Abstract
Background:
Engagement with general practice is a requirement of Australia’s Primary Health Networks (PHNs). We propose a model for engagement that draws on principles of stakeholder and clinician engagement, tailored to meet the needs of PHNs and general practitioners (GPs).
Methods:
A comprehensive literature review was undertaken to identify components, challenges, and approaches to optimizing clinician engagement. Interviews with GPs (n = 18), other practice staff (n = 12), PHN staff, and other stakeholders (n = 15) across 3 PHN regions in Victoria, Australia, were used to identify perceived needs of GPs and opportunities for engagement with PHNs. Interview transcripts, notes, and contact summaries were collated and organized using QSR NVivo to support the process of coding and identification of common themes and perspectives. Information from the literature and interviews was synthesized to inform development of a model for GP engagement that could guide GP strategy and engagement activities undertaken by PHNs.
Findings:
PHNs engaged with GPs for accreditation, quality improvement, data sharing, continuing professional development, commissioning, and population health initiatives, among others. GPs were motivated to engage with PHNs, however, the roles of PHNs and benefits of engagement were not always clear. A model to support PHN engagement with general practice was developed comprising: (1) Organizational values for engagement; (2) Needs of GPs; (3) Areas of engagement; (4) Stages of engagement; (5) Communication planning; and (6) Monitoring and Evaluation.
Conclusion:
The proposed model represents contemporary understanding in clinician engagement, drawing upon concepts from community and stakeholder engagement, and extending established models for engagement into the setting of general practice.
Keywords
Introduction
Australian general practice is the cornerstone of the Australian healthcare system with almost 9 in 10 Australians consulting a GP in the past year. 1 General Practice in Australia is predominantly fee for service, subsidized through the Medicare Benefits Schedule (MBS), and provided by a mix of private businesses, not for profits, publicly funded community health services, and Aboriginal Community Controlled Health Organizations (Australian Government Department of Health. 2 In 2015, the Federal government established 31 Primary Health Networks (PHNs) across Australia to work with general practice and local communities with the goal of improving the efficiency and effectiveness of health services for people, particularly those at risk of poor health outcomes.3,4 This mandate encompassed improving the coordination, accessibility, and quality of health services delivered in primary care within their region of operation. Since their introduction, PHNs have assumed a considerable role in commissioning health services, and tasked with fostering integration and collaborating closely with general practitioners (GPs) to build the capacity of the primary care health workforce, and provide practice support to deliver high-quality primary care. 5
PHNs are intended to strengthen Australia’s primary health care system by gaining a strong understanding of peoples’ needs in their region, commissioning health services to meet those needs and minimizing gaps or duplication. Engagement with the general practice sector within their boundaries represents a core requirement of PHNs to achieve these goals. This engagement can occur at multiple points and has encompassed activities such as accreditation and quality improvement, data sharing, education for continuing professional development, commissioning, and population health initiatives. However, the issue of engagement with general practitioners has continued to be a challenge for PHNs and success has been varied. 6
A growing body of literature suggests that organizations’ engagement with clinicians is critical for improving satisfaction and retention of health staff within the workforce and contributes positively to a range of outcomes including quality of care, patient safety, efficiency, and costs.7,8 Disengagement of clinicians leads to low quality care for patients, resulting in poor patient satisfaction with their experience of care. In contrast, care delivered by more highly engaged clinicians results in higher-quality care, with patients reporting greater satisfaction. 8 Engagement also benefits health staff by preventing burnout and buffering the chronic sense of exhaustion and detachment that is particularly problematic for family doctors. 9
Health care reform is occurring in many health systems internationally, with clinician engagement and leadership identified as key drivers of health system performance and work place culture.10 -12 Although there is no one-size-fits-all approach to engagement, numerous models for engagement within health settings have emerged 13 and strategies for achieving optimal engagement have been established.14,15
In Australia, Safer Care Victoria 16 has adopted a definition of clinician engagement that encompasses “. . . the methods, extent and effectiveness of clinician involvement in the design, planning, decision making, and evaluation of activities that impact the Health System” (p. 8). This definition underpins a framework for the engagement of all clinicians within health systems in Australia, and Victoria, specifically. From an organizational perspective, clinician engagement involves activities and strategies to create stable relationships between health staff and their healthcare organizations. 17 General practice engagement needs to extend beyond these definitions to take into account the unique work environment of general practice within health systems, distinct from large, single-entity organizations like hospitals.
General practice engagement has been conceptualized as the process of working collaboratively with GPs and practice staff to enhance the quality of general practice, improve patients’ health, and/or improve health system efficiency. 18 Improving practice efficiency and communication between service providers have also been described as goals of effective GP engagement.19 -21 However, organizations such as the Royal Australian College of General Practitioners (RACGP) have been critical of the PHNs engagement with general practice, and PHNs have struggled to have a meaningful impact on general practice GPs. 22 It has been perceived that where PHNs have had a poor relationship with their region’s GP it has impacted their ability to meet the objectives of the PHN program. 22
We aimed to develop a model for GP engagement to guide PHN engagement strategy and action that takes into account the needs and preferences of GPs regarding engagement, as well as the distinct roles and responsibilities of PHNs in their engagement with GPs in Australia. We draw upon evidence from a state-of-the-art review of engagement literature, as well as qualitative interviews with GPs and other stakeholders about their experiences of engagement with PHNs and needs for engagement.
Methods
The development of a model for GP engagement formed part of a commissioned evaluation to support the development of a Primary Health Network’s GP engagement strategy. Our approach was situated at the nexus of traditional evaluation and developmental evaluation. 23 In developmental evaluation, innovation, and adaptation occurs within dynamic environments and the evaluation team is positioned closely with the program team, who actively engage in framing issues, and critically reflecting on the findings of the activity under evaluation. 23 In this context, the evaluation is informed by the organization’s values and commitments, is utilization focused, and outcomes are chosen to advance and meet the needs of the organization.
The project proceeded in 3 phases: (1) a state-of-the-art literature review; (2) interviews with GPs and key informants; and (3) development and stakeholder feedback of a model for GP engagement. Ethics approval for the research was provided by the Monash University Human Research Ethics Committee (ID: 23950).
Phase 1: Literature Review
We undertook a state-of-the-art 24 review of national and international peer-reviewed and grey literature. A state-of-the-art literature review enabled the research to focus our attention on the current situation and privileged newer rather than older information. Consistent with this method we aimed for a comprehensive search of literature, but this was not systematic, and we did not appraise papers included for quality. We queried Google and searched Ovid Medline to identify relevant, recent, papers, or reports (see Supplemental Material). We combined terms such as “physician or clinician” with “engagement.” We screened for papers describing models of engagement as well as more focused searches adding terms such as *General Practitioners/ or *Physicians, Family/or *physicians, and primary care. As relevant articles were identified we conducted hand searches of reference lists of key articles to identify further relevant papers, as well as conducting citing article searches using Google Scholar™. Both peer-reviewed and grey literature were incorporated to provide contemporary evidence concerning the components, key challenges, approaches for optimizing, and methods for measuring clinician engagement. We prioritized findings relevant to GP engagement and papers or reports describing engagement within Australian health care settings. Papers published prior to 2000, those not written in English language, or not addressing the inclusion criteria specified above, were excluded.
Phase 2: Interviews With GPs and Key Informants
A series of semi-structured interviews were conducted involving 3 different groups of stakeholders. We interviewed:
(a) GPs and practice staff (including practice nurses and practice managers), as well as GP members of a PHN Clinical Community Council, to determine their preferences regarding engagement with their local PHN.
(b) PHN staff members from 3 PHNs in Victoria Australia, to provide insights into how their PHNs engage with general practice.
(c) Other key informants: Senior staff and GP Liaison Officers from 2 major hospital networks in Victoria, to identify their experiences and perspectives on GP engagement.
Recruitment for Interviews
We sought to recruit a maximum variation sample of GPs, with a variety of participants in terms of years of experience, gender, practice locations, and degrees of involvement with their PHN. This approach ensured that we captured a broad range of perspectives, encompassing those of key stakeholders within general practice clinics, PHNs, and other relevant organizations.
Key informants were identified using snowball sampling, which initially involved leveraging the existing connections of the authorship team and our study partners. When necessary, we also advertised for participants using PHN communication channels, Monash University’s Practice-Based Research Network (MonREN), and social media. For those unable to participate in an interview, we offered the opportunity to make a written submission, although no responses were received.
All interviewees who were not salaried employees were offered an A$50 e-gift voucher in recognition of their time and contribution to the work.
Conduct of Interviews
Interviews were undertaken by research staff members experienced in qualitative interviewing of primary care professionals and health service providers (RL, SS, and SC). These interviews were conducted either online using Zoom™ video conferencing or by phone. The interviews followed a semi-structured interview guide, initially grounded in our previous evaluations of primary health care organizations25,26 and subsequently adapted based on emerging data from the literature review, as well as discussion and preliminary feedback from PHN staff. Interviews ranged in length from 10 to 70 min.
We conducted 35 interviews with 43 participants. These comprised interviews with GPs (n = 18) in 3 PHN regions, practice nurses and practice managers (n = 6), practice owners (n = 4), PHN management and staff (n = 12), and members of a PHN Clinical and Community Council (n = 2). We also interviewed hospital GP Liaison and Health Service Partnership staff (n = 4). Some interviews were conducted individually and some in pairs, and some individuals held multiple roles. As such, responses and interview excerpts are identified by role, rather than using an ID number or pseudonyms. Questions about engagement with PHNs formed 1 part of a broader interview schedule.
Interview Analysis
All interviews were audio recorded. The outcomes and researcher reflections were discussed at regular research team meetings. Due to resource and time restrictions, only the most pertinent (n = 7) of these interviews were transcribed verbatim, and the remainder documented using interviewer notes and/or a contact summary sheets.27,28 Contact summaries provided a structured, detailed account of interviews that acted as road maps to show analysis teams evolving themes and new ideas. 27 The transcripts, notes, and contact summaries were collated and further organized using QSR NVivo to support the process of coding and identification of common themes and perspectives. This drew upon the principles of inductive content analysis and involved reading and re-reading the transcripts and contact summary forms, making notes of first impressions and thoughts, and then proposing preliminary labels for codes that were reflective of key concepts. These were discussed at length iteratively during research team meetings and transcripts/summaries were subsequently re-coded and organized into meaningful categories through this process. 29
Phase 3: Development of a Model for GP Engagement
The project team synthesized data from the above sources in order to develop a model for GP engagement that could guide GP strategy and engagement activities undertaken by PHNs. The model was presented to a PHN project Stakeholder Advisory Group, and feedback received from this group was incorporated into the final formulation of the model.
Results
State-of-the-Art Review of Literature
Critical factors that support family physician engagement have been synthesized in a review by McMurchy. 30 These were grouped by personal characteristics of engaged clinicians and environmental determinants. Factors that hindered engagement included bureaucracy, lack of compensation, undervaluing physician leadership, poor organizational communication, and conflicts. 30 Intra-organizational factors, in particular leadership, are described as more important for engagement than extra-organizational and system level factors. 30 McMurchy 30 emphasizes that approaches to engage family physicians must recognize the distinctions between clinicians and healthcare managers concerning their training, worldviews, value orientation, approaches, priorities, expectations, incentives, and responsibilities. Engaging clinicians requires understanding and appreciating these differences and tailoring engagement accordingly. For example, meeting their patients’ clinical needs is a critical priority for GPs, and they are therefore motivated by opportunities to improve the care and safety of their patients.
This multi-level approach to understanding primary care engagement is also seen in models of health care system influence on primary health care workers engagement with health programs such as the national cancer screening program. 31 In this context, factors across 4 levels were seen as influencing primary care health workers engagement: Environment (eg, financial structures), Organization (eg, practice culture), Care team (eg, program knowledge), and patient. 31
At an organizational level, establishing mutual understanding, trust, and respect between physicians and health organizations is essential, and can be achieved through the creation of formalized roles, clear expectations and responsibilities, and implementation of processes and conditions that enable physicians to actively participate in engagement activities.32,33 Leveraging physician champions and establishing values fit between programs and physicians have been identified as critical parts of engagement, 34 while well-designed formal networks and organizational structures facilitate collaboration, and are enhanced and complemented by vibrant informal networks. 8
Models of Physician Engagement
The first models for physician engagement emerged during the 1990s and early 2000s. Among these, notable examples included the Institute for Healthcare Improvement’s Framework for engaging physicians in quality and safety 35 and the Medical Engagement Model. 32 These models clearly positioned engagement as a complex, multi-dimensional construct, differentiating between individual and organizational influences on engagement. 21 Multi-faceted frameworks for engagement are needed to emphasize the inter-relationship between environments and processes that facilitate clinicians to assume more active roles in leadership and management activities to support engagement. These actions serve to enhance individual perceptions of collaboration and empowerment and trust that can facilitate relationships and are effective for engaging physicians. 36
Reinertsen et al 35 emphasize the complexities and difficulties inherent in the relationship between doctors and managers, which arise from the divergent values, cultures, and beliefs held by these groups. In their influential white paper, they proposed a framework comprising of 6 primary elements which are underscored by the importance of communication in physician engagement. This framework entails: involving physicians from the outset, establishing a shared purpose; reframing values to position doctors as partners; tailoring engagement approaches for different individuals; identifying and developing champions’ and leaders’ skills; simplifying participation; communicating frequently and transparently; and providing ongoing support. 35 This model has been used successfully in several US hospitals and has proven adaptable within other health systems. 10
In Australia, a model for clinician engagement was developed for Safer Care Victoria, commissioned by the Department of Health and Human Services and Better Care Victoria.8,16 This clinician engagement framework includes 4 elements: (1) set the agenda, (2) inform, (3) involve and collaborate, and (4) empower. Within this model, successful clinician engagement requires a range of approaches applied across the individual, organizational, and system levels. These elements for engagement draw from the International Association for Public Participation (IAP2) standard for community and stakeholder engagement, 37 which provides users with a framework (the Public Participation Spectrum) to help define and understand the public’s role in engagement efforts. After establishing engagement objectives, positioning on the Participation Spectrum can be employed to clarify and guide appropriate engagement methods. Within a primary care setting, Australian PHNs have shown interest in these models and their adaptation for guiding GP engagement strategies. 38
Phase 2: Outcomes of Interviews With GPs and Stakeholders
GPs and stakeholders identified a range of motivators and barriers to engagement which are summarized in Table 1. GPs wanted to engage with their PHN “if it is worthwhile.” They valued face to face interaction but were time-poor. GPs wanted PHNs to hear their concerns about wellbeing and advocate on issues such as bulk billing, Medicare rebates, and staffing concerns. These challenges provide important context for general practitioner needs regarding engagement with PHNs and reveal several reasons why GPs do and do not engage with their local PHN. The key themes that were identified and participant quotes illustrating these themes are presented in Table 1.
Motivators and Barriers to Engagement With Local Primary Health Networks and Illustrative Quotes.
Our interviews took place in 2022—a time when the vast majority of engagement activities were still dominated by the COVID-19 pandemic. Support provided by the PHNs for accessing Personal Protective Equipment (PPE) and assistance with the COVID-19 vaccination rollout was described positively by practice owners. This helped increase the visibility of the PHN to general practice in the region compared with perceptions of visibility before 2020.
As a GP, I had to deal with them [PHN] during COVID time, it was very helpful, their advice and guidance. We were like Alice in Wonderland during that time, we didn’t know where to go and what to do but things were put together, we worked out some strategies to cope with all the difficulties. The after effects are still there with us. But with the support of peer group, college, PHN, we are surviving.
(General Practitioner, Practice Owner, Melbourne Victoria)
Beyond support provided by the PHN during the COVID-19 pandemic, the interviews highlighted that GPs who were also practice owners had greater awareness of PHNs than GP contractors and registrars and their role.
I would probably hazard a guess that most of my GP registrar colleagues hadn’t even heard of (local PHN) before, have no idea what it stands for. . .I know there’s a Public Health Network that’s in charge of things like vaccines, and that’s happening behind the scenes. But my engagement with them is negligible.
(General Practitioner, Registrar, Melbourne Victoria)
Some GPs contrasted their experiences of the previous Divisions of General Practice and Medicare Locals with their experience of the PHN model, describing how the PHN was perceived as having a business and commissioning focus, which did not necessarily align with the clinical and patient focus of GPs. This meant that the PHN was not seen as particularly relevant for some GPs in their day-to-day role of providing care to patients. GPs largely believed that support from the PHN is more related to assisting them in running their practice, and engagement between PHNs and general practices was described as predominantly occurring through practice managers and practice owners. This lack of a connection and shared vision presents a challenge for PHNs in achieving their engagement goals with GPs (Table 1).
Phase 3: Our Proposed Model to Guide GP Engagement Activities
Our model for GP engagement was developed iteratively by the team while considering the insights gained from our state-of-the-art literature review and by identifying what was important to GPs and practice staff regarding engagement with PHNs from qualitative interviews. The model is illustrated in Figure 1 and described below. The model comprises 6 components: (1) Organizational values for engagement; (2) Needs of GPs; (3) Areas of engagement; (4) Stages of engagement; (5) Communication plan; and (6) Monitoring and Evaluation for quality improvement (QI). These are described in further detail below.
(1) Values of engagement: Organizational vision, objectives, and goals for GP engagement that are embedded within an organization’s strategic plan inform engagement intentions and priorities. Engagement should be viewed as an organization-wide responsibility underpinned by values that are understood and applied across the organization. To facilitate this, roles and responsibilities for GP engagement should form part of all PHN staff position descriptions and a senior member of staff tasked with oversight and leadership for engagement.
(2) Needs of GPs: Engagement activities should take into account the needs of GPs for engagement. This includes areas that GPs want to engage in and how they want to be engaged. GP needs can be determined as part of the monitoring and evaluation process of the engagement plan and identified through regular stakeholder needs assessment surveys.
(3) Areas of engagement: Areas of engagement are listed at the top of the model and informed by the needs of GPs within a PHN region. Possible core offerings within a PHN are listed as examples of where engagement might occur, but there are opportunities for further engagement based on regional needs.
(4) Stages of engagement: The stages of engagement in the lower third of the model align with measures of practice performance and engagement to benchmark engagement activities and guide levels of support to be provided at organizational level. These stages are envisioned as mapping broadly to, and can be informed by, levels of participation described in the IAP2 public participation spectrum. 37 For example, engagement activities with practices or GPs that are not currently engaged (stage 0 or stage 1) might focus on providing balanced and objective information to inform decisions. That is, “we will keep you informed. 37 ” Where there is a high level of engagement, for example stage 3, or practices marked for high levels of support by the PHN, GPs are empowered to make decisions. That is, “we will implement what you decide.” 37
(5) Communication plan: Effective communication underpins effective engagement. A clear and articulated communication plan is needed to link the upper and lower portions of the engagement model. It considers the different needs for engagement of GPs at different times and in different contexts and is consistent with best practices in communication with general practice (Box 1).19,30,39 The communication strategy requires flexibility to allow for messages to be tailored to a specific practice audience and takes into consideration the stage of engagement. Engagement should be viewed as a social practice that requires repeated interactions over time. Two-way communication needs to be normalized and multi-faceted messaging techniques utilized. An established body of literature describes best practice for communicating with GPs and their teams. Different stakeholders (such as GPs, registrars/trainees, practice managers, practice nurses, practice owners, and corporate practices) will have unique characteristics, needs, and motivations and will require different means of communication.
(6) Monitoring and evaluation for Quality Improvement (QI): Monitoring and evaluation of engagement is crucial for ongoing quality and continuous improvement and provides assurance that processes are effective in engaging with stakeholders. Monitoring can be scheduled at particular intervals or conducted on an as-needed basis. The evaluation outcomes should influence decision-making on how improvements can be made and organizational culture can be enhanced to ensure the principles and processes of engagement in the GP engagement framework are embedded into routine activities.
A proposed model for general practice engagement.
Strategies for Best Practice When Communicating With Primary Care Physicians.
Discussion
Engagement with general practice is a core requirement of Australia’s PHNs, however, there are few models for engagement that can be applied to guide strategy and actions for engagement by health networks wanting to engage with general practices in their area of influence or responsibility. Facilitating engagement requires a multi-faceted approach. Conceptualizations and models for engagement provide a framework for organizations to adopt, taking into account this complexity and provide strategies and tools that can be deployed to support engagement. The model proposed here is based upon best practice evidence and incorporates the views and needs of GPs and other stakeholders from 3 PHNs in Victoria, Australia. Drawing upon principles of stakeholder engagement outlined by the IAP2 37 and models of clinician7,8,14,16,21 and GP engagement, 38 our model provides a systematic and structured approach to support engagement with general practice.
Health programs and interventions benefit when they are underpinned with a sound theoretical foundation and therefore adopting a model to guide organizational or program engagement is likely to aid organizations to achieve their engagement goals. Use of concepts like logic models and frameworks are particularly valuable for conceptualizing how different program components relate to one another, and can be used to help explain or predict outcomes, and provide rationale or explanations for observed and hypothesized processes. 40 With growing interest in engagement with health care providers, models for stakeholder, and community participation have emerged.7,8,10 Adopting a framework to inform engagement strategies encourages organizations to consider implementation issues during the design of the engagement process and consider the context in which it will be used.
Findings from our study interviews suggest a desire for closer engagement between GPs and their PHNs. There was a desire for greater clarity about the roles and responsibilities of the PHN, while others spoke of limited opportunity to engage with the PHN, suggesting engagement with PHNs can be improved if the roles and the benefits of engaging with PHNs are clear to GPs and practice staff. There is opportunity for a broader scope of engagement between PHNs and GPs that can increase the visibility of PHNs and address GP needs for professional development, wellbeing, and advocacy on important issues. Engagement could be framed through the lens of alleviating some of the strain being experienced by the GP workforce and addressing need, as was seen in engagement activities that occurred during the COVID-19 pandemic.
A limitation of this work is that the model has been developed with PHNs in mind, and focused on the needs of GPs in a predominately metropolitan setting. Despite this, it likely holds much broader applicability for groups aiming to engage with GPs both in Australia and internationally. For example, the model could guide GP engagement strategy within Practice-Based Research Networks (PBRNs) or other collaborations of researchers and primary care practitioners who are engaged in conducting healthcare research, addressing questions and problems that emerge from daily practice, translating research findings into evidence-based practice, and improving the quality of healthcare. 41 Similarly, clinically oriented services such as hospital outreach services, local public health units, or other state-based organizations wanting to engage with general practice in their work could benefit from the use of our model. It should be cautioned that the model is a proposal at this stage, developed using a developmental evaluation approach, and has not been tested empirically.
Additionally, our literature search followed State of the Art review methodology but was not a systematic review and did not include a formal quality assessment of papers. 42 A systematic review of the literature may identify additional articles to inform the development of the model, or exclude some papers we retained. Finally, while we used multiple channels and financial reimbursement to recruit stakeholders to participate in interviews, GP participants tended to be from practices more engaged with their PHN then not (5 from practices receiving high support, 8 from practices receiving moderate support, and 2 from practices that receive low support (data not shown). Engaging GPs from practices receiving little support from their PHN may require additional strategies to achieve desired levels of engagement. Performing a greater number of interviews with less engaged GPs may have provided further insights to GP engagement, however, we do not feel further interviews would have substantially altered the model for GP engagement we have proposed.
Conclusion
There is broad acceptance in the literature that high-performing health systems can only be realized when physicians are more engaged. Barriers to engagement exist at individual, organizational, and system levels. Reducing barriers to engagement is complex and requires a multi-faceted approach. Recent conceptualizations and models for engagement provide a framework for organizations to adopt, that consider this complexity and provide a set of strategies and tools that can be deployed to support engagement. Engagement relies on effective communication, and a communication plan that engages physicians in issues that impact their practice and patient care is essential. Effective engagement requires at least a 3-level approach, incorporating individual, organizational, and system level strategies that inform, involve, and empower clinicians through engagement.
Supplemental Material
sj-docx-1-jpc-10.1177_21501319241281579 – Supplemental material for GP Engagement: A Proposed Model to Guide Engagement Activities in Australian Primary Health Networks
Supplemental material, sj-docx-1-jpc-10.1177_21501319241281579 for GP Engagement: A Proposed Model to Guide Engagement Activities in Australian Primary Health Networks by Chris Barton, Susan Saldanha, Riki Lane, Sharon Clifford, Nidhi Achar and Grant Russell in Journal of Primary Care & Community Health
Footnotes
Acknowledgements
We thank SEMPHN and their staff for their support in the conduct of the work and feedback provided throughout the study as well as thoughtful comments on the draft manuscript. We also acknowledge the input from GPs and practice managers who contributed to the project advisory group. We also thank Professor Mark Harris for his comments and advice provided during the development of the GP Engagement model.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this work was provided by South East Melbourne Primary Health Network (SEMPHN).
Ethics Approval
Ethics approval for this work was provided by the Monash University Human Research Ethics Committee (Project ID: 34924)
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
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