL/min/1.73 m2 (derived from a linked pathology dataset that included 88.4% of the state’s adult population, n = 569,481 and the CKD. TASlink study which considered the preceding 1000 days for all deaths between 1/1/2004 and 31/12/2023). Step 2 then incorporated this information during a codesign study with consumers, caregivers and health professionals to create decision support resources for the choice between dialysis and supportive care. Findings: When considering days alive, out of hospital and not on dialysis (‘free time’) people undertaking dialysis had less healthcare free time (median 57, IQR 0 –0.63)) compared to those who chose the conservative care pathway (median 0.96, IQR 0.92-1). This healthcare burden was greater in those aged >80 years, despite relatively similar survival in the two pathways. The codesign process revealed that people with renal failure and caregivers rated the information about healthcare burden highly. They also wanted information embedded in relatable scenarios and in different formats. Conclusion: Information about contact with the healthcare system in the latter stages of kidney disease is now available and useful to consumers when making decisions about care. Making this information available in different ways to support decision making is valuable.

77. Associations of registrars’ use of real-time prescription monitoring services

Anna Ralston^A, Andrew Davey^A, Parker Magin^A, Amanda Tapley^A

^ARoyal Australian College of General Practitioners, Newcastle

Background: Real-time prescription monitoring services (RTPMS) are digital point of care tools assisting clinicians to make informed decisions around prescribing monitored medications (e.g. opioids, benzodiazepines) to individual patients. Within Australia, states and territories have their own RTPMS. In some states it is mandatory for prescribers to check the RTPMS before prescribing. General practice trainees (registrars) in Australia are eligible to register and use RTPMS in their practice. Aims/Objectives: To explore registrar and practice factors associated with a registrar having used a RTPMS. Methods: Data from the Registrars Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of registrar’s in-consultation experiences from 2022–2024 were used. The outcome was if a registrar had used a RTPMS. Multivariable logistic was undertaken. Analysis was restricted to states without mandatory registration. Findings: 1,261 registrars contributed 2173 registrar rounds of data (response rate 91.1%). Registrars in 1712 (78.8% [CI: 77.0, 80.5]) registrar rounds reported having ever used a RTPMS. Registrar factors associated with using RTPMS included later training term (adjusted odds ratio (aOR) 3.88 [CI: 2.87, 5.24] for term 2, aOR 6.30 [CI: 4.61, 8.62] for term 3 compared to term 1) and Australian medical graduates (aOR 1.57 [CI: 1.06, 2.31]). Negatively associated registrar factors included working part-time (aOR 0.64 [CI: 0.49, 0.82]) and female registrars (aOR 0.61 [CI: 0.46, 0.80]). Practice factors associated with using RTPMS included the practice holding journal clubs and/or clinical meetings (aOR 1.32 [CI: 1.02, 1.72]). Implications: Australian medical graduates being more likely to have accessed RTPMS may suggest targeted education of overseas medical graduates is indicated. Registrar exposure to journal clubs/clinical meetings being associated with RTPMS use suggests this may be a marker of higher quality learning environments. Negative associations with female and part-time registrars warrants further investigation, noting though, no adjustment for patient/problem case-mix in our analyses.

78. From hospital to home: a qualitative analysis of community health navigators in chronic and complex care transitions

Jacqueline Ramirez^A, Sharon Parker^A, Carole Bandiera^B, Parisa Aslani^B, Anthony Brown^C, Fiona Doolan-Noble^D, Sara Javanparast^E, Fiona Haigh^A, Regina Osten^F, Sarah Wright^A, Ben Harris-Roxas^G, Debra Donnelly^H, Mark Harris^A

^AInternational Centre for Future Health Systems, University of New South Wales

^BSydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney

^CHealth Consumers New South Wales

^DGoldfields University Department of Rural Health, Curtin University

^ECollege of Nursing and Health Sciences, Flinders University

^FNew South Wales Agency for Clinical Innovation

^GSchool of Population Health, University of New South Wales

^HAged Health, Rehabilitation and Chronic Care, Sydney Local Health District

Background: Community Health Navigators (CHNs) promote healthcare access and care coordination. Three CHNs were employed and located in an Aged Care and Rehabilitation outreach team in Sydney. The CHN role aimed to improve the transition from acute care to home for patients with chronic conditions, through linkage to general practitioners, other professional follow-up, and social and community supports. Aims/Objectives: To explore the perceptions of patients, Health Care Professionals (HCPs), and CHNs about the support provided by CHNs, and to determine what factors supported or impeded the role in this setting. Methods: A total of 20 semi-structured qualitative telephone interviews (12 patients, 5 HCPs, 3 CHNs) were analysed inductively using an interpretive thematic analysis. Findings: There was universal support for the CHN role and positive patient satisfaction. Emotional, informational, and practical support was timely and appreciated by patients overwhelmed by the transition period. CHNs enjoyed the diverse challenges and utilised their interpersonal skills to establish rapport and trust. The team viewed them as a valuable support to patients and a means to provide initial needs assessment, thereby promoting efficiency and quality of patient management. However, increased clarity was needed for HCPs and patients as to what a CHN role entailed. The interface between the clinical focus of the team and the non-clinical nature of the role was challenging, resulting in some resistance and tension around professional boundaries. Strong leadership and supervision were essential to support knowledge, problem solving, and acceptance within the team. Implications: CHN roles offer a ’safety net’ for transitioning patients. Integrating this role within a complex clinical care setting requires time, organisational commitment, and policy and guidelines to clarify role scope and address the interface with professional healthcare roles. Role awareness and promotion is required, as is dedicated supervision to support team cohesion.

79. To incise or not incise: evaluation of the current management of boils by Australian general practice registrars

Mahesh Ravutha Gounden^A, Parker Magin^B, Leanne Hall^A, Clare Heal^A

^AJames Cook University, Cairns

^BUniversity of Newcastle

Background: Boils are a common presentation in general practice (GP), with principal management involving incision and drainage (I&D) of the infection. The use of antibiotics is a point of contention in the literature. Objective: To establish prevalence and associations of management modalities for boils by GP registrars. Methods: Cross-sectional analysis of Registrar Clinical Encounters in Training (ReCEnT) study data between 2010–2023. Univariable and multivariable multinomial logistic regression analyses were performed. Findings: Of 1018 first presentations of boils to Australian GP registrars, 158 (15.52%, 95% confidence interval [CI]: 13.35%–17.89%) were managed with I&D, 674 (66.21%, 95% CI: 63.21%–69.11%) with antibiotics only and 186 (18.27%, 95% CI 15.94%–20.78%) had no treatment. Those who were prescribed adjunctive antibiotics post I&D were included in the I&D group for analyses. Consultations where only antibiotics were prescribed were (compared to I&D) more likely to be shorter in duration (Odds ratio (per minute) [OR] 0.90, 95% CI: 0.86–0.95, p < 0.001) and have a higher number of problems addressed (OR 2.03, 95% CI: 1.27–3.26, p = 0.003). Consultations where no treatment was employed were also (compared to I&D) more likely to be shorter in duration (OR 0.90, 95% CI: 0.85–0.94, p < 0.001) and have a higher number of problems addressed (OR 3.16, 95% CI: 1.88–5.32, p < 0.001). Implications: Despite Australian guidelines recommending I&D for all boils, this is infrequently performed by GP registrars at the initial consultation. Instead, the majority of registrars manage with antibiotics only. This is a concerning finding as overprescribing of antibiotics is a significant global health issue. Further research is required to see if this finding is due to a lack of knowledge regarding appropriate treatment or lack of confidence in performing I&D.

80. Exploring barriers and facilitators for general practitioners engaging with the Victorian Virtual Specialist Consults service

Morgan Rayner^A,B, Cassandra Bramston^B, Joanna Lawrence^B

^AUniversity of Melbourne

^BNorthern Health, Epping

Background: Telehealth has demonstrated great potential in expanding access to healthcare services, improving health outcomes and connection care providers across the state. However, utilizing telehealth to facilitate synchronous collaborative consults between multiple care providers and patients is not occurring. In answer to this, the Victorian Virtual Specialist Consults (VVSC) was developed in 2023 to facilitate early and accessible case conferencing between general practitioners and hospital clinicians across the state of Victoria. Aim/Objective: To identify barriers and facilitators for general practitioners in utilising the VVSC service. Methods: Commencing in the TROPHI region in Victoria, 45-minute semi-structured focus groups were conducted with general practitioners to explore clinical presentations most amenable to virtual consultations, barriers to collaborative virtual models of care, facilitators for collaborative virtual models of care and preferred methods of communication. Meetings were transcribed and underwent reflexive thematic analysis. Findings: 32 general practitioners participated, with focus groups of 3 or 4 used. Seven main themes emerged from transcript codes: (1) any non-acute clinical presentation could be appropriate; (2) physical examinations can be done collaboratively; (3) timing is the greatest barrier; (4) remuneration methods must be clear; (5) not all patients need collaborative consults; (6) asynchronous communication methods should be explored; and (7) regional and remote areas will particularly benefit. Implications: VVSC has focused clinic availability in the early morning and after lunch times, seeing an increased rate of attendance from all clinicians. We have expanded to offer clinics initially thought inaccessible via virtual formats, such as ophthalmology. We have worked with Medicare for clear guidance that case conferences can be used, and are working with colleagues in Western Australia and Queensland to advocate for co-consult item numbers. We are developing an eConsult communication platform, allowing direct messaging before and after VVSC clinics between clinicians. This will facilitate asynchronous consult models.

81. Use of point-of-care resources for management of paediatric asthma in early-career general practitioners: frequency, types and temporal trends

Nina Reid^A, Parker Magin^A,B, Katie Fisher^A, Anna Ralston^A,B, Amanda Tapley^A,B, Liz Holliday^A, Jason Dizon^A, Ben Mitchell^C

^AUniversity of Newcastle

^BRoyal Australian College of General Practitioners, Newcastle

^CUniversity of Queensland

Background: Asthma is the most common chronic disease of childhood, with much of its management occurring in primary care. Point of care resources (POCR) are guidelines used in-consultation for managing medical conditions. Previous research has demonstrated low asthma guideline adherence amongst general practitioners, despite guideline-driven management being shown to improve asthma outcomes. Aims/Objectives: To investigate the frequency and temporal trends in Australian early-career general practitioners (registrars) accessing POCR when managing paediatric asthma. Methods: A longitudinal analysis (2010–2019) within the Registrar Clinical Encounters in Training (ReCEnT) project of registrars’ in-consultation practice. The outcome factor in univariable and multivariable mixed effects logistic regression analyses was whether POCR was accessed for paediatric asthma problems with year the independent variable of interest. Further analyses compared trends (2010–2019) in asthma problem POCR use with non-asthma problem POCR use. Findings: POCR use was greater for asthma (15.2%) than for non-asthma problems (12.6%), and the temporal increase in POCR use for paediatric asthma (15% increase per year), was greater than that for non-asthma problems (11% increase per year), though not statistically significantly so. Implications: Multiple potential reasons for the greater (and increasing) use of POCR seen in paediatric asthma are proposed. The trend may reflect an increasing focus on evidence-based asthma care, and that high-quality asthma management resources are available within Australia. Alternatively, paediatric asthma could represent an area of clinical challenge and possible educational need for early-career GPs. Further studies may explore underlying reasons for the increasing POCR use in paediatric asthma.

82. Temporal trends in the prevalence of GP registrars’ long-term paediatric asthma control medications prescription

Nina Reid^A, Parker Magin^A,B, Katie Fisher^A, Anna Ralston^A,B, Amanda Tapley^A,B, Liz Holliday^A, Jason Dizon^A

^AUniversity of Newcastle

^BRoyal Australian College of General Practitioners, Newcastle

Background: Asthma is one of the most common chronic illnesses affecting children, and in the top ten most commonly seen paediatric presentations by Australian GP registrars (trainees). Long-term asthma control medications (’preventers’) are an important aspect of asthma management, with under-prescription associated with poor asthma control and increased asthma deaths. The increasing evidence for the importance of preventers is reflected in asthma management guidelines. Aims/Objectives: To estimate temporal trends in preventer prescribing s for paediatric patients for presentations of asthma problems to Australian general practice registrars. Methods: Longitudinal analyses (2010–2022) of data from the ReCEnT study of registrars’ in-consultation clinical experience were undertaken. Proportions of paediatric asthma presentations prescribed preventers were calculated, and longitudinal trends analysed and graphed. Preventers included in the analyses were inhaled corticosteroids; inhaled corticosteroid & long-acting beta agonist combinations; leukotriene receptor antagonists; mast cell stabilisers; and biologics. Findings: There was no change over time in prescribing of preventers, though longitudinal changes in the types of preventers prescribed was seen: there was a shift away from combined corticosteroid/other preventer inhalers to single corticosteroid inhalers. Implications: The stability over time in preventer prescribing comes despite guidelines and messaging to GPs on increasing use of these medications to effectively manage paediatric asthma. In Australia, the apprenticeship-style of GP training may mean that registrar prescribing trends could also reflect prescribing of supervisors and other senior GPs within their practice. Findings therefore have implications for clinical practice and for GP education/training interventions.

83. Not just a GP: a qualitative study on the motivators behind choosing a career in general practice

Zoe Reizes^A, Zelda Doyle^A, Charlotte Hespe^A

^AUniversity of Notre Dame Australia, Darlinghurst

Background: The two critical issues facing Australian primary healthcare are rising demands for services and a General Practice (GP) workforce which is struggling to keep pace, particularly in rural areas. Demand for GP services is rising due to population growth and shifting healthcare needs. The growth of the GP workforce and interest from medical students remain insufficient. While barriers to choosing GP – such as poor renumeration, limited institutional exposure and work conditions - are well known, less is known about factors that facilitate a career in GP. Aim: To explore factors that motivated a career in GP from GPs who graduated from the University of Notre Dame, Sydney (UNDS) and to examine factors influencing rural practice. Methods: A mixed-methods online survey of open and closed questions regarding influences on GP practice was securely emailed to 93 alumni (2011–2014) who have completed a GP fellowship. Quantitative demographic data was descriptively analysed whilst qualitative free-text responses were thematically analysed. Findings: 17 participants completed the survey of which 59% were female, with an average age of 43. Most worked full time (53%), 35% had worked rurally as a GP, whilst 72% of GPs expressed interest in rural practice. Over half initially intended to pursue a different speciality, completed academic and subspecialty training, and held further roles. Thematic analysis highlights key motivators for both metropolitan and rural GP included lifestyle factors, flexible practice conditions, professional interests, training pathways and, influence from others. Implications: A career in GP offers personal and professional benefits with opportunities for diverse roles within and beyond medicine. The critical issues may be solved in rural areas if rural practice interest translates to practice. Understanding factors which support a career in GP can inform strategies to attract future GPs and address workforce shortages, particularly in rural areas.

84. Frequency and outcomes of alcohol, tobacco and other substance use consults in general practice registrar training

Matthew Roughan^A, Parker Magin^B,C,D, Amanda Tapley^B,C, Geoff Spurling^A

^AGeneral Practice Clinical Unit, University of Queensland

^BGP Training Research, Royal Australian College of General Practitioners

^CSchool of Medicine and Public Health, University of Newcastle

^DSchool of Population Health, University of New South Wales

Background: Alcohol, tobacco and other substance use was responsible for 15% of the burden of disease in Australia in 2018. Primary care screening and brief interventions are of demonstrated benefit in this space. However, previous research suggests substance use presentations were managed less commonly by GPs than would be suggested by community prevalence, especially for substances other than alcohol and tobacco. GP registrars may have even less exposure to and confidence with substance use presentations, but literature in this area is scarce. Aim: We aim to estimate the frequency with which GP registrars are consulting patients with alcohol, tobacco, and other substance use, and explore patient, registrar, consultation, clinic, and educational factors associated with these consultations. Methods: Cross-sectional analyses used data from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing multisite inception cohort study of GP registrars. We included all participants from 2016–2024 who provided consent for their data to be used for research purposes, providing a generalisable sample of Australian GP registrars. We estimated prevalence of alcohol, tobacco, and other substance use problems in registrar practice, with 95% confidence intervals (CI). Multivariable binomial logistic regression will model patient, registrar, consultation, clinic, and educational associations with seeing these problems. Findings: Preliminary findings indicate 8833 (0.89% [95% CI: 0.87–0.91]) consultations by GP registrars involved substance use with 50.5% [95% CI: 49.4–51.5] of these involving tobacco, 26.3% [95% CI: 23.4–27.2] involving alcohol, and 23.3% [95% CI: 22.4–24.2] other/unspecified substances. Analyses of associations with these consultations will be presented. Implications: This study uses a nationally generalisable sample to define the current landscape for Australian GP registrars in alcohol and other substance use consultations. Findings will provide insight into experiences of GP registrars in this area and highlight areas where further education is required, with implications for GP registrar training in substance use.

85. The business of recruiting: bringing marketing science to Practice-Based Research Networks

Emiko Hunt^A, Chris Barton^A, Grant Russell^A

^AMonash University

Aim and intended outcome/Educational objectives: Primary care academics and Practice-Based Research and Education Networks (PBRNs) have an ongoing need to engage with community based clinicians. The science of marketing has not been widely used in primary care research, and we feel has much to offer. This workshop will build on marketing and business development strategies implemented by Monash University’s Practice-Based Research and Education Network (MonREN). The workshop will help participants: Understand key principles of marketing and audience behaviour relevant to primary care research. Learn how to craft compelling recruitment messages and suitable communication channels. Identify strategies to build trust and credibility with the primary care community. Apply these strategies to enhance recruitment and engagement in primary care research. Format: The workshop will be built around interactive modules: Mini-talk: know your audience (10 mins), We will begin with an introduction to early planning and audience understanding. Key marketing principles such as segmentation, profiling, and channel selection will be shared with examples. Small group discussion: Different Audiences, Different Approaches (10 mins). Then, in small groups, participants will be presented with details of a hypothetical primary care research study. Groups will explore how marketing principles can build appropriate messages, content, and channels to maximise engagement for project implementation of this hypothetical project. Mini-talk: marketing and design psychology basics (10 mins). We will then present key principles of marketing and design psychology, including how language, layout, and visuals have been shown to influence attention, trust, and engagement. We will give examples of using the principles in creating more impactful recruitment materials. Breakout activity: critiquing recruitment materials (15 mins). Groups will critique the appropriateness of sample materials (flyers, emails, social posts) for the hypothetical study. Interpretation will be aided using a checklist based on marketing principles. Groups will share feedback and reflect on effective vs ineffective examples. Group discussion: considering networks (10 mins) – Participants will come together reflect how these materials and strategies could be built into activities of Practice Based Research Networks. We will highlight some of MonREN’s experiences of the benefits (and occasional pitfalls) associated with bringing these principles to the real world of primary care research. Conclusion and reflections: Summary of key takeaways and sharing of practical resources. Opportunity for questions and discussion. Content: Drawing on real-world examples from Monash University’s Practice-Based Research and Education Network, and the science of marketing, the session will explore: How marketing techniques like audience segmentation, message targeting, and design can improve recruitment and engagement. Practical tools and templates that researchers can adapt to their projects (e.g. messaging frameworks, outreach email scripts, flyer templates). The importance of early consideration of recruitment and marketing channels, appropriate budgeting, and innovative ways of involving other organisations in successful implementation. Intended audience: Primary care researchers, educators, and clinicians across all career stages. Professionals involved in participant recruitment for health care studies. No prior marketing or communications knowledge required. Maximum number of participants: 20–30.

86. Feasibility of a new molecular Group A Streptococcal pharyngitis testing in general practices in Victoria

Sajal Kumar Saha^A, Victor Nikolovski^A, Eugene Athan^A

^ADeakin University, Geelong

Background: Up to 70% of pharyngitis consultations in general practices are treated with antibiotics whereas around 20% of cases are caused by Group A Streptococci (GAS) and may need antibiotic treatment. Diagnostic uncertainty of GPs may lead to overuse of antibiotics in pharyngitis patients. A new molecular point-of-care testing (PoCT) can diagnose GAS in 3 minutes to guide GPs’ antibiotic prescribing in pharyngitis infection(s). Aims: We aimed to test if new GAS PoCT testing is feasible to implement in routine general practices and whether it impacts GPs antibiotic prescribing. Methods: This was a partial mixed-method feasibility study. We recruited five general practices in Victoria including an urgent care GP clinic. The GAS PoCT testing service was available for four months between Oct 2024 to Jan 2025. Primary outcome was the proportion of patients who tested positive and prescribed antibiotics. Secondary outcomes were service uptake, prevalence of positive cases, operational feasibility, and acceptability. Findings: In total, 120 patients with acute pharyngitis were tested. Only 22% of tested patients were GAS positive and <20% received antibiotic treatment. GPs rated GAS PoCT service as highly feasible [median 6 (IQR 4–6)]. Almost all GPs (>82%) reported that GAS PoCT service was relevant, easily deliverable, effective, safe, and would improve patient care. Respondent GPs strongly believed that testing service was helpful to diagnose GAS pharyngitis [median 4(IQR 4–5)], make antibiotic use decision [median 4(IQR 3–5)] and they would use this testing in future [median 4(IQR 3–4)]. Urgent care GPs used testing at much higher rate than usual care GPs. Implications: The GAS PoCT service was found feasible to implement in general practices to support GPs’ diagnosis and management of patients with acute pharyngitis infections. Our pilot RCT currently assesses the effectiveness of testing in reducing antibiotic use in pharyngitis infections in Victoria.

87. Point-of-care Group A Streptococcus pharyngitis testing for antibiotic stewardship in general practice: a pilot pragmatic randomised controlled trial

Sajal Kumar Saha^A, Victor Nikolovski^A, Eugene Athan^A

^ADeakin University, Geelong

Background: Up to 70% of pharyngitis consultations in general practices are treated with antibiotics whereas around 20% of cases are caused by Group A Streptococci (GAS) that may need antibiotic treatment. Diagnostic uncertainty of GPs may lead to overuse of antibiotics in pharyngitis patients. A new molecular point-of-care testing (PoCT) can diagnose GAS in 3 minutes and can help guide GPs’ antibiotic prescribing in pharyngitis infection(s). Aims: We aimed to: (1) test if the new GAS PoCT testing is effective in reducing antibiotic prescribing in acute pharyngitis infection and (2) how and why the GAS testing program worked or did not work for the study sites by measuring implementation feasibility and acceptability. Method: Design: A pilot pragmatic randomised controlled trial using a hybrid effectiveness-implementation trial design. Settings and recruitment: Twelve GP practices in rural and regional Victoria will be recruited: six intervention practices and six control practices with 1:1 randomisation. Target Patient Population: Patients both adult and children with acute pharyngitis (sore throat) symptoms and aged >3 years. Intervention: GAS testing over four months intervention period in winter (June–Sept 2025). Primary outcomes: (1) changes in pharyngitis-related antibiotic prescriptions and (2) Implementation feasibility, and acceptability. Secondary outcomes: (1) Changes in the use of broad-spectrum antibiotics; (2) changes in the duration of prescribed antibiotic therapy in pharyngitis Post implementation interviews (N = 18) with intervention GPs, practice manager, and nurses will be conducted to assess implementation challenges and facilitators. The Normalization Process Theory (NPT) will be used to develop the interview guides and analyse the results. Results: Findings will be available in early 2026. Implications: Findings will influence how future care should be provided to the patients with acute pharyngitis infections. Results will inform a larger scale randomised clinical trial and cost-effectiveness to determine normalisation of GAS testing in routine care.

88. Towards pharmacists-led contraceptive implant services: a ccoping review of stakeholder’ perspectives

Myat Phou Pwint San^A,B, Anna Barwick^C,D, Kajol Babu^A,B, Susan Saldanha^A,B, Danielle Mazza^A,B, Anisa Assifi^A,B

^ADepartment of General Practice, Monash University

^BNHMRC SPHERE Centre of Research Excellence

^CSchool of Rural Medicine, University of New England

^DSchool of Pharmacy, University of Queensland

Background: Equitable access to contraception can help mitigate unintended pregnancy, yet the shortage of licensed contraceptive providers remains a key barrier. This issue has prompted a global effort to expand pharmacists’ roles, particularly in prescribing oral contraceptives. Despite the effectiveness and low-maintenance nature of long-acting reversible contraception, pharmacist-led provision for contraceptive implants remains an emerging concept. Aim/Objectives: To explore stakeholders’ perspectives – including community pharmacists, consumers (current and former contraception users) and current contraceptive providers (general practitioners, trained nurses, and midwives) – on pharmacist-led provision, including prescription, insertion, and removal of contraceptive implants in community pharmacies. Methods: We systematically searched six databases, reference lists of included articles, and grey literature, using keyword combinations of ‘contraceptive implants’ and ‘community pharmacy’ for studies of any design published in English, providing stakeholders’ perspectives. MS screened all studies, while KB independently screened 20% of titles/abstracts and full-text using Covidence. Findings: Seven studies were included, capturing perspectives from pharmacists (n = 3), consumers (n = 2), and current contraceptive providers (n = 2). Pharmacists and consumers support the concept of pharmacist-led implant contraceptive services, as direct access in pharmacies may result in quicker appointments and enhanced accessibility. Pharmacists express interest in inserting contraceptive implants but highlight concerns around training, reimbursement, and liability. In contrast, current contraceptive providers tend to be less supportive of the pharmacist-led contraceptive implant provision due to safety concerns. Most studies prioritise exploring pharmacists’ roles in oral contraceptive provision, but none focus specifically on contraceptive implants. Implications: Future research should address the lack of evidence on stakeholders’ perspectives regarding pharmacist-led provision of contraceptive implants. Pharmacist involvement in implant prescription, insertion, and removal remains an emerging concept with the potential to support government investment, improve equitable access to highly effective contraception, and optimise healthcare workforce sustainability by expanding service delivery capacity.

89. Preconception care in general practice: optimizing clinical guidance by incorporating patient and practitioner views

Danielle Schoenaker^A, Elizabeth Lovegrove^A, Miriam Santer^A, Karen Matvienko-Sikar^B, Helen Carr^C, Nisreen Alwan^A, Keith Godfrey^A

^AUniversity of Southampton

^BUniversity College Cork

^CNHS Surrey Heartlands, Woking

Background: Preconception care guidelines recommend primary care practitioners consider a range of topics to support patients who are thinking about having a baby. These topics are based on scientific evidence and expert opinion, but the content does not consider patient and practitioner views. Aim: As part of a consensus study to define priority topics for preconception care in general practice, we aimed to identify topics currently missing from clinical guidance based on patient and primary care practitioner perspectives; and explore differences in their views on which topics should be prioritised for preconception care. Methods: The study involved: (1) identifying initial topics through literature and guideline reviews, and potential additional topics through patient workshops and practitioner interviews; (2) prioritising topics through a three-round Delphi survey; and (3) reaching consensus in an online workshop. UK-based patients and practitioners were recruited via a Public Advisory Group, charities and professional organisations. Data from patients and practitioners were analysed separately. Findings: Literature and guideline reviews identified 32 topics for preconception care. Patients (n = 15) additionally highlighted ‘neurodiversity’ and ‘gender identity and transition’, while practitioners (n = 14) identified ‘pregnancy anxiety’, ‘living circumstances’ and ‘ethnicity’ as relevant. In the first Delphi round, ‘infertility issues/treatment’ and ‘mental health’ were scored important by the majority (>70%) of patients (n = 48), but not practitioners (n = 37). Most practitioners, but not patients, scored ‘weight status’ and ‘folic acid supplement use’ as important. While consensus was reached in the final workshop on four priority topics (n = 21 patients/practitioners), diverse views on for example the importance of infertility and ethnicity remained. Implications: Our study highlights the need to consider both patient and practitioner perspectives when developing evidence-based content of clinical guidance for preconception care. While individualised patient care will be needed, incorporating agreed priority topics into clinical guidance may maximise opportunities to promote healthy pregnancies in primary care.

90. Priority topics for preconception care in general practice in the UK: a consensus study

Danielle Schoenaker^A, Elizabeth Lovegrove^A, Miriam Santer^A, Karen Matvienko-Sikar^B, Helen Carr^C, Nisreen Alwan^A, Keith Godfrey^A

^AUniversity of Southampton

^BUniversity College Cork

^CNHS Surrey Heartlands, Woking

Background: Primary care practitioners are well-positioned to support patients of reproductive age in preparing for pregnancy. Preconception care is ideally integrated when opportunities arise during routine consultations. However, practical and realistic guidance is needed to overcome implementation barriers, such as limited consultation time. Aim: To achieve consensus among primary care practitioners and patients on topics that might be prioritised as part of opportunistic preconception care in general practice. Methods: A three-step consensus process was undertaken: (1) identifying initial candidate topics through literature and guideline reviews, workshops with patients, and interviews with primary care practitioners; (2) prioritising topics using a three-round Delphi survey; and (3) reaching agreement on final priority topics through an online workshop. Participants were UK-based patients and primary care practitioners recruited via a Public Advisory Group, charities, and professional organisations. Findings: The reviews and workshops/interviews with patients (n = 15) and practitioners (n = 14) identified 37 preconception care topics which were included in the Delphi survey. Eighty-five participants completed the first Delphi round, with 63 completing all three rounds. Based on the Delphi rounds, 11 topics were included and no topic met predefined criteria for exclusion. All topics were discussed at the final workshop (n = 21 participants) and six additional topics achieved consensus to be included. Workshop participants agreed that the 17 priority topics should be combined into four topic areas: (1) knowledge of preconception health and pregnancy, (2) ideas, concerns and expectations (e.g. pregnancy intention, timing, prior pregnancy experiences), (3) health conditions (e.g. medication use, mental and physical health, immunisation), and (4) health behaviours (e.g. folic acid supplement use, smoking, alcohol consumption). Implications: The agreed priority topic areas offer a structured foundation for opportunistic patient-centred preconception care in primary care. The findings support the need for further co-development of practical tools and support to enable implementation in routine practice.

91. Badmouthing of general practice: a scoping review of experiences of and impact on medical students

Georgia Sgroi^A, Rebecca Kippen^A, Samia Toukhsati^A,B,C

^AMonash University

^BGeneral Practice Supervision Australia

^CUniversity of Melbourne

Background: Globally, imbalances between GP demand and supply are leading to increasing shortages of GPs. Medical students form an important part of the GP training pipeline, but express declining interest in choosing GP as a specialty. One factor that may negatively impact the perception of GP is ‘badmouthing’, which involves unwarranted, sarcastic and denigratory comments about GP. Aims/objectives: A review of empirical studies to investigate the content, sources and impact of badmouthing of GP experienced by medical students. Methods: Using PRISMA scoping-review protocols, a systematic search was conducted across four online databases to identify relevant studies published 2005–2025. Two authors independently screened titles, abstracts and full texts with the third author resolving any disagreements. All three authors developed a data charting table using Microsoft Excel, and one author extracted the data. Findings: 32 studies were included. Through inductive qualitative analysis, four key themes emerged relating to the content of GP badmouthing: (1) the perceived lower intellect of GPs; (2) GP is the ‘backup’ option; (3) GP is considered less prestigious and the doctors less capable; and (4) criticism of GPs’ skills and knowledge. The most common sources of GP badmouthing identified in the studies were hospital specialists and other medical students. The badmouthing exposure experienced by medical students negatively influenced their attitudes towards GP, alongside their intentions to pursue a career in GP. Implications: Badmouthing of GP is a persisting issue worldwide, and it negatively impacts medical students’ perceptions of GP careers. With only two small Australian studies in this review, further research is required to investigate the badmouthing of GP in the Australian context. Strategies to eliminate GP badmouthing may strengthen the pipeline of medical students choosing GP as their future specialty. These strategies can include anti-denigration policy implementation within hospitals and universities, campaigns alongside student reporting systems.

92. Exploring Aboriginal and Torres Strait Islander young people’s perspectives on health and health assessments in primary care: a qualitative study

Geoffrey Spurling^A, Claudette Tyson^B, Kalisha Soe^B, Noel Hayman^B

^AUniversity of Queensland

^BQueensland Health – Inala COE

Background: Most Aboriginal and Torres Strait Islander youth protect their wellbeing by harnessing cultural, community and personal strengths despite immense challenges of ongoing intergenerational trauma, racism and socioeconomic disadvantage. The Aboriginal and Torres Strait Islander health assessment can be an effective way of identifying previously undetected social and emotional wellbeing and other health concerns. Aim: This study aimed to explore young Aboriginal and Torres Strait Islander people’s perspectives on appropriate content of a youth Aboriginal and Torres Strait Islander health assessments. Methods: We conducted thematic analysis of semi-structured and focus group interviews with Aboriginal and Torres Strait Islander young people to understand what kept young people healthy and what should be included in a comprehensive primary care health assessment. Findings: We interviewed 13 participants in three focus groups and three individual semi-structured interviews. Themes included strength in cultural connection, family relationships, autonomy and control over one’s life including gaining education, driver’s licence, work, and a healthy routine. Young people were concerned about mental health, all-consuming social media use and drug use as a coping mechanism especially if you didn’t have the words to talk about difficult feelings. Health checks could be a risk to the young person’s relationship with the health service risking experiences of shame, boredom, and confusion. Young people gave clear messages about the need for Aboriginal and/ or Torres Strait Islander health workers conducting health checks, care regarding who else was in the room for the health check, and care assessing mental health. Implications: This research reinforces supporting Aboriginal and Torres Strait Islander young people’s cultural connections, family relationships and healthy routines. The challenge for policy-makers, clinicians and researchers will be ensuring health checks do not continue to be a negative experience of shame, misunderstanding and confusion for Aboriginal and Torres Strait Islander young people.

93. A scoping review of opioid agonist therapy in Australian general practice

Geoffrey Spurling^A, Warren Jennings^B, Idin Panahi^A, Deborah Askew^A, Charlotte Wirtz^A, David Ting^A, Tim Piatkowski^C

^AUniversity of Queensland

^BQueensland Health – Inala COE

^CGriffith University, Gold Coast

Background: In Australia, opioid use disorder (OUD) is a major public health concern with 3 opioid-related overdose deaths every day. Opioid dependence treatment (ODT) is an effective, evidence-based approach for treating OUD, halving mortality, reducing morbidity, and is highly cost-effective. ODT involves medication (methadone and buprenorphine) and psychosocial support. In Australia, most ODT occurs in general practice, but significant barriers to ODT exist, prompting calls for reform. Aim/Objective: We aimed to find and describe research which informs provision of ODT in primary care in Australia including characteristics and evaluation of different models of primary care based ODT. Methods: Following the PRISMA guidelines for scoping reviews, a systematic search was conducted of PubMed, Embase, Scopus and CINAHL, as well as grey literature databases. Seventeen relevant articles were identified that reported primary research on general practice based ODT prescribing. Findings: We found 19 studies over 32 years investigating ODT in Australian general practice. Seven studies evaluated general practice ODT, six examined prescriber attitudes and behaviour, two described single-models of care, one international study investigated primary care ODT policy, and two studies examined client experiences. The studies showed primary care ODT is safe and effective. An ODT prescriber deficit exists, with lack of remuneration and stigma common barriers. Specialist support is a common facilitator. The few multidisciplinary models of care described all received external funding, with GPs well placed but underfunded to coordinate multidisciplinary care. Implications: The limited research on ODT prescribing in Australian primary care is predominantly focussed on prescriber attitudes and behaviour, with gaps identified in nation-wide service delivery, models of care, funding, and views of people who use drugs. The research lens needs to be broadened to encompass patient views, models of primary care including funding, holistic supportive and coordination. and structural supports to recruit and retain active prescribers.

94. Exploring Aboriginal and Torres Strait Islander young people’s perspectives on health and health assessments in primary care: a qualitative study

Geoffrey Spurling^A, Sissy Tyson^B, Kalisha Soe^B, Noel Hayman^B

^AUniversity of Queensland

^BSouthern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health

Background: Most Aboriginal and Torres Strait Islander youth protect their wellbeing by harnessing cultural, community and personal strengths despite immense challenges of ongoing intergenerational trauma, racism and socioeconomic disadvantage. The Aboriginal and Torres Strait Islander health assessment can be an effective way of identifying previously undetected social and emotional wellbeing and other health concerns. Aim: This study aimed to explore young Aboriginal and Torres Strait Islander people’s perspectives on appropriate content of a youth Aboriginal and Torres Strait Islander health assessments. Methods: We conducted thematic analysis of semi-structured and focus group interviews with Aboriginal and Torres Strait Islander young people to understand what kept young people healthy and what should be included in a comprehensive primary care health assessment. Findings: We interviewed 13 participants in three focus groups and three individual semi-structured interviews. Themes included strength in cultural connection, family relationships, autonomy and control over one’s life including gaining education, driver’s licence, work, and a healthy routine. Young people were concerned about mental health, all-consuming social media use and drug use as a coping mechanism especially if you didn’t have the words to talk about difficult feelings. Health checks could be a risk to the young person’s relationship with the health service risking experiences of shame, boredom, and confusion. Young people gave clear messages about the need for Aboriginal and/ or Torres Strait Islander health workers conducting health checks, care regarding who else was in the room for the health check, and care assessing mental health. Implications: This research reinforces supporting Aboriginal and Torres Strait Islander young people’s cultural connections, family relationships and healthy routines. The challenge for policy-makers, clinicians and researchers will be ensuring health checks do not continue to be a negative experience of shame, misunderstanding and confusion for Aboriginal and Torres Strait Islander young people.

95. I love my job, but it’s time to go: wellbeing triggers for early retirement by female GPs

Louise Stone^A

^AUniversity of Adelaide

Background: Australia is facing a critical shortage of GPs, with an estimated shortfall of 11,000 GPs by 2032. Less than 15% of junior doctors are now choosing General Practice as a specialty. 30% of GPs are intending to retire within the next 5 years. Female GPs practice differently to their male colleagues and seem to be reducing their clinical work at higher rates. If we are to retain their expertise and capacity in the workforce, we need to better understand why. Aims: To explore the reasons why Australian female GPs: Become GPs, Remain in General Practice, Choose to leave, May come back. Methods: Narrative methodology using a survey method. We recruited female GPs who retire or educe their clinical work by at least 50% within 5 years through social media, medical media, GP organisations and snowballing. The survey focussed on four questions: Why did you become a GP? What sustained you as a GP? What were the reasons you left/are leaving? What would encourage you to return? Findings: Within a month, we had 1200 GPs accessing the survey with 800+ eligible to complete. They supplied >80 000 words of free text, highlighting a deep commitment to the purpose and meaning of their role, but a sense of sorrow and grief around needing to abandon it to repair their mental health from the harms of their profession. Participants described financial, social and occupational triggers for leaving, including occupational violence, administrative harms, moral distress, community and political “malignant disregard” and financial exploitation. Many experienced deep mental health harms undertaking the “Sisyphean” task of contemporary general practice. Implications: There may be unintended consequences of recent primary care workforce policy change which is strongly gendered and has a disproportionate impact on women GPs.

96. Implementation of the Virtual Integrated Practice (VIP) Partnership Program: supporting access to primary care in rural Queensland

Ruby Strauss^A, Dr Jenny Job^A, Claire Jackson^A,B

^ACentre for Health System Reform and Integration, Mater Research – University of Queensland

^BGeneral Practice Clinical Unit, University of Queensland

Background: The Virtual Integrated Practice (VIP) Partnership Program, co-created to address critical general practitioner (GP) shortages in rural/remote Queensland, supports urban-based GPs to provide ongoing care to patients in rural/remote general practices via telehealth 1–2 days/week, augmented with biannual practice visits. Aim/Objectives: This study aimed to evaluate the implementation and sustainability of the VIP model in rural/remote general practices across Queensland. Methods: VIP GP service, billing, cost and patient survey data collected were retrospectively reviewed. Qualitative interviews were conducted with practice staff/providers to identify barriers and enablers to implementation with thematic analysis guided by Consolidated Framework for Implementation Research and implementation strategies were informed by Expert Recommendations for Implementing Change. Findings: Since 2021, 15 GPs have been recruited for 15 rural/remote practices and have provided 12,875 services. Patients were majority female (59.5%), average age 54.4 years (SD 22.1) and 4.8% identified as Aboriginal or Torres Strait Islander. Over half of the appointments were repeat patient encounters, 70.5% were delivered via video health and 65% of patients attended the appointment at the practice. Billings averaged $1685/day and recurrent costs included VIP GP wages ($1400–$1600/day) and an average of $1083 per VIP GP onsite visit to the practice. Patient survey feedback (n = 482) found 99% were highly satisfied/satisfied, 96% would use the service again, 93% said that VIP GP improved their access to primary care and 85 patients (18%) reported that the consult prevented a visit to the emergency department. In addition to digital infrastructure and support from onsite staff to triage bookings and facilitate virtual appointments, partnership codesign and funding were identified as key implementation determinants and strategies to supported sustainability of the model. Implications: This evaluation is informing strategies to promote ongoing implementation of a virtual GP model to provide continuity of care and workforce sustainability for rural Queensland communities.

97. Community views on using public health and social measures to reduce transmission and severity of Influenza, Covid-19 and other respiratory infections

Maria Stubbe^A, Amanda Sexton^A, Susan Bibby^A, Samantha Marsh^B, Jo Hilder^A, Nayyereh Aminisani^C, Cass Byrnes^B, Lorraine Castelino^B, Sue Huang^c, Ruth Seeds^c, Nikki Turner^B, Anthony Dowell^A

^AUniversity of Otago, Wellington

^BUniversity of Auckland

^CInstitute of Environmental Science and Research, Wellington

Background: During the Covid-19 border closures, respiratory viruses like Respiratory Syncytial Virus and influenza) did not circulate in New Zealand (NZ) for up to two years. Return of these viruses provided a unique opportunity to study how the pandemic had influenced community perceptions regarding use of non-pharmaceutical interventions (NPIs) to reduce respiratory disease spread. Aims/Objectives: To explore community-level knowledge, attitudes and behaviours regarding use of NPIs to mitigate virus transmission and disease burden of respiratory illnesses in NZ during and since the Covid-19 pandemic. Methods: A mixed methods exploratory study conducted in the Wellington region in 2023, in two stages: (1) in-depth interviews with 22 diverse households from the SHIVERS-IV WellKiwis cohort study of influenza transmission (2021–2028), and (2) a survey of 227 patients who had recently received a multi-viral POCT in seven primary care clinics. Results from a thematic analysis of interviews were synthesised with survey responses to assess community views regarding acceptability of NPIs, views on diagnostic testing, and any resulting changes in behaviour and attitudes. Findings: Experiences during the pandemic led to improved understanding of the nature of respiratory viruses, and that NPIs are not only important for Covid-19. Attitudes towards use of NPIs reflected strong motivation amongst all groups to protect the vulnerable and a desire for self-management and exercising choice. Reported NPI use varied according to symptom severity, diagnosis, perceived vulnerability to severe illness, and household, social, and economic factors. There was strong support for using multi-viral POCTs in primary care and community settings. Implications: People can make nuanced decisions about how to reduce spread of respiratory viruses in their own households and communities when supported by the right information, tools and resources. Early point-of care diagnosis may pave the way for improved tailoring of disease response in terms of both pharmaceutical and non-pharmaceutical interventions.

98. Manuscript to masterpiece: navigating the maze of publishing as an author

Elizabeth Sturgiss^A, Virginia Lewis^B, Annette Peart^C, Jessica Botfield^C, Deepika Ratnaike^B, Natasha Yates^D

^ABond University

^BLatrobe University

^CMonash University

^DNewMed

Aim and intended outcome/Educational objectives: An important aspect of knowledge dissemination is publishing about research and innovation in research journals. Many researchers find the publishing process like a maze and are disheartened after their experience of the peer review process. The role of the peer reviewer is crucial in academic publishing. Timely publication of high-quality research and innovation depends on responsive, effective peer review. Acting as a reviewer is a highly effective way to develop academic writing skills, including how to evaluate manuscripts for quality, and communicate appropriately to authors. Potential peer reviewers may not understand the nature of the task or be aware of the potential benefits and miss an opportunity to actively engage with academic publishing. This interactive workshop presented by the editorial team at the Australian Journal of Primary Health (AJPH) is for researchers and health professionals who have a desire to publish in academic journals and/or be actively involved in the peer review and publishing process. The purpose of the workshop is to enable participants to get the most out of the peer review process – whether this is an author or a reviewer. The workshop will accelerate the acquisition of skills, knowledge and confidence that are usually gained over time through experience. The learning outcomes of this workshop include: Greater understanding of the academic publishing journey and the roles of editors, publishers, authors and reviewers, Improved skills in responding to reviewers’ feedback, Increased skill and confidence to be an effective reviewer including how research reporting guidelines can support the review, Increased motivation to share skills with the broader primary care research community, Increased connectedness with the broader research community. Format: The workshop will be engaging and focused on knowledge and skill building. The format of the presentation will be: 40% didactic presentation, 30% task-driven work including individual and small group work (approximately 5 people), 30% group discussion with support/facilitation from AJPH editors. Content: The workshop will consist of four main parts – an overview of the publishing process, followed by activities focused on the peer review process from the perspective of authors and reviewers – as outlined here: Members of the AJPH editorial team will provide an overview of the academic publishing process and the history of the AJPH, Participants will work in small groups to share their experiences of publishing and reviewing, Participants will take part in a group activity targeting knowledge, skills and confidence to prepare a (high quality) review of a manuscript, Finally, a Q&A session with the editors of AJPH will enable the audience to ask specific questions. Intended audience (include a maximum number of participants if you wish: This conference workshop aims to build skills in early- to mid-career researchers by introducing them to the publishing journey. The material will be relevant to participants who have only commenced their publishing journey and those who are well on their way. The workshop has capacity for 50–75 participants.

99. Inter-practice variability in opioid prescribing: a cross-sectional study of early-career general practitioners

Jordan Tait^A, Amanda Tapley^A,B, Elizabeth Holliday^B, Jason Dizon^C, Parker Magin^A,B,D

^ARoyal Australian College of General Practitioners

^BUniversity of Newcastle, Callaghan

^CHunter Medical Research Institute

^DUniversity of New South Wales

Background: Overprescribing has significantly contributed to increasing opioid-related harm. GPs, including GP registrars, play a significant role in opioid prescribing, however, considerable evidence-practice gaps exist. Internationally, there is emerging evidence for unwarranted variability in opioid prescribing rates across primary care practices. Aim/Objectives: To assess inter-practice variability in Australian GP registrars’ opioid prescribing. Methods: Cross-sectional analysis (2010–2023) from the ReCEnT study, which documents Australian GP registrars’ in-consultation clinical experiences/behaviours. Outcomes were: (1) any registrar opioid prescriptions (including prescription renewals), and (2) new opioid prescriptions initiated by registrar, for patients 16 years and older with non-cancer, non-palliative care problems/diagnoses. Within a Bayesian modelling framework, a mixed-effects logistic regression with cross-classified random effects for registrar and practice was used to estimate outcome variance attributable to practice. Inter-practice variability was estimated using Median Odds Ratios (MORs). Findings: 4,641 registrars from 976 practices participated. Of 874,676 problems/diagnoses, 2.54% (n = 22,218) involved an opioid prescribed by the registrar, and of 860,815 problems/diagnoses, 0.97% (n = 8,357) involved a new opioid prescription initiated by the registrar. For any opioid prescription, the MOR was 1.55 (95%Credible Interval [CrI]:1.50–1.60) in the baseline model with random effects for practice and registrar, and 1.39 (95%CrI:1.35–1.44) in the final model adjusted for time/registrar/patient/consultation/practice variables. For opioid initiation, the MOR was 1.39 (95%CrI:1.33–1.45) in the baseline model, and 1.32 (95%CrI:1.26–1.39) in the final model. Implications: After controlling for registrar, patient, consultation, and practice variables, there remains significant inter-practice variation in registrars’ opioid prescribing rates. Our findings indicate that randomly changing practice increases the median odds of any opioid prescription by 39% (or, alternately, decreases by 28%), while the median odds of initiating a new opioid prescription increases by 32% (or decreases by 24%). These findings may indicate inappropriate opioid prescribing in some practices and suggest that registrars’ prescribing habits are influenced by their practice’s environment/culture.

100. Evaluating a social inclusion program for Karen and Karenni refugees in Victoria, Australia: a qualitative approach

Emma Tam^A, Lester Mascarenhas^B, Alison Mynard^C, Meredith Temple-Smith^A

^ADepartment of General Practice and Primary Care, University of Melbourne

^BUtopia Refugee and Asylum Seeker Health, Hoppers Crossing

^CNext Door Psychology, Werribee

Background: Karen and Karenni refugees from Myanmar face significant barriers to access and engagement in health services due to their high levels of vulnerability and disability. Despite growing resettlement numbers, research on refugee health interventions remain limited with methodological constraints. Understanding the impact of social inclusion programs on health engagement will inform the development of more comprehensive, tailored care for this vulnerable population. Aim/Objectives: The aim of this study was to evaluate the impact of a social inclusion program on the health-seeking behaviours of Karen and Karenni refugees in Melbourne’s Western suburbs, by identifying the key enablers and barriers to improving health engagement. Methods: Semi-structured interviews were conducted with 14 refugees and 5 healthcare practitioners. Interviews explored refugees’ understanding of their health conditions, and their engagement with the Victorian healthcare system, as well as healthcare practitioners’ impressions of the above. Findings: Health practitioners and refugees had similar perspectives. Outcomes demonstrated a greater willingness to engage in care for physical health compared to mental health complaints following program involvement, and a clear preference for community-based over hospital care. Enablers included social connection and psychological safety, which fostered confidence and identity that enhanced individual capacity for health-seeking. Program effectiveness was hampered by refugee-specific and systemic barriers including ingrained cultural differences, low health literacy compounded by social issues, and inaccessible and overwhelming hospital systems. Implications: This research highlights the importance of a community-led, culturally-sensitive intervention in fostering identity and independence in refugee populations, and its effectiveness in empowering refugees to engage in healthcare. Findings have the potential to support increased funding for ongoing program delivery, and inform development of more refugee-specific health services nationwide. Results highlight the need for healthcare practitioners to include social prescribing and refugee-centered care in their practice, to improve health outcomes and well-being for refugee populations in Australia.

101. Delayed prescribing management strategies for non-pneumonia acute respiratory tract infections: proportions and associations

Amanda Tapley^A, Alex Turner^A, Parker Magin^A, Andrew Davey^A, Jason Dizon^B, Elizabeth Holliday^C

^ARoyal Australian College of General Practitioners

^BHunter Medical Research Institute

^CUniversity of Newcastle

Background: Antibiotics are overused for non-pneumonia acute respiratory tract infections (ARTIs), where antibiotics are mostly not indicated. Delayed prescribing management strategies can significantly reduce antibiotic consumption for ARTIs. Aim/Objectives: Investigate the proportion and associations of management of ARTIs with delayed and immediate antibiotic prescribing strategies. Methods: A cross-sectional analysis of data (2016–2023) from the ReCEnT inception cohort study of GP registrars’ in-consultation experience in each of their three GP training terms. Multinomial regression was used with outcome ‘antibiotic prescribing strategy’: being ‘no prescribing’, ‘immediate prescribing’, or ‘delayed prescribing’(referent). The population for the primary analysis included initial presentations of acute bronchitis. Sore throat, otitis media, sinusitis, and URTI were examined in secondary analyses. Findings: 3675 registrars (response rate 93.3%) contributed 829,648 problems/diagnoses. For bronchitis, antibiotic prescribing strategy was 36% ‘no prescribing’, 12% ‘delayed prescribing’ and 52% ‘immediate prescribing’. Prescribing antibiotics (delayed or immediate) was significantly more likely (5–6 times, depending upon age group) if the patient was older than 0–4 years. ‘Immediate prescribing’ was significantly more likely if imaging was ordered (OR 1.99), and follow-up arranged (OR 2.24) (markers of clinical concern). Proportions and associations for our secondary analyses will be presented at the conference. Implications: European quality indicators suggest less than 30% of bronchitis should receive antibiotics. GP registrars’ prescribing exceeds this. Our findings suggest that, where there is clinical concern for bronchitis, ‘immediate prescribing’ is preferred. Antibiotics (delayed or immediate) are more likely to be prescribed in all age groups older than 0 to 4 years. Bronchitis still presents a challenge for adherence to Australian guidelines that advise antibiotics are not indicated. Prevalence of delayed prescribing for bronchitis is modest. Efforts to increase the proportion of ‘delayed prescribing’ may be a way to balance clinical concern with reduced consumption of antibiotics.

102. Sustaining social connections for socially isolated and lonely older people – partnering for a nurse-led intervention in general practice

Cristina Thompson^A,D, Kath Peters^B, Amy Montgomery^C, Elizabeth Halcomb^A,D

^ASchool of Nursing, Faculty of Science, Medicine and Health, University of Wollongong

^BSchool of Nursing and Midwifery, Western Sydney University

^CIMPAACT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney

^DHealth Innovations, Faculty of Science, Medicine and Health, University of Wollongong

Background: General Practice Nurses (GPNs) work in 90% of Australian general practices yet remain underutilised. A GPN-led social prescribing model could support older people at risk of social isolation and loneliness, and enhance GPNs’ job satisfaction by using nurses’ full scope of practice. Aim/Objectives: This paper explores factors affecting the sustainability of a general practice nurse-led intervention to improve the social connectedness of older people. Methods: This exploratory pilot study was the qualitative phase of a concurrent mixed methods evaluation. Seven general practices in the Hawkesbury region of NSW partnered with a Primary Health Network and community organisations in an intervention for older people at risk of social isolation and loneliness. Eight GPNs who had been trained and delivered the intervention participated in data collection. Implementation was explored via semi-structured interviews at implementation-end (n = 8) and 12-months later (n = 5). Two focus groups (n = 6) with GPNs discussed intervention delivery and sustainability. All sessions were audio-recorded and transcribed verbatim. Reflexive thematic analysis guided inductive data analysis. Findings: Five key themes reflected the GPNs’ perspectives about intervention sustainability including: beliefs about the benefits of the intervention, alignment with the nursing role, training and capacity, practice culture, and community partnerships and infrastructure. Implementation of the intervention was significantly influenced by context, as a series of natural disasters and the COVID-19 pandemic shifted community attitudes. Conclusion: Sustaining a nurse-led social prescribing intervention to improve social connectedness of older people requires success at three levels: an intervention that works for the older person, the general practice team and the community. Implications: General practice-based nurse-led interventions build workforce capacity, increasing job satisfaction; however, careful integration with the general practice eco-system is crucial to sustainability.

103. Experiences of miscarriage in the LGBTIQA+ community – what can we do to improve online information and support?

Emily Thrower^A, Meredith Temple-Smith^A, Max Twycross^A, Jade Bilardi^A,B, Clare Bellhouse^A

^AUniversity of Melbourne

^BMonash University

Background: Miscarriage is estimated to occur in up to 26% of all pregnancies, however a ‘cultural silence’ has been described in the literature regarding a social norm not to discuss pregnancy until after the first trimester. People from the LGBTIQA+ community also experience this cultural silence, but additionally face other factors such as minority stress and discrimination, which further complicates the experience of pregnancy loss and ability to access relevant supports. Aim: Explore the views and experiences of LGBTIQA+ people who have been affected by miscarriage to inform tailored information and resources. Methods: Semi-structured interviews are being conducted with people from the LGBTIQA+ community who have experienced miscarriage personally, through their partner or through a surrogacy arrangement. Interviews explore their miscarriage experiences, social and healthcare support experiences and networks, and views on the Miscarriage Australia website. Data collection is underway with six interviews to date and further interviews scheduled. Findings: Preliminary thematic analysis has demonstrated there is a need for LGBTIQA+ specific lived-experience anecdotes in early pregnancy loss resources for this community. Experiences of stigma and discrimination have been reported as common for participants thus far. Interestingly, being with a partner of the same sex has been reported as a protective factor for some participants. Implications: The findings from this study will help shape online information and resources for LGBTIQA+ community on the Miscarriage Australia website.

104. Finding your tribe: supporting women in GP supervision

Samia Toukhsati^A,B,C, Kisanet Tesfu^A,C, Leila Greenfield^A, Jade Bilardi^A,B,C, Belinda O’Sullivan^A,B,D, Elisabeth Wearne^E, Simon Morgan^A,F, Rebecca Kippen^B, Jillian Benson^G, Carla Taylor^A,B, Leonie Chamberlain^A, Kay Flynn^H, Bill Geyer^I

^AGeneral Practice Supervision Australia

^BMonash University

^CUniversity of Melbourne

^DUniversity of Queensland

^EGippsland and East Gippsland Aboriginal Co-operative

^FRoyal Australian College of General Practitioners

^GUniversity of Adelaide

^HChristies Beach Medical Centre

^ITanunda Medical Centre

Background: In Australia, women GPs outnumber men, yet they remain under-represented in GP supervision. Although the barriers to women’s participation in supervision are well understood, solution-focused research is needed to support women GPs in rewarding portfolio careers. Aim: To co-design programs to enhance the recruitment, retention, and support of women in GP supervision. Methods: This was a mixed method, participatory action research design. In phase one, women GPs (N = 54) participated in an interview or focus group to identify and define the key features of programs needed to support the recruitment and retention of women in supervision. In phase two, women GPs (N = 23) were invited back to provide feedback on two draft programs via interviews or focus groups. Qualitive data were coded in NVivo 14; a combination of deductive thematic analysis and Delphi-style review was used to explore, extract, and inform the development and refinement of programs. Findings: Themes and sub-themes emerging from qualitative data informed the development and revision of two new programs, designed to support women GPs entry to and retention in supervision. An ‘orientation to supervision’ program was developed to provide clarity about the supervision role, comprising a suite of multi-modal resources, including information sheets, video vignettes, and a webinar. A ‘CIRCLE’ program, inspired by First Nations participants and their communities’ rich tradition of yarning circles, was developed to provide an opportunity for women GPs to share experiences, refine supervision skills, build confidence, and expand professional networks. Implications: This mixed methods project yielded the co-design of two novel programs, co-created by women GPs, to enhance the recruitment, retention, and support of women in GP supervision. Quasi-experimental research is underway to evaluate the impact, experience, and perception of the programs as ways of attracting and supporting women GPs in supervision.

105. Adapting a measure of shared decision making of healthcare decisions with Aboriginal and Torres Strait Islander people: an e-Delphi study

Marguerite Tracy^A, David Follent^C, Tara Dimopoulos-Bick^C, Melissa Cawley^C, Emma Webster^D, Regina Osten^C, Michelle Dickson^E, Lyndal Trevena^B, Heather Shepherd^B

^AGeneral Practice Clinical School, University of Sydney

^BSydney Health Literacy Lab, University of Sydney

^CNSW Agency for Clinical Innovation

^DSchool of Rural Health, University of Sydney

^EPoche Centre for Indigenous Health, University of Sydney

Background: Shared decision making (SDM) is a process which involves an exchange of information between healthcare professionals and patients about options (including watch and wait) and the patient’s preferences. It is recognised as an important part of person centred health care and is part of national standards for delivery of care in Australia. SDM improves health outcomes and resources specifically designed to support this in Aboriginal and Torres Strait Islander communities are increasing. However, to date no culturally appropriate measure has been created to evaluate SDM and the impact of these resources. SDM-Q-9 is an internationally recognised and validated measure for SDM. Aim: To develop a culturally appropriate measure of shared decision making for Aboriginal and Torres Strait Islander people. Methods: An expert panel of Aboriginal and Torres Strait Islander Health professionals and community members and experts in SDM attended a hybrid briefing session incorporating Yarning methods follow by two rounds of online Delphi surveys with the aim of consensus agreement on a culturally safe adapted version of SDM-Q-9. Findings: Eighteen participants attended the briefing and 14 participated in the e-Delphi rounds. Consensus was reached for a measure with 11 items, their wording and the cultural concepts supporting each. A five-item version was also agreed on for next stage testing. Implications: Using Yarning and e-Delphi methodology a culturally adapted measure of SDM was created. Validation and real-world testing of the measure are planned for the 11- and 5-item version created.

106. Evaluating generative AI responses in patient-use scenarios

Michael Tran^A, Joel Rhee^A, Jitendra Jonnagaddala^A, Alexander McColl^A, Anika Devi^A, Isobel Funnell^A, Chloe Montague^A

^AUniversity of New South Wales

Background: Patients are increasingly turning to generative AI (GenAI) technology to obtain information about their health conditions, benefiting from its ability to provide personalised and easily understandable explanations. Aim: This study examines the effectiveness and accuracy of GenAI responses when utilised by patients to research their symptoms and medical conditions. Methods: Three medical students provided prompts as mock-patients for fictional clinical vignettes developed based on the 20 most common presentation types in general practice, as determined by previous Bettering the Evaluation and Care of Health research. The AI-generated responses from ChatGPT (OpenAI, GPT-4o) were evaluated and scored by a small expert panel of general practitioners against the Quality, Understanding, Expression, Safety & Harm, and Trust & Confidence (QUEST) framework. Findings: AI-generated responses were of variable quality and changed with date of query, and, while factual, were American-centric with poor expression of uncertainty. Responses could be overwhelming due to large differentials and extensive advice. Regarding expression, AI-generated answers utilised an empathetic first-person voice, and ensured understanding of prompts by reiterating input. Answers were individualised, with safety netting, and red flags identified for follow up. Mental health-related responses lacked safety planning. The specificity of answers was proportional to the level of detail in prompts. The overall average QUEST score was 17.35 out of 25, with an average of 13.57 out of 25 for less-detailed prompts. Implications: The study highlights the variability in the quality and safety of AI-generated medical information and introduces a framework for evaluation. Clinicians will need to become familiar with GenAI outputs and be able to inform patients about the limitations and risks associated with GenAI use and the value of prompt engineering. By being informed about the strengths and weaknesses of AI-generated medical information, clinicians can better support their patients in navigating and interpreting this information safely.

107. The supervisory cognitive load in clinical consultations with simultaneous medical student teaching

Michael Tran^A, Kerry Uebel^A, Oliver Smith^A, Joel Rhee^A, Rick Varma^B, Rosalind Foster^B, Arvin Damodaran^A, Melanie Fentoullis^A, Shing Wong^A, Megan Kalucy^A, Chinthaka Balasooriya^A

^AUniversity of New South Wales

^BThe Kirby Institute

Background: Clinical supervision requires the ability to incorporate high-quality training with safe/effective patient care. A paucity of literature exists that considers ’supervisor’-specific factors that impact responsibilities for ensuring both patient care and student learning. Aim: This study evaluates potential outcomes where competing cognitive load demands exist – balancing student supervision with the delivery of patient care in primary/community care settings. Methods: Interviews from fifteen supervisors in diverse primary/community care settings (general practice, sexual health, diabetes/endocrine, paediatric clinics) were transcribed and reflexively analysed exploring the impact of integration of medical students into patient consultations. Findings: Three major themes emerged: (1) there can be negative impacts of student supervision on the patient, consultation, and supervisor due to increased cognitive load from managing competing agendas; (2) the positives of supervision are apparent when risks are well-managed, ensuring patient care and motivating supervisors; and (3) proactive and intentional planning and mitigation of anticipated conflicts and issues ensures optimum patient care and includes scheduling extra time, spreading supervisory loads, being intentional about consent and re-consenting patients as needed, and deliberately limiting student opportunity for interruptions during critical consultation moments. Implications: There is a need to balance patient care and teaching responsibilities. Effective strategies, including clear communication and setting expectations, can help manage cognitive load and enhance the learning experience for students while ensuring patient care. Supervisors also need to be aware of context-specific concerns including financial considerations and the management of vulnerable populations at greater risk of feeling coerced into having medical students present. Supervisor longevity is made possible by acknowledging the cognitive load of supervision, managing the logistics of the consultation, and tipping the balance towards the positives of the supervisor-patient-student interaction. The insights from this study will inform the development of resources and training for new supervisors.

108. Transitions in telehealth use by Australian general practice registrars – implications for educational practice

Michael Tran^A, Parker Magin^A,B,C, Angelo D’Amore^B, Ben Mundy^B, Andrew Davey^B,C, Irena Patsan^B, Hemi Robinson-Kingi^B, Liz Holliday^C, Jason Dizon^D, Amanda Tapley^B

^AUniversity of New South Wales

^BRoyal Australian College of General Practitioners

^CUniversity of Newcastle

^DHunter Medical Research Institute

Background: Telehealth has become an integral part of Australian healthcare delivery, transforming the educational experience of GP registrars. Registrars are adopting this consultation type early in training, during the transition period where there is an adaptation to the responsibilities of general practice. Careful consideration is needed when identifying both the optimal timing to introduce, and increase, telehealth consultations by registrars. Transitions theory suggests that there is decreased educational utility, and adaptation to general practice, with early introduction of consultation stressors which may include telehealth. Managing the tension between opportunities for progressive clinical independence and adverse processes that impede learning and development is critical to support GP registrars. Aim: We aimed to investigate within-registrar trends of telehealth use. Methods: Data were from the Registrar Clinical Encounters in Training (ReCEnT) cohort project, including 285,092 consultations by GP registrars, 2020–2023. ReCEnT collects detailed data on registrars’ in-consultation experience. Primary analysis used mixed effects multivariable logistic regression, with outcome factor ‘consultation modality’ (telehealth or face-to-face). The study factor was registrar training term (T1, T2, or T3). Findings: 19.6% of all consultations were telehealth: 18.4% (95%CI 17.7, 19.1) in T1, 19.9% in T2 (19.2, 20.5), 20.3% in T3 (19.5, 21.1). Adjusted odds of conducting consultations by telehealth were 10% greater in T2 than in T1 (aOR 1.10 (CI 1.05, 1.15) p < 0.001), and 12% greater in T3 compared with T1 (aOR 1.12 (CI 1.06, 1.18) p < 0.001). Implications: The most significant increase in telehealth consultations rates is early – from T1 to T2. This may represent a rapid increase in clinical confidence and competence. There may also be an expectation by practices of registrars increasing telehealth rates to that comparable with independent specialist GPs. Front-loading an increase in telehealth consultations early in the transition process may magnify the known educational implications of this consultation method, where consultations are, on average, shorter in duration, have fewer problems addressed, and involve less supervisory support.

109. Is establishing aetiology important for GP registrars’ management of respiratory tract infections?

Alexandria Turner^A,B,C, Amanda Tapley^A,B, Andrew Davey^A,B, Jason Dizon^C, Elizabeth Holliday^B, Joshua Davis^B,C, Parker Magin^A,B,C

^ARoyal Australian College of General Practitioners, GP Training Research

^BUniversity of Newcastle

^CHunter Medical Research Institute

Background: Inappropriate prescribing for self-limiting acute respiratory tract infections (ARTIs) is an important driver of antibiotic resistance. Many GPs consider viral versus bacterial aetiology as important in their decision-making regarding antibiotics prescribing for RTIs, an idea supported in educational resources. However, antibiotics make little or no difference to ARTI recovery time or symptom severity, regardless of viral, bacterial, or mixed aetiology. Most evidence in antibiotic treatment of ARTIs addresses syndromic presentation rather than aetiology. Evidence supports aetiological knowledge having limited import in upper respiratory tract infections. Aim/Objectives: To identify variables associated with registrars deeming the ARTI aetiology as important in management decision-making. Methods: Registrars within the ongoing ReCEnT inception cohort study of registrars’ in-consultation experience, answered the question: ‘when you are working in general practice, how important is it, to your management decisions, to distinguish between a viral and bacterial cause for each of, an upper respiratory infection, acute bronchitis, sore throat, or acute otitis media.’ The effect of explanatory variables on perceived importance was estimated using univariable and multivariable logistic regression. Findings: From 2022.2–2023.2, 1,050 registrars contributed 1,765 registrar rounds of data (response rate 92.3%). Most registrars rated establishing aetiology as important to their management decisions for URTI (79.2% [95%CI:77.2–81.1]), sore throat (78.3% [95%CI:76.3–80.2]), bronchitis (74.3% [95%CI:72.2–76.3]) and otitis media (69.6% [95%CI:67.4–71.7]). Characteristics associated with rating aetiology important included: female gender, international graduate status and practice rurality. Implications: The findings suggest a shift in GP training to focus on treating patients syndromically, rather than expending effort and resources on establishing viral or bacterial aetiology. Our multivariable results suggest targeting education to particular demographic groups may be useful. Further research is necessary to establish whether deeming aetiology as important is associated with higher antibiotic prescribing rates.

110. RELEASE antidepressant drug dose tapering protocols in practice: a mixed methods study with general practitioners

Chloe Tyson^A

^AUniversity of Queensland

Background: Antidepressant use in Australia has steadily increased, with many individuals remaining on these medications for extended periods beyond clinical recommendations. Long-term antidepressant use can result in withdrawal symptoms upon discontinuation, often misinterpreted as relapse. Evidence suggests that hyperbolic tapering of antidepressant drug dose may mitigate symptoms of withdrawal. The RELEASE (REdressing Long-tErm Antidepressant uSE) is an effectiveness implementation hybrid type-1 trial, conducted across 32 general practices in southeast Queensland. The RELEASE tapering plans aim to support the safe cessation of antidepressants by following a hyperbolic tapering regime. As the trial has commenced there has been a growing interest in safe antidepressant deprescribing. Many people have contacted the lead investigator Professor Wallis to share the RELEASE plans. On specific request the tapering plans have been provided to GPs who contact CIA Wallis to request the plans to use in their practice. Aim/Objectives: This study aims to evaluate General Practitioners (GPs) experiences using the RELEASE antidepressant tapering protocols in clinical practice. Methods: The study will employ a mixed-methods design. First, GPs who requested the RELEASE protocols will be invited to complete an online survey. Following the survey, a purposive sample of at least 15 GPs will be selected for semi-structured interviews to provide deeper qualitative insights. All participants will be practicing in Australia and will have used the RELEASE protocols. Findings: As this is a proposed study, findings are pending. However, the research is expected to illuminate practical challenges and support mechanisms related to the use of hyperbolic tapering strategies in real-world clinical settings. Implications: The study’s results will provide critical insight into the feasibility and effectiveness of the RELEASE tapering protocols outside the confines of clinical trials. Findings will guide strategies for national implementation and policy development around safe antidepressant deprescribing in Australia.

111. Training Tasmanian GPs in early autism surveillance to promote sustainable primary care

Nilushka Van Der Walt^A, Anthea Dallas^A, Judi Walker^A, Tim Jones^B, Georgie Alexander^A

^ATasmanian School of Medicine, University of Tasmania

^BRoyal Australian College of General Practitioners, Hobart

Background: Autism Spectrum Disorder (ASD) affects around 2% of the population and remains a significant challenge for health systems. Although ASD can be reliably identified from 12 months of age, the average age of diagnosis in Australia remains 4–6 years. A sustainable, primary care-based approach is needed to improve early identification. The Social Attention and Communication Surveillance–Revised plus Preschool (SACS-R+PR) tool, validated in 2022 with a positive predictive value of 83%, offers an effective option for earlier detection and intervention. While Maternal Child Health Nurses are trained in its use, many children are lost to follow-up after 12 months. General Practitioners (GPs), who frequently see young children for immunisations and health checks, are well placed to bridge this gap. In Tasmania, where paediatric waitlists are particularly long, GP engagement in developmental surveillance could support earlier diagnosis, timely referral, and more sustainable service provision. Aim: To evaluate the effectiveness of a webinar training GPs in Tasmania to use the SACS-R+PR tool, focusing on improvements in knowledge, confidence, and perceptions of feasibility and acceptability of both the tool and training format. Methods: A mixed-methods design will be used. Data collection includes pre- and post-webinar surveys and optional semi-structured interviews three months post-training. Surveys will assess demographics, knowledge, confidence, and perceptions of feasibility and acceptability. Qualitative data will be gathered through free-text responses and interviews. Descriptive statistics and thematic analysis will be applied. Findings: Preliminary survey data will be presented, highlighting shifts in GPs’ knowledge, confidence, and perceptions of the tool’s feasibility and acceptability. Implications: The findings are expected to support the integration of regular webinar-based training for GPs and encourage broader adoption of the SACS-R+PR tool to improve early autism detection in Tasmania and enable its application to other similar primary care settings.

112. Older driver medical assessment: validating a screening toolkit for use in general practice

Katharine Wallis^A, Geoffrey Spurling^A, Louise Bassingthwaighte^B, Janelle Griffin^C, Josh Knowles^A

^AUniversity of Queensland

^BGriffith University

^CMetro South Hospital and Health Service

Background: Some Australian states and territories require older drivers (>75 years) to have annual assessment of their fitness to drive. Some General Practitioners (GPs) are not comfortable in this role, citing concern to maintain relationships, concern about the impact of driving cessation, and poor access to on-road driving assessments. An objective measure could help to both inform GP clinical judgement and support maintaining relationships. We developed the 3-Domains screening toolkit that measures across the three functional domains essential for driving (sensory, motor, cognitive) using tests that are feasible in general practice: Snellen visual acuity; functional reach; and the road signs recognition test. An online calculator combines the three test scores to generate a predictive score that is the likelihood the older driver would pass a specialist OT driving assessment (%). The toolkit calculator predictive equation is based on Belgian data. We piloted the toolkit in general practice, finding that it is feasible and acceptable to both older drivers and practitioners. Aim: To improve accuracy of the toolkit predictive equation for older Australian drivers. Methods: Validation study in specialist Occupational Therapy Driving Assessment and Rehabilitation Service. Participants are older drivers referred by their GP for driving assessment including on-road driving test. Data includes demographics, visual acuity, functional reach, road signs recognition, Trail Making Test B, Rapid Pace Walk Test, Montreal Cognitive Assessment, Adelaide Driving Self-efficacy scale, previous incidents, and assessment outcome. Data analysis: Predictive validity will be displayed with absolute numbers and percentages. A receiver operating characteristic (ROC) curve will be produced, and the area under the ROC curve calculated. Driving assessment outcome will be dichotomized into pass/fail categories with ‘conditional’ merged with ’fail’. Findings: Data collection is ongoing. Implications: The toolkit could be used regularly in older driver medical assessments to inform GP clinical judgement and support communication.

113. Assessing RACGP registrars’ confidence in managing women’s health presentations in general practice

Belynda Walsh^A, Parker Magin^A, Amanda Tapley^A, Kylie Vuong^B

^ARoyal Australian College of General Practitioners, Newcastle

^BGriffith University, Sunshine Coast

Background: General practice as a profession has been criticised in recent years for a perceived lack of confidence in managing women’s health issues. A number of media campaigns which highlighted issues including dismissal of symptoms, undertreatment of pain, and diagnostic delays have been published, often directly referencing patient experiences with primary care. Whilst this is a seemingly a widely-shared view, this study aims to determine the validity of such views. This study examines surrogate measures of confidence of RACGP registrars in managing women’s health presentations. Aim/Objectives: The research explores: Confidence of RACGP registrars in managing women’s health presentations (compared with general medical and paediatric health presentations (where registrars have mandatory pre-training hospital-based experience). Factors associated with high confidence, including prior hospital experience. Changes in confidence during GP training. Methods: We will analyse the ReCEnT study, which records registrars’ in-consultation clinical and educational experiences, using cross-sectional and longitudinal approaches. Women’s health, general medical and paediatric presentations will be categorized using age of patients and ICPC-2Plus codes. Confidence will be inferred by the registrars’ recourse to supervisors for assistance. To determine how confidence levels may vary across different specialty areas, a comparison will be made between how frequently supervisor assistance is sought for women’s health issues compared to general medical issues and paediatric issues. We will employ logistic regression and mixed effects logistic regression to assess factors associated with high confidence, and within-registrar temporal trends in confidence during training. Findings: Preliminary cross-sectional analysis indicates that registrars seek supervisor support at a similar frequency when encountering medical issues compared with women’s health issues. Registrars seek supervisor support more frequently for paediatric issues compared with women’s health issues. Further findings to be presented. Implications: The findings will inform GP training practice and policy, such as in-training educational program content and training.

114. Australian optometry students’ perspectives on environmental sustainability and climate change

Hayley Way^A, Kerryn Hart^A, Alexandra Jaworski^A

^ADeakin University, Waurn Ponds

Background: Climate change is increasingly being recognised as a threat to public health with healthcare in Australia contributing approximately 7% of Australia’s carbon emissions. Thus, there is a responsibility for healthcare workers, including optometrists, to practise in an environmentally sustainable (ES) way. While the perceptions of British optometrists and ophthalmologists in Australia and New Zealand to ES and climate change have been published, presently the perceptions of optometry students in Australia are unknown. Aim/objectives: To capture the current perceptions of optometry students on ES and climate change in Australia. Methods: A modified version of the validated survey by Joury, contextualised to optometry, and the validated New Ecological Paradigm questionnaires were used to capture participants’ attitudes and barriers to ES practices. Invitations were sent to all optometry schools and student societies in Australia. Findings: In total, 47 complete survey responses were received. The majority (92%) of participants were 20–29 years of age and female (66%). Most (83%), originated from a metropolitan location and approximately half were completing their first degree. Most students (94%) agreed that climate change due to carbon emissions is an urgent issue and that action is required. However, 89% reported no prior study in climate change or ES, with social media representing the most common information source. Most (81%) rated their current knowledge on sustainability as “slightly” or “not knowledgeable at all”. Furthermore, at least one third indicated that the health sector and their university were not taking sufficient measures to be sustainable. The majority (89%) agreed that they should practise sustainable approaches, but lack of education was a prominent barrier. Implications: This pilot study suggests that education regarding ES and climate change during optometric training in Australia should be improved.

115. Health@Home Pathways++ Program: enhancing chronic disease management through strategic partnerships

Vanessa White^A, Geraldine Marsh^A, Heng (Jason) Jiang^A, Virginia Lewis^A

^ALa Trobe University

Background: The Health@Home Pathways++ Program is an initiative funded by the Eastern Metropolitan Health Alliance and delivered in partnership by Eastern Health (a metropolitan Health Service) and EACH (a registered independent Community Health service). Aim/Objectives: The program aimed to improve the long-term management of chronic health conditions and reduce hospital demand by leveraging partnerships at multiple levels, including governance, local public hospital departments, community health centres, health professionals, and clinician-client relationships. Methods: A mixed-methods approach was adopted, including: (1) secondary data analysis of client demographics, service delivery data, Patient Reported Outcome Measures (PROMs), and Patient Reported Experience Measures (PREMs), (2) key stakeholder surveys and interviews and (3) a cost benefit analysis. Findings: Key findings include: Governance and funding: Effective governance and funding partnerships supported program sustainability and scalability. Service Collaboration: The partnership between EACH and EH fostered a greater understanding of working across different areas of the local health system. Regular reviews of the partnership helped identify emerging service and client needs. Clinician Involvement: Clinician representatives in governance structures provided valuable insights into program implementation and monitoring. Client Outcomes: Surveys indicated high levels of client satisfaction and perceived benefits, including improved self-management and health outcomes. System Impacts: The program led to a 30% reduction in emergency department presentations and a 25% decrease in hospital admissions among enrolled clients. The cost-benefit analysis showed a return of $8.81–$13.28 for every dollar spent. Implications: The Health@Home Pathways++ Program highlights the importance of strategic partnerships and collaboration in sustaining service provision for chronic disease management. The integration of community and acute care services, supported by strong governance and client-clinician relationships, is crucial for achieving positive health outcomes and reducing healthcare costs. The findings underscore the potential for broader implementation of similar models to enhance healthcare delivery and efficiency.

116. Feeling comfortable in my own skin: a constructivist grounded theory study in Pākehā wellbeing

Anna Williams^A

^AUniversity Of Otago

Background: A wide range of Western and Indigenous models exist to explain health and wellbeing. In Aotearoa New Zealand Sir Mason Durie’s model Te Whare Tapa Whā, a model of Māori wellbeing, has been widely adopted in a range of sectors, including health and education. It provides a holistic view to wellbeing that is benefitting many. However, does this model resonate with Pākehā New Zealanders (New Zealanders of European descent)? Is there a need for an alternative model for Pākehā? It is important for Pākehā to understand their own cultural influences and perspectives on wellbeing and how they can address those needs. Aim/Objectives: To explore Pākehā ways of wellbeing in the Aotearoa New Zealand context. Methods: A constructivist grounded theory and ethnographic approach was taken. Participants were British descendants or migrants living in Otago and Southland. Data was collected through 21 participant interviews, participant observation, document analysis, digital ethnography and autoethnography. Themes were developed to inform the development of a Pākehā model of wellbeing. Findings: Findings show that considering the cultural legacy of being a migrant nation, that has been significantly impacted by World War One and Two, are important factors to consider when addressing Pākehā wellbeing. The ways Pākehā address these challenges in their lives include conducting family histories, home-making practices, building communities and memorialising. These ways that Pākehā attend to their own wellbeing help form a model of Pākehā wellbeing. Implications: As a multicultural nation, and a colonised country, it is important for Pakehā to understand their own cultural wellbeing to also support the wellbeing of Māori. If Pākehā are ‘comfortable in their own skin’ they will be in a ‘healthier’ place to connect with Māori.

117. NSW GP experience diagnosing and managing opioid dependence in their patients’ prescribed opioids for chronic pain: longitudinal qualitative research through the lens of the theory of planned behaviour: 2021–2023

Hester Wilson^A, Ben Harris Roxas^A, Nicholas Lintzeris^B, Mark Harris^A

^ASchool of Population Health, University of New South Wales

^BDepartment of Addiction Medicine, University of Sydney

Background: Chronic pain is a common general practice presentation. Over some decades, opioids have increasingly been prescribed long-term for chronic pain. This has led to increasing harms, including the development or exacerbation of opioid dependence, a chronic, potentially life-threatening condition with effective treatment. This research builds on our previously published research that found GPs often experienced negative attitudes, social norms and perceived behavioural controls that decreased intentions to diagnose and manage opioid dependence in people prescribed opioids for chronic pain. Aim/Objectives: To understand the changing experience of NSW GPs diagnosing and managing opioid dependence in their patients’ prescribed opioids for chronic pain. Methods: This longitudinal qualitative research employed semi-structured interviews with 24 NSW GPs to analyse their experiences through the lens of the Theory of Planned Behaviour (attitudes, social norms, and perceived behavioural controls), examining change over, across, and through time. Findings: Over the time of the study, some participants described a positive shift in attitudes, social norms and perceived behavioural controls towards diagnosing and managing opioid dependence. This resulted in more positive conversations about opioids and risk, and positive experiences of deprescribing opioids. Those who continued or started to prescribe medications for the management of opioid dependence expressed more strongly positive attitudes, social norms and behavioural controls. Positive changes in social norms were often driven by patients, leading to less negative participant attitudes. Support remained an important driver of behavioural controls. This included prescription monitoring tools and specialist support. Many decreased their work hours in general practice, added portfolio roles, or moved entirely out of general practice. This had a profound impact on their engagement with opioids, chronic pain and the management of dependence. Implications: Increasing positive attitudes, social norms and behavioural controls towards diagnosing and managing opioid dependence may lead to greater engagement in opioid dependence treatment.

118. Stroke prevention using oral anticoagulants among patients with atrial fibrillation: perspectives of Australian general practitioners

Solomon Wright^A, Omar Hamed^A, Katrina Giskes^B, Nicole Lowres^C, Ben Freedman^C, Charlotte Hespe^B

^ASchool of Medicine, University of Notre Dame, Sydney

^BDepartment of General Practice, School of Medicine, University of Notre Dame, Sydney

^CHeart Research Institute, Sydney

Background: Patients with atrial fibrillation (AF) are at an increased risk of thromboembolic complications, such as transient ischaemic attacks and ischaemic stroke. As such, the use of oral anticoagulants (OACs) is an essential component of managing patients with AF. Aim/Objective: To examine Australian general practitioners’ (GPs) confidence in the initiation of oral anticoagulants (OACs) and approach to monitoring treatment adherence among patients with atrial fibrillation (AF). Method: GPs were invited for semi-structured interviews following an online survey to elucidate their perspectives. Interviews were recorded and transcribed, and thematic analysis was used to identify common themes. Findings: 14 GPs practicing in urban and rural areas participated in the interviews. Three overall themes were identified. (1) Knowledge and confidence of OAC use for stroke prevention. GPs reported varied use of stroke risk assessment algorithms, commonly CHA2DS2VA and CHA2DS2-VASc. Additionally, some GPs employed HAS-BLED in the decision-making process. (2) Monitoring patient adherence and persistence to OAC stroke prevention. GPs described different approaches to monitoring this with no consistent method being identified. GP strategies ranged from rigorous monitoring using practice software to the use of no monitoring strategies. Novel OACs (NOACs) were preferred by most GPs due to better patient adherence and persistence compared to warfarin. (3) Factors impacting patient adherence and persistence to OAC stroke prevention. Patient knowledge and education were identified as the most common factor impacting patient adherence and persistence with OAC prevention. Implications: Australian GPs are not consistent in their approaches to managing stroke risk in patients with AF and had varied approaches to monitoring adherence/persistence to OACs. To reduce strokes, GP education needs to address current guidelines on risk assessment and providing skills to monitor/address patient barriers and adherence and persistence to OACs.

119. Preventive interventions to address physical health risks for people with severe mental ill-health in primary care and community settings: a narrative review and synthesis of published literature

Yichen Xue^A,B, Matthew Lewis^A,B, Wen Liu^A, Victoria Palmer^A,B

^ADepartment of General Practice and Primary Care, University of Melbourne

^BALIVE National Centre for Mental Health Research Translation, Department of General Practice and Primary Care, University of Melbourne

Background: People with severe mental ill-health die prematurely from physical comorbidities such as cardiovascular disease and diabetes. Primary and community care are important settings where preventive care is provided to improve the physical health outcomes for people with severe mental ill-health. Lifestyle and pharmacological interventions have been effective in reducing the cardiometabolic risks for people with severe mental ill-health, but no previous reviews have examined how these interventions are implemented in primary care and community settings in this vulnerable population group. Aim: To identify the type and effectiveness of the interventions to prevent the physical health risks for people with severe mental ill-health in primary care and community settings, a narrative review and synthesis of the published literature was conducted. Methods: Peer-reviewed articles published between 2000–2025 were searched using electronic databases including Medline, Embase, Web of Science, PsycINFO and CINAHL. Two reviewers independently screened titles and abstracts and conducted a full-text review. The term “severe mental illness” was applied in the search strategy as it is a common term used in the literature. Study information, participant details, intervention content and study outcomes were extracted and synthesised. Findings: total of 45 studies were included, with most studies conducted in the United States. Eighteen studies were conducted in primary care, nineteen in community settings and eight in integrated primary and community care. Common intervention types included early identification of cardiometabolic risk factors, individualised care plans for patient behavioural change and provider training to enhance their knowledge and skills in delivering care. Fourteen studies involved people with lived experience in intervention design or delivery. Implications: Our review will inform the future development of intervention strategies and sustainable implementation of person-centred co-produced models of care to prevent the physical health morbidity and mortality for primary and community care attendees with severe mental ill-health.

120. Impact of comorbid depression on myocardial infarction mortality and/or all-cause mortality in adult patients: a scoping review using a systematic approach

Deng Yong Deng^A, Alison Flehr^A, Konstancja Densley^A, Caroline Johnson^A, Patty Chondros^A

^ADepartment of General Practice and Primary Care, University of Melbourne

Background: The Royal Australian College of General Practitioners recently called for more exploration of the link between cardiology and mental health. These two conditions are prevalent within primary care and are associated with high mortality rates yet the impact of comorbid depression on cardiovascular mortality post cardiac event is not well understood. Objective: To explore the scope of the literature and the evidence available on cardiac mortality and/or all-cause mortality in patients with myocardial infarction (MI) and comorbid depression. We aim to use the findings to help inform primary care clinician management of post-MI patients. Methods: We conducted a systematic search of PubMed and PsycInfo for the following articles discussing myocardial infarction, comorbid depression, and mortality: cohort studies, clinical trials, observational studies, and pertinent systematic reviews. All studies were imported into Covidence for screening and data charting. We also employed a citation search of any identified systematic reviews for any additional studies. The ‘PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. Findings: The initial search generated 687 articles with additional 14 retrieved via the citation search. After removing 30 duplicates the remaining articles were title and abstract screened and then full text reviewed, with a total of 8 articles retained for the charting process. The included studies comprised of 3 observational prospective cohort studies, a prospective longitudinal study, 3 retrospective population-based cohort studies and a historical design of 225,094 participants from 8 different countries. Untreated depression regardless of the severity was a significant predictor of all-cause mortality post-MI. The need for earlier screening for depression in MI patients was a recurrent theme. Implications: Further research into the impact of depression on cardiovascular mortality following MI is warranted. Early screening for depression in post-MI patients within the general practice setting has the potential to positively influence patient outcomes.

121. Breaking the silence: understanding young adults’ hesitancy in discussing vulvovaginal symptoms with general practitioners

Jenny Yun^A, Bianca Cannon^A, Melissa Kang^A

^AUniversity of Sydney

Background: Vulvovaginal symptoms are common during adolescence, yet many young people hesitate to seek help due to embarrassment, stigma, fear of pain during assessment, and logistical barriers. As a result, they often turn to family, friends, or online sources instead of primary care. These symptoms can persist into adulthood, and delayed management may increase the risk of chronic infections, structural damage, and sexual dysfunction. While some qualitative research explores communication preferences around general sexual health topics such as STIs and contraception, little is known about how young people prefer to discuss vulvovaginal symptoms. Aim/Objectives: This study explores how young adults in Australia experience vulvovaginal conditions, seek information, and navigate communication barriers, and their preferences for GP support. Methods: A mixed-methods, cross-sectional study will be conducted using an anonymous survey and semi-structured interviews with young adults (aged 18–24) living in Australia. Participants will be recruited through Instagram advertisements. Inclusion criteria require participants to self-identify as having experienced vulvovaginal symptoms during adolescence or young adulthood. Survey data, collected via REDCap, will assess demographics, symptom history, health-seeking behaviours, and barriers to care. Participants will be invited to a 30-to-45-minute interview via Zoom or phone to explore their experiences, and how, when and why they seek help. Interviewees will receive a $40 gift voucher for their time. Survey data will be analysed using SPSS, and interview data will undergo thematic analysis using NVivo. An ethics application has been submitted to the University of Sydney Human Research Ethics Committee. Findings: This study is in progress. Results will highlight key themes and patterns emerging from the data analysis. Implications: This study will enhance understanding of young adults’ experiences with vulvovaginal symptoms and challenges in discussing these with GPs. Findings will inform strategies to support inclusive, timely, and effective care for vulvovaginal health concerns in young adults.

122. Research and Evaluation Study of digital Treatment of insomnia in Underserved Populations (REST UP)

Nicholas Zwar^A, Alexander Sweetman^B, Bianca Cannon^D, Cele Richardson^E, Kieran Le Plastrier^A, Elizabeth Hoon^C, Amanda Tauber^A

^ABond University

^BFlinders University

^CUniversity of Adelaide

^DUniversity of Sydney

^EUniversity of Western Australia

Background: Chronic insomnia (more than three months duration) is a significant health problem affecting 15% of Australian adults. This primary sleep disorder impacts negatively on mental and physical health, quality of life, and is associated with increased healthcare utilisation costs. Cognitive behavioural therapy for insomnia (CBTi) is an effective non-drug intervention. General practitioners commonly manage patients with insomnia, but lack the knowledge, tools and referral options to either provide or refer patients for CBTi. These issues are compounded in rural and regional Australia, where mental health professionals such as psychologists are in short supply. In this context, use of sedative/hypnotic medications that can cause dependence and have adverse effects is common. Aim/Objectives: The study aims to compare two methods of delivering digital CBTi for chronic insomnia in Australian primary care, with usual care (sleep hygiene advice). Methods: The research plan has been co-designed with consumers and representatives of professional associations. In a three-arm cluster randomised controlled trial we compare the effectiveness and cost effectiveness of: (1) self-guided digital CBTi (access to an interactive digital CBTi program without GP support), (2) clinician-guided digital CBTi (digital CBTi + individualised onboarding and follow-up support from GPs), and (3) augmented usual care control (sleep hygiene advice, provided digitally). Patient outcomes assessed will include insomnia severity, depression, and use of sedative/hypnotic medication. A process evaluation will explore experience of the interventions from the perspectives of consumers and health professionals. Findings: To date 39 practices in regional and rural Australia have expressed interest in participating in the study. Implications: The study will explore whether digital CBTi is acceptable to people living in regional and rural Australia, whether it is more effective than digital sleep hygiene advice, and the extent to which GP involvement increases uptake and effectiveness.