2024-03-29T10:10:35Z
https://researchonline.jcu.edu.au/cgi/oai2
oai:researchonline.jcu.edu.au:39418
2024-02-29T14:32:13Z
7374617475733D707562
74797065733D61727469636C65
Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial
Seferiadis, Aris
Ohlin, Pernilla
Billhult, Annika
Gunnarsson, Ronny
Purpose: Chronic whiplash-associated disorders (WAD) incur both costs and suffering. Treatments that can relieve chronic WAD are therefore needed. Exercise therapy (ET) has been shown to provide pain relief. Another often used treatment for chronic pain in Scandinavia is basic body awareness therapy (BAT). We compared the effectiveness of 10 weeks of twice-weekly, 90-min sessions of either ET or BAT in a randomized comparative trial.
Method: We recruited 113 patients suffering from chronic WAD grades I–III and several years’ duration of symptoms in a primary health care setting. 57 were allocated to ET and 56 to BAT. Primary outcome measures were Neck Disability Index and SF-36 v.2.
Results: From baseline to post-treatment, the BAT group increased their physical functioning (median 5, IQR = 15) more than the ET group (median = 0, IQR = 15), p = 0.032, effect size −0.54. Three months after the end of treatment, the BAT group had less bodily pain (m = 17.5, 95% CI 6.9–17.6) than the ET group (m = 4.9, 95% CI −0.1 to 9.8), p = 0.044, effect size −0.4. The BAT group had also increased their social functioning (m = 13.3, 95% CI 6.6–19.9) more than the ET group (m = 3.5, 95% CI −3 to 9.9), p = 0.037, effect size −0.41. No statistically significant differences between groups were found for the change of other outcomes. No serious adverse effects were found in either groups.
Conclusions: The present trial indicates that BAT led to greater improvements than ET for the patients with chronic WAD.
Informa Healthcare
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/39418/1/39418_Seferiadis_etal_2016.pdf
http://dx.doi.org/10.3109/09638288.2015.1044036
Seferiadis, Aris, Ohlin, Pernilla, Billhult, Annika, and Gunnarsson, Ronny (2016) Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial. Disability and Rehabilitation, 38 (5). pp. 442-451.
https://researchonline.jcu.edu.au/39418/
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oai:researchonline.jcu.edu.au:42352
2024-03-05T14:58:31Z
7374617475733D707562
74797065733D61727469636C65
Are general practice characteristics predictors of good glycaemic control in patients with diabetes? A cross-sectional study
Esterman, Adrian J.
Fountaine, Tim
McDermott, Robyn
Objectives: To determine whether certain characteristics of general practices are associated with good glycaemic control in patients with diabetes and with completing an annual cycle of care (ACC).
Research design and methods: Our cross-sectional analysis used baseline data from the Australian Diabetes Care Project conducted between 2011 and 2014. Practice characteristics were self-reported. Characteristics of the patients that were assessed included glycaemic control (HbA₁(c) level ≤ 53 mmol/mol), age, sex, duration of diabetes, socio-economic disadvantage (SEIFA) score, the complexity of the patient's condition, and whether the patient had completed an ACC for diabetes in the past 18 months. Clustered logistic regression was used to establish predictors of glycaemic control and a completed ACC.
Results: Data were available from 147 general practices and 5455 patients with established type 1 or type 2 diabetes in three Australian states. After adjustment for other patient characteristics, only the patient completing an ACC was statistically significant as a predictor of glycaemic control (P = 0.011). In a multivariate model, the practice having a chronic disease-focused practice nurse (P = 0.036) and running educational events for patients with diabetes (P = 0.004) were statistically significant predictors of the patient having complete an ACC.
Conclusions: Patient characteristics are moderately good predictors of whether the patient is in glycaemic control, whereas practice characteristics appear to predict only the likelihood of patients completing an ACC. The ACC is an established indicator of good diabetes management. This is the first study to report a positive association between having completed an ACC and the patient being in glycaemic control.
Australasian Medical Publishing Company
2016-01-18
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/42352/1/42352_McDermott_2016.pdf
http://dx.doi.org/10.5694/mja15.00739
Esterman, Adrian J., Fountaine, Tim, and McDermott, Robyn (2016) Are general practice characteristics predictors of good glycaemic control in patients with diabetes? A cross-sectional study. Medical Journal of Australia, 204 (1). 23. e1-e6.
https://researchonline.jcu.edu.au/42352/
restricted
oai:researchonline.jcu.edu.au:42363
2024-03-05T14:48:39Z
7374617475733D707562
74797065733D61727469636C65
Is there a mismatch between who gets iron supplementation and who needs it? A cross-sectional study of iron supplements, iron deficiency anaemia and socio-economic status in Australia
Callander, Emily J.
Schofield, Deborah J.
Fe deficiency anaemia (IDA) is more prevalent in lower socio-economic groups; however, little is known about who actually receives Fe supplements. This paper aims to determine whether the groups most likely to have IDA are the most likely to be taking Fe supplements. Logistic regression analysis was conducted using the cross-sectional, nationally representative National Nutrition and Physical Activity Survey and National Health Measures Survey. After adjusting for other factors, those whose main language spoken at home was not English had twice the odds of having IDA compared with those whose main language spoken at home was English (95 % CI 1·00, 4·32). Those who were not in the labour force also had twice the odds of having IDA as those who were employed (95 % CI 1·16, 3·41). Those in income quintile 1 had 3·7 times the odds of having IDA compared with those in income quintile 5 (95 % CI 1·42, 9·63). Those whose main language spoken at home was not English were significantly less likely to take Fe supplements (P=0·002) than those whose main language spoken at home was English. There was no significant difference in the likelihood of taking Fe supplements between those who were not in the labour force and those who were employed (P=0·618); between those who were in income quintile 1 and in higher income quintiles; and between males and females (P=0·854), after adjusting for other factors. There is a mismatch between those who are most in need of Fe supplements and those who currently receive them.
Cambridge University Press
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/42363/7/42363-Callander-Schofield-2016-Accepted-Version.pdf
application/pdf
https://researchonline.jcu.edu.au/42363/1/Is%20there%20a%20miss-match%20between%20who%20gets%20iron%20supplementation%20and%20who%20needs%20it.pdf
http://dx.doi.org/10.1017/S0007114515004912
Callander, Emily J., and Schofield, Deborah J. (2016) Is there a mismatch between who gets iron supplementation and who needs it? A cross-sectional study of iron supplements, iron deficiency anaemia and socio-economic status in Australia. British Journal of Nutrition, 115 (4). pp. 703-708.
https://researchonline.jcu.edu.au/42363/
open
oai:researchonline.jcu.edu.au:43237
2024-03-04T15:18:37Z
7374617475733D707562
74797065733D61727469636C65
Training for general practice: how Australia's programs compare to other countries
Sen Gupta, Tarun
Hays, Richard
Background: General practice in Australia and internationally has undergone a dramatic transformation over the past half century in terms of recognition, academic status, organisation and funding. Training pathways have also evolved in response to this changing environment.
Objectives: This paper compares some of the features of Australian and international general practice training using the educational standards developed by the World Organization of Family Doctors' (WONCA) Working Party on Education as a framework.
Discussion: General practice training in Australia, particularly rural training, is strong by international standards, but more lessons can still be learnt from other settings. Local contextual factors mean there are substantial differences in training across jurisdictions, but there are a number of similarities. There is increasing attention being paid to the many roles of a general practitioner, and the importance of a formalised, structured and well-resourced training program. More needs to be done internationally to ensure high-level primary care is available to all people, particularly the underserved.
Royal Australian College of General Practitioners
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/43237/1/43237%20Gupta%20et%20al%202016.pdf
http://www.racgp.org.au/afp/2016/januaryfebruary/training-for-general-practice-how-australia%E2%80%99s-programs-compare-to-other-countries/
Sen Gupta, Tarun, and Hays, Richard (2016) Training for general practice: how Australia's programs compare to other countries. Australian Family Physician, 45 (1-2). pp. 18-21.
https://researchonline.jcu.edu.au/43237/
openpub
oai:researchonline.jcu.edu.au:44605
2024-03-03T14:57:50Z
7374617475733D707562
74797065733D61727469636C65
Protocol for a randomised controlled trial comparing aqueous with alcoholic chlorhexidine antisepsis for the prevention of superficial surgical site infection after minor surgery in general practice: the AVALANCHE trial
Heal, C.F.
Charles, D.
Hardy, A.
Delpachitra, M.
Banks, J.
Wohlfahrt, M.
Saednia, Sabine
Buettner, P.
Introduction: Surgical site infection (SSI) after minor skin excisions has a significant impact on patient morbidity and healthcare resources. Skin antisepsis prior to surgical incision is used to prevent SSI, and is performed routinely worldwide. However, in spite of the routine use of skin antisepsis, there is no consensus regarding which antiseptic agents are most effective. The AVALANCHE trial will compare Aqueous Versus Alcoholic Antisepsis with Chlorhexidine for Skin Excisions.
Methods and analysis: The study design is a prospective, randomised controlled trial (RCT) with the aim of investigating the impact of two different antiseptic preparations on the incidence of superficial SSI in patients undergoing minor skin excisions. The intervention of 0.5% chlorhexidine gluconate (CHG) in 70% alcohol will be compared with that of 0.5% CHG in aqueous solution. The trial will be conducted in four Australian general practices over a 9-month period, with 920 participants to be recruited. Consecutive patients presenting for minor skin excisions will be eligible to participate. Randomisation will be on the level of the patient. The primary outcome is superficial SSI in the first 30 days following the excision. Secondary outcomes will be adverse effects, including anaphylaxis, skin irritation, contact dermatitis and rash and patterns of antibiotic resistance.
Ethics and dissemination: The study has been approved by the James Cook University Human Research Ethics Committee (HREC). Findings will be disseminated in conference presentations and journals and through online electronic media.
Discussion: RCTs conducted in general practice differ from hospital-based projects in terms of feasibility, pragmatism and funding. The success of this trial will be cemented in the fact that the research question was established by a group of general practitioners who identified an interesting question which is relevant to their clinical practice and not answered by current evidence.
BMJ Group
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/44605/2/44605%20Heal%20et%20al%202016.pdf
https://doi.org/10.1136/bmjopen-2016-011604
Heal, C.F., Charles, D., Hardy, A., Delpachitra, M., Banks, J., Wohlfahrt, M., Saednia, Sabine, and Buettner, P. (2016) Protocol for a randomised controlled trial comparing aqueous with alcoholic chlorhexidine antisepsis for the prevention of superficial surgical site infection after minor surgery in general practice: the AVALANCHE trial. BMJ Open, 6 (7). e011614.
https://researchonline.jcu.edu.au/44605/
open
oai:researchonline.jcu.edu.au:44680
2024-03-03T14:59:40Z
7374617475733D707562
74797065733D61727469636C65
General practitioners' perspectives on the management of gout: a qualitative study
Jeyaruban, Andrew
Soden, Muriel
Larkins, Sarah
Background: Many quantitative studies globally have identified suboptimal management of gout.
Purpose: To explore management of gout from the perspective of general practitioners (GPs), while identifying the barriers and possible strategies for improvement.
Study design: This descriptive qualitative study used semistructured interviews with 14 purposely selected GPs from four separate general practices in Townsville. The questions focused on management strategies, practicalities in managing gout, barriers and possible strategies to improve management.
Results: Indomethacin was commonly reported to be used in acute gout with progression to allopurinol after the acute stage had subsided. There were differences with the initial allopurinol dose and follow-up periods. GPs reported lack of patient adherence to allopurinol and lifestyle modifications, mainly due to lack of education. Most suggested the need for allied health input and improved patient education.
Conclusions: Tailor-made plan in terms of education and lifestyle advice could help adherence to gout management.
BMJ Group
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/44680/6/44680_Jeyaruban_etal_2016.pdf
http://dx.doi.org/10.1136/postgradmedj-2015-133920
Jeyaruban, Andrew, Soden, Muriel, and Larkins, Sarah (2016) General practitioners' perspectives on the management of gout: a qualitative study. Postgraduate Medical Journal, 92 (1092). pp. 603-607.
https://researchonline.jcu.edu.au/44680/
restricted
oai:researchonline.jcu.edu.au:45783
2024-03-01T15:04:20Z
7374617475733D707562
74797065733D61727469636C65
Experiences of nurse practitioners and medical practitioners working in collaborative practice models in primary healthcare in Australia - a multiple case study using mixed methods
Schadewaldt, Verena
McInnes, Elizabeth
Hiller, Janet E.
Gardner, Anne
Background: In 2010 policy changes were introduced to the Australian healthcare system that granted nurse practitioners access to the public health insurance scheme (Medicare) subject to a collaborative arrangement with a medical practitioner. These changes facilitated nurse practitioner practice in primary healthcare settings. This study investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together under the new policies and aimed to identify enablers of collaborative practice models.
Methods: A multiple case study of five primary healthcare sites was undertaken, applying mixed methods research. Six nurse practitioners, 13 medical practitioners and three practice managers participated in the study. Data were collected through direct observations, documents and semi-structured interviews as well as questionnaires including validated scales to measure the level of collaboration, satisfaction with collaboration and beliefs in the benefits of collaboration. Thematic analysis was undertaken for qualitative data from interviews, observations and documents, followed by deductive analysis whereby thematic categories were compared to two theoretical models of collaboration. Questionnaire responses were summarised using descriptive statistics.
Results: Using the scale measurements, nurse practitioners and medical practitioners reported high levels of collaboration, were highly satisfied with their collaborative relationship and strongly believed that collaboration benefited the patient. The three themes developed from qualitative data showed a more complex and nuanced picture: 1) Structures such as government policy requirements and local infrastructure disadvantaged nurse practitioners financially and professionally in collaborative practice models; 2) Participants experienced the influence and consequences of individual role enactment through the co-existence of overlapping, complementary, traditional and emerging roles, which blurred perceptions of legal liability and reimbursement for shared patient care; 3) Nurse practitioners' and medical practitioners' adjustment to new routines and facilitating the collaborative work relied on the willingness and personal commitment of individuals.
Conclusions: Findings of this study suggest that the willingness of practitioners and their individual relationships partially overcame the effect of system restrictions. However, strategic support from healthcare reform decision makers is needed to strengthen nurse practitioner positions and ensure the sustainability of collaborative practice models in primary healthcare.
BioMed Central
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/45783/1/45783%20Schadewaldt%20et%20al%202016.pdf
http://dx.doi.org/10.1186/s12875-016-0503-2
Schadewaldt, Verena, McInnes, Elizabeth, Hiller, Janet E., and Gardner, Anne (2016) Experiences of nurse practitioners and medical practitioners working in collaborative practice models in primary healthcare in Australia - a multiple case study using mixed methods. BMC Family Practice, 17. 99. pp. 1-16.
https://researchonline.jcu.edu.au/45783/
open
oai:researchonline.jcu.edu.au:46311
2024-03-03T14:57:06Z
7374617475733D707562
74797065733D61727469636C65
Topical antibiotics for preventing surgical site infection in wounds healing by primary intention
Heal, Clare F.
Banks, Jennifer L.
Lepper, Phoebe D.
Kontopantelis, Evangelos
van Driel, Mieke L.
Background: Surgical site infections (SSI) can delay wound healing, impair cosmetic outcome and increase healthcare costs. Topical antibiotics are sometimes used to reduce microbial contaminant exposure following surgical procedures, with the aim of reducing SSIs.
Objectives: The primary objective of this review was to determine whether the application of topical antibiotics to surgical wounds that are healing by primary intention reduces the incidence of SSI and whether it increases th e incidence of adverse outcomes (allergic contact dermatitis,
infections with patterns of antibiotic resistance and anaphylaxis).
Search methods: In May 2015 we searche d: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL;the Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL. We also searched clinical trial registries for ongoing studies, and bibliographies of relevant publications to identify further eligible trials. There was no restriction of language, date of study or setting. The search was repeated in May 2016 to ensure currencyof included studies.
Selection criteria: All randomized controlled trials (RCTs) and quasi-randomised trials that assessed the effects of topical antibiotics (any formulation,including impregnated dressings) in people with surgical wounds healing by primary intention were eligible for inclusion.
Data collection and analysis: Two review authors independently selected studies and independently extracted data. Two authors then assessed the studies for risk of bias. Risk ratios were calculated for dichotomous variables, and when a sufficient number of comparable trials were available, trials were pooled in a meta-analysis.
Main results: A total of 10 RCTs and four quasi-randomised trials with 6466 participants met the inclusion criteria. Six studies involved minor procedures conducted in an outpatient or emergency department setting; eight studies involved major surgery conducted in theatre. Nine different topical antibiotics were included. We included two three-arm trials, two four-arm trials and 10 two-arm trials. The control groups comprised; an alternative topical antibiotic (two studies), topical antiseptic (six studies) and no topical antibiotic (10 studies), which comprised inert ointment (five studies) no treatment (four studies) and one study with one arm of each. The risk of bias of the 14 studies varied. Seven studies were at high risk of bias, five at unclear risk of bias and two at low risk of bias. Most risk of bias concerned risk of se lection bias. Twelve of the studies (6259 participants) reported infection rates, although we could not extract the data for this outcome from one study. Four studies (3334 participants) measured allergic contact dermatitis as an outcome. Four studies measured positive wound swabs for patterns of antimicrobial resistance, for which there were no outcomes reported. No episodes of anaphylaxis were reported.
Topical antibiotic versus no topical antibiotic: We pooled the results of eight trials (5427 participants) for the outcome of SSI. Topical antibiotics probably reduce the risk of SSI in people with surgical wounds healing by primary intention compared with no topical antibiotic (RR 0.61, 95% CI 0.42 to 0.87; moderate-quality evidence downgraded once for risk of bias). This equates to 20 fewer SSIs per 1000 patients treated with topical antibiotics (95% CI 7 to 29) and a number needed to treat for one additional beneficial outcome (NNTB) (i.e. prevention of one SSI) of 50.
We pooled the results of three trials (3012 participants) for the outcome of allergic contact dermatitis, however this comparison was underpowered, and it is unclear whether topical antibiotics affect the risk of allergic contact dermatitis (RR 3.94, 95% CI 0.46 to 34.00; very low-quality evidence, downgraded twice for risk of bias, once for imprecision).
Topical antibiotic versus antiseptic: We pooled the results of five trials (1299 participants) for the outcome of SSI. Topical antibiotics probably reduce the risk of SSI in people with surgical wounds healing by primary intention compared with using topical antiseptics (RR 0.49, 95% CI 0.30 to 0.80; moderate-quality evidence downgraded once for risk of bias). This equates to 43 fewer SSIs per 1000 patients treated with topical antibiotics instead of antiseptics (95% CI 17 to 59) and an NNTB of 24.
We pooled the results of two trials (541 participants) for the outcome of allergic contact dermatitis; there was no clear difference in the risk of dermatitis between topical antibiotics and antiseptics, however this comparison was underpowered and a difference cannot be ruled out (RR 0.97, 95% CI 0.52 to 1.82; very low-quality evidence, downgraded twice for risk of bias and once for imprecision).
Topical antibiotic versus topical antibiotic: One study (99 participants) compared mupirocin ointment with a combination ointment of neomycin/polymyxin B/bacitracin zinc for the outcome of SSI. There was no clear difference in the risk of SSI, however this comparison was underpowered (very low-quality evidence downgraded twice for risk of bias, once for imprecision).
A four-arm trial involved two antibiotic arms (neomycin sulfate/bacitracin zinc/polymyxin B sulphate combination ointment versus bacitracin zinc, 219 participants). There was no clear difference in risk of SSI between the combination ointment and the bacitracin zinc ointment. The quality of evidence for this outcome was low, downgraded once for risk of bias, and once for imprecision.
Authors' conclusions: Topical antibiotics applied to surgical wounds healing by primary intention probably reduce the risk of SSI relative to no antibiotic, and relative to topical antiseptics (moderate quality evidence). We are unable to draw conclusions regarding the effects of topical antibiotics on adverse outcomes such as allergic contact dermatitis due to lack of statistical power (small sample sizes). We are also unable to draw conclusions regarding the impact of increasing topical antibiotic use on antibiotic resistance. The relative effects of different topical antibiotics are unclear.
Wiley-Blackwell
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/46311/1/Heal_et_al-2016-The_Cochrane_Library.pdf
http://dx.doi.org/10.1002/14651858.CD011426.pub2
Heal, Clare F., Banks, Jennifer L., Lepper, Phoebe D., Kontopantelis, Evangelos, and van Driel, Mieke L. (2016) Topical antibiotics for preventing surgical site infection in wounds healing by primary intention. Cochrane Database of Systematic Reviews , 2016 (11). CD011426. pp. 1-71.
https://researchonline.jcu.edu.au/46311/
openpub
oai:researchonline.jcu.edu.au:48542
2024-03-02T15:05:06Z
7374617475733D707562
74797065733D61727469636C65
Reducing menopausal symptoms for women during the menopause transition using group education in a primary health care setting — a randomized controlled trial
Rindner, Lena
Strömme, Gunilla
Nordeman, Lena
Hange, Dominique
Gunnarsson, Ronny
Rembeck, Gun
Objectives: Women's physical and mental ill-health shows a marked increase during menopause, which usually occurs between 45 and 55 years of age. Mental illness and somatic symptoms are common causes of long-term sick leave. Women suffer from a lack of knowledge about the menopause transition and its associated symptoms. The aim of the study was to investigate whether group education for women in primary health care (PHC) about the menopause transition can improve their physical and mental ill-health.
Study design: This randomized controlled study was conducted in PHC and aimed to evaluate a Group education programme for women aged 45–55 years, around the menopause transition. A total of 131 women were randomized to group education or no intervention. The group intervention included two education sessions with topics related to menopause. They answered two questionnaires at baseline and at four-month follow-up: the Menopause Rating Scale (MRS) and the Montgomery-Asberg Depression Rating Scale (MADRS).
Main outcome measure: Change in MRS and MADRS scores over the four months.
Results: The intervention group experienced a slight reduction in symptoms while the control Group mostly experienced the opposite.
Conclusion: This study showed that it was feasible to implement group education on menopause for women aged 45–55 years.
The clinical trial registration number: NTC02852811
Elsevier
2017-04
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/48542/1/2017%20---%20Rindner%20-%20RCT.pdf
http://dx.doi.org/10.1016/j.maturitas.2017.01.005
Rindner, Lena, Strömme, Gunilla, Nordeman, Lena, Hange, Dominique, Gunnarsson, Ronny, and Rembeck, Gun (2017) Reducing menopausal symptoms for women during the menopause transition using group education in a primary health care setting — a randomized controlled trial. Maturitas, 98. pp. 14-19.
https://researchonline.jcu.edu.au/48542/
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oai:researchonline.jcu.edu.au:49880
2024-03-02T14:58:38Z
7374617475733D707562
74797065733D61727469636C65
Gonorrhoea testing and positivity in non-remote Aboriginal Community Controlled Health Services
Harrod, Mary Ellen
Couzos, Sophie
Ward, James
Saunders, Mark
Donovan, Basil
Hammond, Belinda
Delaney-Thiele, Dea
Belfrage, Mary
Williams, Sid
Smith, Lucy Watchirs
Kaldor, John
Background: Gonorrhoea occurs at high levels in young Aboriginal and Torres Strait Islander people living in remote communities, but there are limited data on urban and regional settings. An analysis was undertaken of gonorrhoea testing and positivity at four non-remote Aboriginal Community Controlled Health Services participating in a collaborative research network.
Methods: This was a retrospective analysis of clinical encounter data derived from electronic medical records at participating services. Data were extracted using the GRHANITE program for all patients aged 15-54 years from 2009 to 2013. Demographic characteristics and testing and positivity for gonorrhoea were calculated for each year.
Results: A total of 2971 patients (2571 Aboriginal and/or Torres Strait Islander) were tested for gonorrhoea during the study period. Among Aboriginal and/or Torres Strait Islander patients, 40 (1.6%) tested positive. Gonorrhoea positivity was associated with clinic location (higher in the regional clinic) and having had a positive chlamydia test. By year, the proportion of patients aged 15-29 years tested for gonorrhoea increased in both men (7.4% in 2009 to 15.9% in 2013) and women (14.8% in 2009 to 25.3% in 2013). Concurrent testing for chlamydia was performed on 86.3% of testing occasions, increasing from 75% in 2009 to 92% in 2013. Factors related to concurrent testing were sex and year of test.
Conclusions: The prevalence of gonorrhoea among young Aboriginal and/or Torres Strait Islander people in non-remote settings suggests that the current approach of duplex testing for chlamydia and gonorrhoea simultaneously is justified, particularly for women.
CSIRO Publishing
2017
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/49880/1/49880_Harrod%20et%20al_2017.pdf
http://dx.doi.org/10.1071/SH16046
Harrod, Mary Ellen, Couzos, Sophie, Ward, James, Saunders, Mark, Donovan, Basil, Hammond, Belinda, Delaney-Thiele, Dea, Belfrage, Mary, Williams, Sid, Smith, Lucy Watchirs, and Kaldor, John (2017) Gonorrhoea testing and positivity in non-remote Aboriginal Community Controlled Health Services. Sexual Health, 14 (4). pp. 320-324.
https://researchonline.jcu.edu.au/49880/
restricted
oai:researchonline.jcu.edu.au:55828
2024-02-28T14:21:12Z
7374617475733D707562
74797065733D61727469636C65
Factors correlating to the propensity of general practitioners to substitute borderline vitamin B12 deficiency
Cham, Grace
Davis, Nichola
Strivens, Edward
Traves, Aileen
Manypeney, Grant
Gunnarsson, Ronny
Objective: This study aims to identify factors which correlate to the propensity of general practitioners (GPs) to prescribe supplementation for borderline vitamin B12 deficiency.
Design: Cross-sectional surveys were distributed in person.
Setting: Conferences held in Cairns, Palm Cove Beach, Mt Isa; educational meetings in Atherton; and meetings with individual general practices within the Cairns and Hinterland region. All located in Queensland, Australia.
Subjects: 128 practicing GP specialists and registrars (practitioners in training).
Main outcome measures: Responses to the Likert scale statements with its five options scaling from 'strongly disagree' to 'strongly agree' were recoded to have binary outcomes for analysis.
Results: A survey response rate of 89% was achieved. Participants who felt patient demands influence the management of borderline vitamin B12 deficiency were more likely to prescribe supplementation (OR 2.4, p=0.037). Participants who perceived an overuse of vitamin B12 were less likely to prescribe B12 (OR 0.39, p=0.019). Participants who often saw patients with vitamin B12 deficiency were less likely to request for the complementary biomarkers plasma methylmalonic acid or total homocysteine (OR 0.41, p=0.045).
Conclusions: The identified disparity to prescribe vitamin B12 for borderline deficiency may be described as an attempt in the GP collective to seek a balance between being the patient's or the society's doctor. We propose that relevant authorities try to reduce this disparity by describing a management strategy for borderline vitamin B12 deficiency.
Informa Healthcare
2018
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/55828/1/55828_Cham_et_al_2018.pdf
https://doi.org/10.1080/02813432.2018.1487522
Cham, Grace, Davis, Nichola, Strivens, Edward, Traves, Aileen, Manypeney, Grant, and Gunnarsson, Ronny (2018) Factors correlating to the propensity of general practitioners to substitute borderline vitamin B12 deficiency. Scandinavian Journal of Primary Health Care, 36 (3). pp. 242-248.
https://researchonline.jcu.edu.au/55828/
open
oai:researchonline.jcu.edu.au:56463
2024-02-28T15:15:49Z
7374617475733D707562
74797065733D61727469636C65
Prediction of lung function using handgrip strength in healthy young adults
Mgbemena, Nnamdi C.
Aweto, Happiness A.
Tella, Bosede A.
Emeto, Theophilus L.
Malau-Aduli, Bunmi S.
Background: Positive association between physical activity and spirometry have been reported to be possibly attributed to handgrip strength (HGS), particularly in the elderly. However, the nature of the association between HGS and lung function in young adults is still unclear. This study investigated the prediction of lung function using HGS in young adults.
Methods: A cross-sectional analytical study was carried out on four hundred (400) apparently healthy medical students who are aged 16-30 years. Handgrip strength (dominant and non-dominant) and lung function (FEV1, FVC and PEFR) of these students were assessed using Jamar dynamometer and a portable spirometer respectively. Data was analysed using inferential statistics.
Results: Independent t-test showed that the mean values of HGS and lung function of the males were significantly higher than the females (p<0.0005). The relationship between HGS and lung function indices was significant (p<0.0005) in all the participants but strongest for FEV1 (r = 0.64). The regression analysis showed that in addition to gender and height, HGS was a significant (p<0.0005) predictor of lung function. Regression equations were also proposed for the prediction of these lung function indices using HGS, gender and height.
Conclusion: This study is the first to report HGS as a significant predictor of pulmonary function in healthy young adults living in a low-resource country. Hence, its use could enhance medical practice in being an indicator of lung function status in healthy young adults.
Wiley
2019
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/56463/11/JCU_56463_Mgbemena_et_al_2019_AA.pdf
application/pdf
https://researchonline.jcu.edu.au/56463/6/56463_Mgbemena_et_al_2019_Published_Version.pdf
https://doi.org/10.14814/phy2.13960
Mgbemena, Nnamdi C., Aweto, Happiness A., Tella, Bosede A., Emeto, Theophilus L., and Malau-Aduli, Bunmi S. (2019) Prediction of lung function using handgrip strength in healthy young adults. Physiological Reports, 7 (1). e13960. pp. 1-8.
https://researchonline.jcu.edu.au/56463/
open
oai:researchonline.jcu.edu.au:57018
2024-03-04T14:42:01Z
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Producing a general practice workforce: let's count what counts
Sen Gupta, Tarun
Reeve, Carole
Larkins, Sarah
Hays, Richard
Background: Medical workforce problems still dominate headlines despite considerable investment in education, training and other initiatives. There is little consensus about what Australia's general practice workforce should look like or what training outcomes should be reported.
Objective: The aim of this paper was to explore a number of issues relevant to outcomes of workforce programs and offer suggestions for identifying and overcoming these issues.
Discussion: Social accountability literature highlights the importance of outcomes focusing on community needs. We suggest that evaluations should 'count what counts' and be careful what is counted. Numbers are only part of the story; not everything that counts is counted, and synergies and cooperation are key. Australia has many general practice workforce programs that are generally heading in the right direction. We believe that closer attention to appropriate outcome measures is important if we are to maximise return on investment and get the best outcomes for the community.
Royal Australian College of General Practitioners
2018
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/57018/1/AJGP-08-2018-Focus-Sen-Gupta-GP-Workforce.pdf
https://doi.org/10.31128/AJGP-02-18-4488
Sen Gupta, Tarun, Reeve, Carole, Larkins, Sarah, and Hays, Richard (2018) Producing a general practice workforce: let's count what counts. Australian Journal of General Practice, 47 (8). pp. 514-517.
https://researchonline.jcu.edu.au/57018/
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oai:researchonline.jcu.edu.au:57305
2022-06-12T19:30:07Z
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General practitioners’ use of risk prediction tools and their application to Barrett’s oesophagus: a qualitative study
Ireland, Colin J.
Laws, Tom A.
Gordon, Andrea L.
Thompson, Sarah K.
Esterman, Adrian
Background: Risk prediction tools are widely used for the early identification of disease and expediting referrals to medical specialists for further assessment. This study provides an understanding of general practitioners preferences for using some prediction tools over others. The recent development of a risk prediction model for Barrett's oesophagus prompted our investigation of General Practitioners perspectives of the barriers and enablers to its use and screening tools perse.
Method: Individual semi-structured interviews explored the use of risk prediction tools in the general practice setting. A case scenario was used to create a schema that described the risk assessment process for Barrett's oesophagus. A content analysis of verbatim transcripts was coded for barriers and enablers to tool use and linked to explanatory themes.
Results: Data was collected from five general practitioners and one gastroenterologist. Barriers to regular use of risk prediction tools were identified and grouped using five themes; time poverty, tool format style, remembering to use, relevance of questions, and reduced autonomy in clinical decision making. Five key reasons for regular use were also identified; simple to use, memory prompt, provides a clear guide, aids in keeping me focused, and easy to access. All participants acknowledged the need for identifying Barrett's oesophagus, the precursor to oesophageal adenocarcinoma, and viewed our tool as a significant contribution to risk assessment of this condition.
Conclusion: Identifying barriers and enablers is essential to wide implementation of risk prediction tools. Participants provided information crucial to the translation of our risk prediction model for Barrett's oesophagus into clinical practice. They also confirmed that the developed model would be useful in the clinical setting.
Scient
2018
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/57305/1/Esterman%20General%20Practitioners%E2%80%99%20Use%20of%20Risk%20Prediction%20Tools.pdf
http://scientonline.org/fulltext/general-practitioners-use-of-risk-prediction-tools-and-their-application-to-barretts-oesophagus-a-qualitative-study/21694
Ireland, Colin J., Laws, Tom A., Gordon, Andrea L., Thompson, Sarah K., and Esterman, Adrian (2018) General practitioners’ use of risk prediction tools and their application to Barrett’s oesophagus: a qualitative study. Journal of Primary Health Care & General Practice, 2 (1). 014.
https://researchonline.jcu.edu.au/57305/
open
oai:researchonline.jcu.edu.au:58620
2024-03-01T14:46:44Z
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74797065733D61727469636C65
HIV pre-exposure prophylaxis: knowledge and attitudes among general practitioners
Lane, William
Heal, Clare
Banks, Jennifer
Background: Human Immunodeficiency Virus (HIV) Pre-Exposure Prophylaxis (PrEP) was accepted onto the Australian Pharmaceutical Benefits Scheme on the 1st of April 2018, allowing General Practitioners (GPs) to prescribe to patients in general practice. This study provides a timely assessment of GPs knowledge and attitudes towards HIV PrEP.
Methods: An explanatory mixed method approach was used. A content-validated questionnaire was distributed to GPs in the Mackay region to assess knowledge and attitudes towards PrEP, followed by individual in-depth interviews.
Results: Forty-five of 109 GPs (41.1%) responded. One third (15/45) had previously heard of PrEP, with 71.4% (30/42) indicating a lack of comfort with its prescription while 60% (27/45) reported that provision of formalised guidelines (27/45, 60%) was likely to increase prescription confidence. Ten GPs were interviewed until data saturation was achieved. Results supported the quantitative findings.
Conclusion: GPs expressed positive attitudes towards HIV PrEP. Limited knowledge could be overcome through formalised guidelines and education.
Royal Australian College of General Practitioners
2019
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/58620/6/AJGP-09-2019-Research-Banks-HIV-Pre-exposure-Prophylaxis-WEB.pdf
https://doi.org/10.31128/AJGP-02-19-4860
Lane, William, Heal, Clare, and Banks, Jennifer (2019) HIV pre-exposure prophylaxis: knowledge and attitudes among general practitioners. Australian Journal of General Practice, 48 (10). pp. 722-727.
https://researchonline.jcu.edu.au/58620/
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oai:researchonline.jcu.edu.au:60046
2024-03-04T15:20:55Z
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Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: a prospective cohort study
Slagman, Anna
Greiner, Felix
Searle, Julia
Harriss, Linton
Thompson, Fintan
Frick, Johann
Bolanaki, Myrto
Lindner, Tobias
Möckel, Martin
Objectives: To investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools are currently being discussed in the context of reorganisation of emergency care in Germany.
Design: Prospective cohort study.
Setting: Single centre University Hospital Emergency Department.
Participants: Adult, non-surgical ED patients.
Exposure: A non-urgent triage category was defined as a green or blue triage category according to the German version of the MTS.
Primary and secondary outcome measures: Surrogate parameters for short-term risk (admission rate, diagnoses, length of hospital stay, admission to the intensive care unit, in-hospital and 30-day mortality) and long-term risk (1-year mortality).
Results: A total of 1122 people presenting to the ED participated in the study. Of these, 31.9% (n= 358) received a non-urgent triage category and 68.1% (n= 764) were urgent. Compared with non-urgent ED presentations, those with an urgent triage category were older (median age 60 vs 56 years, p= 0.001), were more likely to require hospital admission (47.8% vs 29.6%) and had higher inhospital mortality (1.6% vs 0.8%). There was no significant difference observed between non-urgent and urgent triage categories for 30-day mortality (1.2% [n= 4] vs 2.2% [n= 15]; p= 0.285) or for 1-year mortality (7.9% [n= 26] vs 10.5% [n= 72]; p= 0.190). Urgency was not a significant predictor of 1-year mortality in univariate (HR= 1.35; 95% CI 0.87 to 2.12; p= 0.185) and multivariate regression analyses (HR= 1.20; 95% CI 0.77 to 1.89; p= 0.420).
Conclusions: The results of this study suggest the German MTS is unsuitable to safely identify patients for redirection to non-ED based GP care.
BMJ Group
2019-05
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/60046/1/JOURNAL_2019_Slagman_BMJ%20Open_Suitability%20of%20the%20Manchester%20Triage%20System%20to%20identify%20general%20practitioner%20patients%20in%20the%20ED%20-%20a%20prospective%20cohort%20study.pdf
https://doi.org/10.1136/bmjopen-2018-024896
Slagman, Anna, Greiner, Felix, Searle, Julia, Harriss, Linton, Thompson, Fintan, Frick, Johann, Bolanaki, Myrto, Lindner, Tobias, and Möckel, Martin (2019) Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: a prospective cohort study. BMJ Open, 9. e024896.
https://researchonline.jcu.edu.au/60046/
open
oai:researchonline.jcu.edu.au:60587
2024-03-01T15:07:23Z
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General practice research priority setting in Australia: informing a research agenda to deliver best patient care
Heal, Clare
Roberts, Gail
Background:
General practice research is the subsection of primary care research that addresses gaps in evidence about care
delivered in general practice. Despite delivering care to 85% of the Australian population annually, general practice receives a paucity of government health research funding when compared with tertiary healthcare settings. However, general practitioners (GPs) require evidence-based tools and guidelines applicable to their patients.
Objectives:
The aim of this study was to establish a set of general practice research priorities to guide resource allocation, and to inform a research agenda that optimises the delivery of the bestpatient care.
Method:
A comprehensive literature review was conducted, followed by a modified two-round Delphi survey of general practice
stakeholders.
Results:
There were 67 general practice research priorities identified. Top priorities included quality care and
evidence-based practice.
Discussion:
The results provide a contemporary reference point for an Australian general practice research agenda that helps
prioritise and advocate for funding, and enables delivery of evidence-based
patient care.
Royal Australian College of General Practitioners
2019
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/60587/6/60891.pdf
Heal, Clare, and Roberts, Gail (2019) General practice research priority setting in Australia: informing a research agenda to deliver best patient care. Australian Journal of General Practice, 48 (11). pp. 789-795.
https://researchonline.jcu.edu.au/60587/
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oai:researchonline.jcu.edu.au:60834
2024-03-02T16:11:54Z
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Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo
Heal, Clare
Gorges, Hilary
van Driel, Mieke L.
Tapley, Amanda
Davis, Josh
Davey, Andrew
Holliday, L.
Ball, Jean
Najib, Nashwa
Spike, Neil
FitzGerald, Kristen
Magin, Parker
ABSTRACT
Objective To establish the prevalence and associations
of systemic antibiotic prescription for impetigo by earlycareer general practitioners (GPs) (GP registrars in their first 18 months in general practice).
DESIGN
A cross-sectional analysis of data from the
Registrar Clinical Encounters in Training (ReCEnT) study.
Setting ReCEnT is an ongoing multisite cohort study
of Australian registrars’ in-consultation clinical practice across five Australian states. Participants Registrars participating in ReCEnT from 2010 to 2017.
Outcome measures Management of impetigo with systemic antibiotics.
RESULTS
1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434
consultations. Impetigo, on first presentation or followup, was managed in 930 (0.38%, 95% CI 0.35 to 0.40)
consultations and comprised 0.24% (95% CI 0.23 to 0.26)
of problems. 683 patients presented with a new diagnosis
of impetigo of which 38/683 (5.6%) were not prescribed
antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01).
CONCLUSIONS
Australian early-career GPs prescribe
systemic antibiotics (the majority broad-spectrum) for a
high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.
BMJ Group
2019-10-28
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/60834/1/Clare%20Heal.%20Antibiotic%20Stewardship%20in%20skin%20infections.pdf
https://doi.org/10.1136/bmjopen-2019-031527
Heal, Clare, Gorges, Hilary, van Driel, Mieke L., Tapley, Amanda, Davis, Josh, Davey, Andrew, Holliday, L., Ball, Jean, Najib, Nashwa, Spike, Neil, FitzGerald, Kristen, and Magin, Parker (2019) Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo. BMJ Open, 9. e031527.
https://researchonline.jcu.edu.au/60834/
open
oai:researchonline.jcu.edu.au:60864
2024-03-04T15:19:42Z
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Improving type 2 diabetes management in general practice using a second-generation basal insulin analogue insulin glargine 300 U/mL: a practical guide
Deed, Gary
Rasalam, Roy
Khoo, Chee
Dover, Tom
Forgione, Nick
Type 2 diabetes management can be improved by the use of second-generation basal insulin analogues as the first choice on commencement of insulin, in this instance focussing on insulin glargine 300 U/mL (Gla-300). The clinical application of the use of Gla-300 include advantages such as less intra- and interpatient variability in glucose control resulting in rather less hypoglycaemia, longer duration of action and greater flexibility in the timing of administration thus suiting a wide range of patient presentations.
Springer
2019
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/60864/1/60864_Deed_et_al_2019.pdf
https://doi.org/10.1007/s13300-019-00704-0
Deed, Gary, Rasalam, Roy, Khoo, Chee, Dover, Tom, and Forgione, Nick (2019) Improving type 2 diabetes management in general practice using a second-generation basal insulin analogue insulin glargine 300 U/mL: a practical guide. Diabetes Therapy, 10 (6). pp. 1887-1994.
https://researchonline.jcu.edu.au/60864/
open
oai:researchonline.jcu.edu.au:62988
2024-03-01T14:49:03Z
7374617475733D707562
74797065733D61727469636C65
Links between perceived general practitioner support and the
wellbeing of Australian patients with persistent pain
Mitra, Farzana
Woolley, Torres
Background and objective: Approximately one-fifth of the population have persistent pain of moderate-to-severe intensity, which affects patients physically, mentally, psychosocially and financially. The aim of this study was to investigate the association between self‑reported wellbeing of patients with persistent pain attending a pain clinic and perceptions of care from general practitioners (GPs) and other treating health professionals.
Methods: Patients with persistent pain completed a self-administered survey.
Results: Overall, only 29 (35%) patients with persistent pain were satisfied with their overall wellbeing, with a positive sense of wellbeing solely predicted by a belief that their GPs are 'treating their problem sympathetically' (P = 0.001; prevalence odds ratio = 5.4; 95% confidence interval: 1.9, 14.9). Voluntarily disclosed free-form comments from patients with persistent pain also appear to indicate that GP-managed pain clinics may be able to provide a more consistent level of support and care to patients with persistent pain than other practice settings.
Discussion: These findings suggest psychological support provided by GPs is an important factor for the maintenance of a positive sense of wellbeing for patients with persistent pain.
Royal Australian College of General Practitioners
2020
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/62988/1/AJGP-04-2020-Research-Woolley-Australian-Persistent-Pain-Patients-WEB-1.pdf
https://doi.org/10.31128/AJGP-06-19-4959
Mitra, Farzana, and Woolley, Torres (2020) Links between perceived general practitioner support and the wellbeing of Australian patients with persistent pain. Australian Family Physician, 49 (4). pp. 221-225.
https://researchonline.jcu.edu.au/62988/
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oai:researchonline.jcu.edu.au:63009
2024-02-28T14:57:03Z
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Prevalence and associations of General Practice registrars’ management of Impetigo: a cross-sectional analysis from the registrar clinical encounters in training (ReCEnT) study
Gorges, Hilary
Heal, Clare
van Driel, Mieke
Tapley, Amanda
Davis, Joshua
Holliday, Elizabeth
Ball, Jean
Najib, Nashwa
Spike, Neil
Fitzgerald, Kirsten
Magin, Parker
Background: Impetigo is a mild bacterial skin infection of childhood that is usually managed empirically in primary care. Objective: To establish the prevalence and associations of impetigo in general practice (GP) registrars’ consultations. Methods: Cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study data.
Results: Impetigo was managed in 0.24% of problems and 0.43% of consultations. Patient variables associated with impetigo presentations were younger age and impetigo as a new problem, while patients with non–English-speaking backgrounds were less likely to present with impetigo. Associated registrar variables were being new to the registrar and practicing in outer regional/remote locations. Compared with all other problems/diagnoses, impetigo more often involved information seeking, ordering pathology, and prescription of medication, but less often involved follow-up or referral. Conclusions: Impetigo accounts for 0.43 per 100 GP registrar consultations in Australia. Association with outer regional/remote areas may reflect climate and socioeconomic factors that predispose to impetigo. Associated pathology requests may reflect a lack of confidence in GP registrars’ management of impetigo. Cultural differences may exist regarding health-seeking behavior relating to impetigo.
Derm101
2020-04-03
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/63009/1/GorgesImpetigo.pdf
https://doi.org/10.5826/dpc.1002a43
Gorges, Hilary, Heal, Clare, van Driel, Mieke, Tapley, Amanda, Davis, Joshua, Holliday, Elizabeth, Ball, Jean, Najib, Nashwa, Spike, Neil, Fitzgerald, Kirsten, and Magin, Parker (2020) Prevalence and associations of General Practice registrars’ management of Impetigo: a cross-sectional analysis from the registrar clinical encounters in training (ReCEnT) study. Dermatology Practical & Conceptual, 10 (2). e2020043.
https://researchonline.jcu.edu.au/63009/
open
oai:researchonline.jcu.edu.au:63511
2024-03-01T15:13:30Z
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The impact of localised general practice training on Queensland's rural and remote general practice workforce
Peel, Raquel
Young, Louise
Reeve, Carol
Kanakis, Katerina
Malau-Aduli, Bunmi
Sen Gupta, Tarun
Hays, Richard
Background: The diverse rural medical education initiatives that have been developed in Australia to address the medical workforce maldistribution have been less successful in many smaller and remote communities. This study explored the factors that attract and retain GP registrars and supervisors and the impact that localised training (i.e., rural and remote workplace-based training and support) has on both GP registrars and supervisors, and the GP workforce in rural and remote underserved areas.
Methods: A purposive sample of 79 GP registrars, supervisors, practice managers, health services staff and community representatives living and working in areas of low GP workforce in rural and remote Australia were invited to participate in semi-structured interviews and one focus group divided over two phases. Thematic analysis was used to explore themes within the data.
Findings: Attractors and barriers to rural and remote practice were identified as the main themes. Attractors include family and community lifestyle factors, individual intrinsic motivators, and remote medicine experiences. In contrast, barriers include work related, location, or family factors. Further, localised GP training was reported to specifically influence GP registrars and supervisors through education, social and financial factors.
Conclusion: The current study has provided a contemporary overview of the issues encountered in expanding GP training capacity in rural and remote communities to improve the alignment of training opportunities with community and workforce needs. Strategies including matching scope of practice to registrar interests have been implemented to promote the attractors and lessen the barriers associated with rural and remote practice.
BioMed Central
2020
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/63511/1/63511_Peel_et_al_2020.pdf
https://doi.org/10.1186/s12909-020-02025-4
Peel, Raquel, Young, Louise, Reeve, Carol, Kanakis, Katerina, Malau-Aduli, Bunmi, Sen Gupta, Tarun, and Hays, Richard (2020) The impact of localised general practice training on Queensland's rural and remote general practice workforce. BMC Medical Education, 20. 119.
https://researchonline.jcu.edu.au/63511/
open
oai:researchonline.jcu.edu.au:63513
2024-03-03T14:37:10Z
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To stay or go? Unpacking the decision-making process and coping strategies of International Medical Graduates practising in rural, remote, and regional Queensland, Australia
Malau-Aduli, Bunmi S.
Smith, Amy M.
Young, Louise
Sen Gupta, Tarun
Hays, Richard
Australia is one of many countries to rely on International Medical Graduates (IMGs) to fill general practitioner (GP) positions throughout its regional, rural, and remote (RRR) communities. Current government initiatives requiring IMGs to work for specified periods in RRR areas offer only short-term solutions. The need to improve the long-term retention of IMGs practising in RRR areas has motivated this research to improve our understanding of how IMGs make decisions about where to practise. Specifically, this study sought to: (a) identify the factors that influence an IMG’s decision to remain working in RRR areas, and (b) develop a theory, grounded in the data, to explain how these factors are prioritised, evaluated and used to inform a decision to remain working in RRR areas. This study adopted a qualitative approach and employed grounded theory methods. Data collection and analysis occurred concurrently, using constant, comparative analysis, guided by theoretical sampling and data saturation. Data sources were transcripts from semi-structured interviews with IMG registrars (n = 20) and supervisors (n = 5), interviewers’ notes and analytic memos. Interviewees were all currently working in RRR areas of Queensland, Australia. The analysis involved a three-phase coding process, progressing from specific, inductive coding to abstract, abductive coding. The analysis revealed that the IMG decision-making process involves a complex, dynamic, and iterative process of balancing life goals based on life stage. Many factors are considered when assessing the balance of three main life goals: satisfaction with work, family, and lifestyle. The prioritisation and balance of these life goals can vary as the IMG moves through varying work-, family-, and age-related life stages. It is hoped that having this understanding of the complexity of the IMG decision-making process, will better equip medical educators, policy makers and support service providers to tailor services to encourage IMGs to continue practising in these regions.
Public Library of Science
2020
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/63513/1/63513_Malau-Aduli_et_al_2020.pdf
https://doi.org/10.1371/journal.pone.0234620
Malau-Aduli, Bunmi S., Smith, Amy M., Young, Louise, Sen Gupta, Tarun, and Hays, Richard (2020) To stay or go? Unpacking the decision-making process and coping strategies of International Medical Graduates practising in rural, remote, and regional Queensland, Australia. PLoS ONE, 16 (6). e0234620.
https://researchonline.jcu.edu.au/63513/
open
oai:researchonline.jcu.edu.au:63761
2024-02-29T14:37:09Z
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Qualitative exploration of barriers to alcohol management in patients with chronic disease in a regional setting
Mudd, Julie
Preston, Robyn
Larkins, Sarah
Chronic diseases are a major contributor to the burden of disease in Australia. Alcohol consumption is similar in people with chronic disease and the general public, and may contribute to management challenges. In regional Australia, there are limited options for the management of excess alcohol consumption, so most of this burden falls to general practitioners. This study explored how staff in general practices are managing alcohol in patients with chronic disease with a view to determining what additional services may be appropriate. Brief interviews were conducted with doctors, nurses and allied health practitioners across three general practices in a regional centre. Interviews were analysed using abductive thematic techniques to elicit broad themes. In all, 18 interviews were conducted. All interviewees found the management of patients with chronic disease who were drinking in excess of guidelines to be challenging. The complexity of patients, in terms of health needs and social circumstances, affected management and self-care. Australian drinking cultural norms also affected patients' and practitioners' behaviour. Multidisciplinary care was highlighted by all health professionals; however, there were challenges maintaining staff motivation, a lack of training in alcohol management and a lack of referral or assistance services. Experienced practitioners identified that the patient was the key stakeholder who needed to take ownership of their health. The combined burden of excess alcohol consumption and chronic disease is a common management challenge faced by staff in general practice. Although there was evidence of awareness of the issue and a concerted effort to address the problem, most staff felt they had inadequate training, skills and resources. More undergraduate or postgraduate training in alcohol management and more resources are required to support general practitioners in this area.
CSIRO Publishing
2020
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/63761/1/63761.pdf
https://doi.org/10.1071/PY19176
Mudd, Julie, Preston, Robyn, and Larkins, Sarah (2020) Qualitative exploration of barriers to alcohol management in patients with chronic disease in a regional setting. Australian Journal of Primary Health, 26 (3). pp. 265-270.
https://researchonline.jcu.edu.au/63761/
restricted
oai:researchonline.jcu.edu.au:65910
2024-02-28T15:07:50Z
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Improving antibiotics targeting using PCR point-of-care testing for group A streptococci in patients with uncomplicated acute sore throat
Gunnarsson, Ronny K.
Orda, Ulrich
Elliott, Bradley
Heal, Clare
Gorges, Hilary
Glasziou, Paul
Del Mar, Chris
Background and objectives
Evidence supports some beneficial effects of antibiotics prescribed to patients with a sore throat and proven presence of group A streptococci (GAS).
Methods
A total of 283 patients were included from North and North-West Queensland, Australia, at their first presentation for uncomplicated acute sore throat. Patterns of antibiotic prescribing were explored before and after testing for GAS using a rapid point-of-care polymerase chain reaction (PCR) test.
Results
The results of the study showed the Australian Therapeutic Guidelines were often not adhered to. The PCR test reduced the proportion of patients prescribed antibiotics from 46% to 40%. The decision to prescribe antibiotics was changed in 30% of patients (P <0.001): before testing only 40% of patients prescribed antibiotics had a positive GAS PCR while this increased to 97% after testing.
Discussion
An easy-to-use point-of-care test to detect GAS allows better targeting of antibiotic prescribing in patients with an uncomplicated acute sore throat.
Royal Australian College of General Practitioners
2021
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/65910/2/65910_Gunnarsson.pdf
https://doi.org/10.31128/AJGP-07-20-5518
Gunnarsson, Ronny K., Orda, Ulrich, Elliott, Bradley, Heal, Clare, Gorges, Hilary, Glasziou, Paul, and Del Mar, Chris (2021) Improving antibiotics targeting using PCR point-of-care testing for group A streptococci in patients with uncomplicated acute sore throat. Australian Journal of General Practice, 50 (1-2). pp. 76-83.
https://researchonline.jcu.edu.au/65910/
restricted
oai:researchonline.jcu.edu.au:66774
2024-02-29T14:39:05Z
7374617475733D707562
74797065733D61727469636C65
What role does the GP play for emergency department utilizers? A qualitative exploration of respiratory patients' perspectives in Berlin, Germany
Oslislo, Sarah
Heintze, Christoph
Möckel, Martin
Schenk, Liane
Holzinger, Felix
Background: While motives for emergency department (ED) self-referrals have been investigated in a number of studies, the relevance of general practitioner (GP) care for these patients has not been comprehensively evaluated. Respiratory symptoms constitute an important utilization trigger in both EDs and in primary care. In this qualitative study, we aimed to explore the role of GP care for patients visiting EDs as outpatients for respiratory complaints and the relevance of the relationship between patient and GP in the decision making process leading up to an ED visit.
Methods: Qualitative descriptive study. Semi-structured, face-To-face interviews with a sample of 17 respiratory ED patients in Berlin, Germany. Interviews were recorded and transcribed verbatim. Qualitative content analysis was performed. The study was embedded into the EMACROSS (Emergency and Acute Care for Respiratory Diseases beyond Sectoral Separation) cohort of ED patients with respiratory symptoms, which is part of EMANet (Emergency and Acute Medicine Network for Health Care Research).
Results: Three patterns of GP utilization could be differentiated: long-Term regular consulters, sporadic consulters and patients without GP. In sporadic consulters and patients without GP, an ambivalent or even aversive view of GP care was prevalent, with lack of confidence in GPs' competence and a deficit in trust as seemingly relevant influencing factors. Regardless of utilization or relationship type, patients frequently made contact with a GP before visiting an ED.
Conclusions: With regard to respiratory symptoms, our qualitative data suggest a hypothesis of limited relevance of patients' primary care utilization pattern and GP-patient relationship for ED consultation decisions.
BioMed Central
2020
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/66774/1/66774_Oslislo_et_al_2020.pdf
https://doi.org/10.1186/s12875-020-01222-w
Oslislo, Sarah, Heintze, Christoph, Möckel, Martin, Schenk, Liane, and Holzinger, Felix (2020) What role does the GP play for emergency department utilizers? A qualitative exploration of respiratory patients' perspectives in Berlin, Germany. BMC Family Practice, 21. 154.
https://researchonline.jcu.edu.au/66774/
open
oai:researchonline.jcu.edu.au:69352
2024-03-01T14:54:31Z
7374617475733D707562
74797065733D61727469636C65
Essentials of a new clinical practice guidance on familial hypercholesterolaemia for physicians
Watts, Gerald F.
Sullivan, David R.
Hare, David L.
Kostner, Karam M.
Horton, Ari E.
Bell, Damon A.
Brett, Tom
Trent, Ronald J.
Poplawski, Nicola K.
Martin, Andrew C.
Srinivasan, Shubha
Justo, Robert N.
Chow, Clara K.
Pang, Jing
FH Australasia Network Consensus Working Group,
Familial hypercholesterolaemia (FH) is a common, heritable and preventable cause of premature coronary artery disease. New clinical practice recommendations are presented to assist practitioners in enhancing the care of all patients with FH. Core recommendations are made on the detection, diagnosis, assessment and management of adults, children and adolescents with FH. Management is under-pinned by the precepts of risk stratification, adherence to healthy lifestyles, treatment of non-cholesterol risk factors and appropriate use of low-density lipoprotein (LDL)-cholesterol-lowering therapies including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. The recommendations need to be utilised using judicious clinical judgement and shared decision-making with patients and families. New government-funded schemes for genetic testing and use of PCSK9 inhibitors, as well as the National Health Genomics Policy Framework, will enable adoption of the recommendations. However, a comprehensive implementation science and practice strategy is required to ensure that the guidance translates into benefit for all families with FH.
Wiley-Blackwell
2021
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/69352/1/69352.pdf
https://doi.org/10.1111/imj.15327
Watts, Gerald F., Sullivan, David R., Hare, David L., Kostner, Karam M., Horton, Ari E., Bell, Damon A., Brett, Tom, Trent, Ronald J., Poplawski, Nicola K., Martin, Andrew C., Srinivasan, Shubha, Justo, Robert N., Chow, Clara K., Pang, Jing, and FH Australasia Network Consensus Working Group, (2021) Essentials of a new clinical practice guidance on familial hypercholesterolaemia for physicians. Internal Medicine Journal, 51 (5). pp. 769-779.
https://researchonline.jcu.edu.au/69352/
restricted
oai:researchonline.jcu.edu.au:69353
2024-03-02T16:08:03Z
7374617475733D707562
74797065733D61727469636C65
Improving detection and management of familial hypercholesterolaemia in Australian general practice
Brett, Tom
Chan, Dick C.
Radford, Jan
Heal, Clare
Gill, Gerard
Hespe, Charlotte
Vargas-Garcia, Cristian
Condon, Carmen
Sheil, Barbara
Li, Ian W.
Sullivan, David R.
Vickery, Alistair W.
Pang, Jing
Arnold-Reed, Diane E.
Watts, Gerald F.
Objective: Familial hypercholesterolaemia (FH) is characterised by elevated low-density lipoprotein (LDL)-cholesterol and increased risk of cardiovascular disease. However, FH remains substantially underdiagnosed and undertreated. We employed a two-stage pragmatic approach to identify and manage patients with FH in primary healthcare.
Methods: Medical records for 232 139 patients who attended 15 general practices at least once in the previous 2 years across five Australian States were first screened for potential risk of FH using an electronic tool (TARB-Ex) and confirmed by general practitioner (GP) clinical assessment based on phenotypic Dutch Lipid Clinic Network Criteria (DLCNC) score. Follow-up GP consultation and management was provided for patients with phenotypic FH.
Results: A total of 1843 patients were identified by TARB-Ex as at potential risk of FH (DLCNC score ≥5). After GP medical record review, 900 of these patients (49%) were confirmed with DLCNC score ≥5 and classified as high-risk of FH. From 556 patients subsequently clinically assessed by GPs, 147 (26%) were diagnosed with phenotypic FH (DLCNC score >6). Follow-up GP consultation and management for 77 patients resulted in a significant reduction in LDL-cholesterol (-16%, p<0.01). A higher proportion of these patients attained the treatment target of 50% reduction in LDL-cholesterol (74% vs 62%, p<0.001) and absolute levels of LDL-cholesterol goals compared with baseline (26% vs 12%, p<0.05).
Conclusions: A pragmatic approach integrating electronic medical record tools and clinical GP follow-up consultation is a feasible method to identify and better manage patients with FH in the primary healthcare setting.
BMJ Publishing
2021
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/69353/1/69353.pdf
https://doi.org/10.1136/heartjnl-2020-318813
Brett, Tom, Chan, Dick C., Radford, Jan, Heal, Clare, Gill, Gerard, Hespe, Charlotte, Vargas-Garcia, Cristian, Condon, Carmen, Sheil, Barbara, Li, Ian W., Sullivan, David R., Vickery, Alistair W., Pang, Jing, Arnold-Reed, Diane E., and Watts, Gerald F. (2021) Improving detection and management of familial hypercholesterolaemia in Australian general practice. Heart, 107 (15). pp. 1213-1219.
https://researchonline.jcu.edu.au/69353/
open
oai:researchonline.jcu.edu.au:70693
2024-03-02T15:37:26Z
7374617475733D707562
74797065733D61727469636C65
Integration of non-dispensing pharmacists into primary healthcare services: an umbrella review and narrative synthesis of the effect on patient outcomes
Shaw, Caitlin
Couzos, Sophie
Background and objective: Australian primary care services must address increasingly complex and chronic disease. When integrated into general practice, non-dispensing pharmacists (NDPs) provide clinical services within a team-based model of care to improve patient outcomes and quality use of medications. This review synthesises available systematic reviews and meta-analyses to assess the effect of the integration of NDPs on outcomes of primary care patients.
Methods: PubMed, CINAHL, Cochrane Database of Systematic Reviews and JBI Database of Systematic Reviews were searched from August 2019 until December 2019 for systematic reviews and meta-analyses that assessed the integration of NDPs into primary care, as well as patient outcomes.
Results: In total, 591 publications were identified, of which five were suitable for inclusion. Outcomes in the included studies were classified into changes in biomedical markers, changes in prescribing practices and patient-reported outcomes.
Discussion: The results of this review suggest that the integration of NDPs has a positive effect on patient outcomes in primary care.
Royal Australian College of General Practitioners
2021
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/70693/1/AJGP-06-2021-Research-Shaw-Non-dispensing-Pharmacists-WEB.pdf
https://doi.org/10.31128/AJGP-08-20-5565
Shaw, Caitlin, and Couzos, Sophie (2021) Integration of non-dispensing pharmacists into primary healthcare services: an umbrella review and narrative synthesis of the effect on patient outcomes. Australian Journal of General Practice, 50 (6). pp. 403-408.
https://researchonline.jcu.edu.au/70693/
restricted
oai:researchonline.jcu.edu.au:71099
2023-02-23T05:55:24Z
7374617475733D756E707562
74797065733D746865736973
An investigation of the effects of alcohol on chronic disease management in a regional setting
Mudd, Julie
Julie Mudd investigated the effect of alcohol consumption on chronic disease management. She found that alcohol consumption is challenging for both the patients and their health practitioners, resulting in poorer outcomes and decreased health engagement. GPs will use this information to better manage alcohol use in patients with chronic disease.
2020
Thesis
NonPeerReviewed
application/pdf
https://researchonline.jcu.edu.au/71099/1/JCU_71099_Mudd_2020_thesis.pdf
https://doi.org/10.25903/m3sh-ax41
Mudd, Julie (2020) An investigation of the effects of alcohol on chronic disease management in a regional setting. PhD thesis, James Cook University.
https://researchonline.jcu.edu.au/71099/
open
oai:researchonline.jcu.edu.au:72100
2024-03-04T14:51:27Z
7374617475733D707562
74797065733D61727469636C65
General practitioners' roles in disaster health management: perspectives of disaster managers
Burns, Penelope L.
FitzGerald, Gerard J.
Hu, Wendy C.
Aitken, Peter
Douglas, Kirsty A.
Introduction:
General Practitioners (GPs) are inevitably involved when disaster strikes their communities. Evidence of health care needs in disasters increasingly suggests benefits from greater involvement of GPs, and recent research has clarified key roles. Despite this, GPs continue to be disconnected from disaster health management (DHM) in most countries.
Study Objective:
The aim of this study was to explore the perspectives of disaster management professionals in two countries, across a range of all-hazard disasters, regarding the roles and contributions of GPs to DHM, and to identify barriers to, and benefits of, more active engagement of GPs in disaster health care systems.
Methods:
A qualitative research methodology using semi-structured interviews was conducted with a purposive sample of Disaster Managers (DMs) to explore their perspectives arising from experiences and observations of GPs during disasters from 2009 through 2016 in Australia or New Zealand. These involved all-hazard disasters including natural, man-made, and pandemic disasters. Responses were analyzed using thematic analysis.
Results:
These findings document support from DM participants for greater integration of GPs into DHM with New Zealand DMs reporting GPs as already a valuable integrated contributor. In contrast, Australian DMs reported barriers to inclusion that needed to be addressed before sustained integration could occur. The two most strongly expressed barriers were universally expressed by Australian DMs: (1) limited understanding of the work GPs undertake, restricting DMs' ability to facilitate GP integration; and (2) DMs' difficulty engaging with GPs as a single group. Other considerations included GPs' limited DHM knowledge, limited preparedness, and their heightened vulnerability. Strategies identified to facilitate greater integration of GPs into DHM where it is lacking, such as Australia, included enhanced communication, awareness, and understanding between GPs and DMs.
Conclusion:
Experience from New Zealand shows systematic, sustained integration of GPs into DHM systems is achievable and valuable. Findings suggest key factors are collaboration between DMs and GPs at local, state, and national levels of DHM in planning and preparedness for the next disaster. A resilient health care system that maximizes capacity of all available local health resources in disasters and sustains them into the recovery should include General Practice.
World Association for Disaster and Emergency Medicine
2021
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/72100/1/72100.pdf
https://doi.org/10.1017/S1049023X21001230
Burns, Penelope L., FitzGerald, Gerard J., Hu, Wendy C., Aitken, Peter, and Douglas, Kirsty A. (2021) General practitioners' roles in disaster health management: perspectives of disaster managers. Prehospital and Disaster Medicine, 37 (1). pp. 124-131.
https://researchonline.jcu.edu.au/72100/
restricted
oai:researchonline.jcu.edu.au:74646
2024-02-28T14:29:07Z
7374617475733D707562
74797065733D61727469636C65
Impact of clinical placement sites on general practice as a career preference for Australian medical students
Yeoh, Alexandra
Sathiakumar, Angeline Kavitha
Leung, Cynthia Nga Yu
Hoffman, Rebekah
Gosbell, Andrew
Tan, Kang Ning
Objective: This study investigates whether General Practice placement experience or locations (urban/metropolitan vs non-metropolitan) promote student interest in pursuing general practice. Design: SurveyMonkey was used in the design of the survey. Setting: The study was conducted online. Participants: A total of 520 and 705 clinical-year students were surveyed in 2009 and 2019, respectively. The study was conducted online, using SurveyMonkey, and the participants were mostly non-indigenous Australian medical students, between the ages of 18 and 30. Interventions: Students were recruited from the General Practice Students' Network membership database to complete the survey online. Chi-squared testing, Pearson's correlation and a multivariate logistic regression analysis were used to investigate the correlation between general practice placements and intention to become a general practice. Main outcome measures: The association and causation between general practice placement location, student experience and students' intended career outcomes. Results: In 2009, majority of students rated their general practice experience ‘mostly positive’ while most metropolitan participants and majority of non-metropolitan placement participants in the 2019 survey responded with ‘mostly positive’ in 2019. Based on 2009 and 2019 data, general practice placement location had no association with the likelihood of pursuing general practice as a career, while student experience had a stronger positive correlation with the likelihood of pursuing general practice as a career. Conclusion: Our study shows that students' overall experience with their general practice placements significantly encourages medical students to pursue the general practice pathway. As such, increasing both metropolitan and non-metropolitan placement experiences can potentially overcome general practice shortage.
Wiley-Blackwell
2022
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/74646/1/74646.pdf
https://doi.org/10.1111/ajr.12819
Yeoh, Alexandra, Sathiakumar, Angeline Kavitha, Leung, Cynthia Nga Yu, Hoffman, Rebekah, Gosbell, Andrew, and Tan, Kang Ning (2022) Impact of clinical placement sites on general practice as a career preference for Australian medical students. Australian Journal of Rural Health, 30 (1). pp. 95-102.
https://researchonline.jcu.edu.au/74646/
restricted
oai:researchonline.jcu.edu.au:74875
2024-03-05T14:21:48Z
7374617475733D707562
74797065733D61727469636C65
Resilience and adaptability of general practice education during the COVID-19 pandemic
Sen Gupta, Tarun
Poolman, Claire
McGonigal, Emma
[Extract] Unprecedented times demand unprecedented measures. The COVID-19 pandemic has taught us that nothing is impossible. While the pandemic has profoundly affected medical services and education, general practitioners (GPs) – yes, the generalists – are uniquely placed to observe, to think and to respond.
Royal Australian College of General Practitioners
2022
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/74875/1/74875.pdf
https://doi.org/10.31128/AJGP-03-22-6383
Sen Gupta, Tarun, Poolman, Claire, and McGonigal, Emma (2022) Resilience and adaptability of general practice education during the COVID-19 pandemic. Australian Journal of General Practice, 51 (5). p. 293.
https://researchonline.jcu.edu.au/74875/
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oai:researchonline.jcu.edu.au:75240
2024-03-02T16:01:53Z
7374617475733D707562
74797065733D61727469636C65
General practice registrars' use of dermoscopy: Prevalence, associations and influence on diagnosis and confidence
Whiting, Georgina
Stocks, Nigel
Morgan, Simon
Tapley, Amanda
Henderson, Kim
Holliday, Elizabeth
Ball, Jean
van Driel, Mieke
Spike, Neil
McArthur, Lawrie
Davey, Andrew
Magin, Parker
Background and objective Dermoscopy increases accuracy for melanoma diagnosis by trained primary care physicians. We aimed to establish prevalence of dermatoscope use by general practice registrars, and identify factors associated with dermatoscope use and the implications of dermatoscope use for diagnosis and confidence in diagnosis.
Methods This was a cross-sectional study nested within the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study of general practice registrars’ consultations. The study was conducted during two six-monthly rounds of ReCEnT data collection in four regional training providers in 2014.
Results Forty-nine per cent of registrars reported having dermoscopy training. Dermoscopy was used in 61% of consultations involving skin or pigmented lesion checks. Dermatoscope use changed provisional diagnosis in 22% of instances and increased diagnostic confidence in 55%.
Discussion Dermoscopy is performed by general practice registrars in a modest proportion of skin and pigmented lesion checks. Its use influences registrars’ diagnoses and increases their confidence in their diagnoses.
Royal Australian College of General Practitioners
2019
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75240/1/75240.pdf
https://doi.org/10.31128/AJGP-11-18-4773
Whiting, Georgina, Stocks, Nigel, Morgan, Simon, Tapley, Amanda, Henderson, Kim, Holliday, Elizabeth, Ball, Jean, van Driel, Mieke, Spike, Neil, McArthur, Lawrie, Davey, Andrew, and Magin, Parker (2019) General practice registrars' use of dermoscopy: Prevalence, associations and influence on diagnosis and confidence. Australian Journal of General Practice, 48 (8). pp. 547-553.
https://researchonline.jcu.edu.au/75240/
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oai:researchonline.jcu.edu.au:75241
2024-03-02T16:01:53Z
7374617475733D707562
74797065733D61727469636C65
Emergency department referral patterns of Australian general practitioner registrars: A cross-sectional analysis of prevalence, nature and associations
Catzikiris, Nigel
Tapley, Amanda
Morgan, Simon
Van Driel, Mieke
Spike, Neil
Holliday, Elizabeth G.
Ball, Jean
Henderson, Kim
McArthur, Lawrie
Magin, Parker
Objective: Limited international evidence suggests general practice registrars' emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap by establishing the prevalence, nature and associations of Australian GP registrar ED referrals.
Methods: A cross-sectional analysis was performed of the Registrar Clinical Encounters in Training (ReCEnT) cohort study of GP registrars' consultation experiences, between 2010 and 2015. The outcome factor in logistic regression analysis was referral to an ED. Independent variables included patient-level, registrar-level, practice-level and consultation-level factors.
Results: In all, 1161 GP registrars (response rate 95.5%) contributed data from 166 966 consultations, comprising 258 381 individual problems. Based on responses, 0.5% of problems resulted in ED referral, of which nearly 25% comprised chest pain, abdominal pain and fractures. Significant (P < 0.05) associations of ED referral included patient age <15 and >34 years, the patient being new to the registrar, one particular regional training provider (RTP), in-consultation information or assistance being sought and learning goals being generated. Outer regional-, remote-or very remote-based registrars made significantly fewer ED referrals than more urban registrars. Of the problems referred to the ED, 45.5% involved the seeking of in-consultation information or assistance, predominantly from supervisors.
Conclusions: Registrars' ED referral rates are nearly twice those of established GPs. The findings of the present study suggest acute illnesses or injuries present registrars with clinical challenges and real learning opportunities, and highlight the importance of continuity of care, even for acute presentations.
CSIRO Publishing
2019
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75241/1/75241.pdf
https://doi.org/10.1071/AH17005
Catzikiris, Nigel, Tapley, Amanda, Morgan, Simon, Van Driel, Mieke, Spike, Neil, Holliday, Elizabeth G., Ball, Jean, Henderson, Kim, McArthur, Lawrie, and Magin, Parker (2019) Emergency department referral patterns of Australian general practitioner registrars: A cross-sectional analysis of prevalence, nature and associations. Australian Health Review, 43 (1). pp. 21-28.
https://researchonline.jcu.edu.au/75241/
open
oai:researchonline.jcu.edu.au:75242
2024-03-02T16:01:54Z
7374617475733D707562
74797065733D61727469636C65
Management of transient ischemic attacks diagnosed by early-career general practitioners: A cross-sectional study
Davey, Andrew R.
Lasserson, Daniel S.
Levi, Christopher R.
Tapley, Amanda
Morgan, Simon
Henderson, Kim
Holliday, Elizabeth G.
Ball, Jean
Van Driel, Mieke L.
McArthur, Lawrie
Spike, Neil A.
Magin, Parker J.
Background: Transient ischemic attack incurs a risk of recurrent stroke that can be dramatically reduced by urgent guideline-recommended management at the point of first medical contact. Aims: This study describes the prevalence and associations of new transient ischemic attack presentations to general practice registrars and the management undertaken. Methods: A cross-sectional analysis of the Registrar Clinical Encounters in Training cohort study. General practice registrars from five Australian states (urban to very remote practices) collected data on 60 consecutive patient encounters during each of their three six-month training terms. The proportion of problems managed being new transient ischemic attacks and proportion of transient ischemic attacks with guideline-recommended management were calculated. Univariate and multivariable logistic regression established associations of patient, registrar, and practice factors with a problem being a new transient ischemic attack. Results: A total 1331 general practice registrars contributed data (response rate 95.8%). Of the 250,625 problems, there were 65 new transient ischemic attacks diagnosed (0.03% [95% confidence interval: 0.02–0.03%]). General practice registrars were more likely to seek help, generate learning goals, and spend more time for a new transient ischemic attack compared to other problems. Compliance with management guidelines was modest: 15.4% ordered brain and arterial imaging, 36.9% prescribed antiplatelet medication, and 3.1% prescribed antihypertensive medication. Conclusions: Transient ischemic attack is a very infrequent presentation for general practice registrars, giving little clinical opportunity to reinforce training program education regarding guideline-recommended management. General practice registrars found transient ischemic attacks challenging and management was not ideal. Since most transient ischemic attacks first present to general practice and urgent management is essential, an enhanced model of care utilizing rapid access to specialist transient ischemic attack support and follow-up could improve guideline compliance.
Sage
2018
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75242/1/75242.pdf
https://doi.org/10.1177/1747493017743053
Davey, Andrew R., Lasserson, Daniel S., Levi, Christopher R., Tapley, Amanda, Morgan, Simon, Henderson, Kim, Holliday, Elizabeth G., Ball, Jean, Van Driel, Mieke L., McArthur, Lawrie, Spike, Neil A., and Magin, Parker J. (2018) Management of transient ischemic attacks diagnosed by early-career general practitioners: A cross-sectional study. International Journal of Stroke, 13 (3). pp. 313-320.
https://researchonline.jcu.edu.au/75242/
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oai:researchonline.jcu.edu.au:75243
2024-03-02T16:01:54Z
7374617475733D707562
74797065733D61727469636C65
Focus on early-career GPs: Qualitative evaluation of a multi-faceted educational intervention to improve antibiotic prescribing
Deckx, Laura
Anthierens, Sibyl
Magin, Parker J.
Morgan, Simon
McArthur, Lawrie
Yardley, Lucy
Dallas, Anthea
Little, Paul
Van Driel, Mieke L.
Background. We conducted an educational intervention emphasizing rational antibiotic prescribing in early-career General Practitioners (GP) in vocational training (trainees). The intervention consisted of an online introduction module, an online communication training module, face-toface workshops, and cases to be discussed one-on-one by the trainee-supervisor dyad during regular scheduled education sessions.
Objectives. To explore the participants' experiences with the intervention.
Methods. A qualitative study of 14 GP trainees and supervisors. Interviews followed a semistructured interview guide, were transcribed and analysed using concurrent thematic analysis.
Results. Overall, the intervention was well received. Resources were not often used in practice, but GP trainees used the information in communicating with patients. The intervention improved trainees' confidence and provided new communication strategies, e.g. explicitly asking about patients' expectations and talking patients through the examination to form an overall clinical picture. Trainees seemed eager to learn and adapt their practice, whereas GP supervisors rather commented that the intervention was reinforcing. None of the participants reported prescribing conflicts between trainee and supervisor. However, most participants identified conflicts within the GP practice or with specialists: other doctors who prescribe more antibiotics perpetuate patients' ideas that antibiotics will fix everything, which in turn causes conflict with the patient and undermines attempts to improve antibiotic prescribing.
Conclusion. The educational intervention was received positively. Early-career GPs thought it influenced their prescribing behaviour and improved their confidence in non-prescribing. Interventions that target teams (e.g. entire practice) could minimize conflict, ensure consistency of messages and support overall antibiotic stewardship in primary care.
Oxford University Press
2018
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75243/1/75243.pdf
https://doi.org/10.1093/fampra/cmx074
Deckx, Laura, Anthierens, Sibyl, Magin, Parker J., Morgan, Simon, McArthur, Lawrie, Yardley, Lucy, Dallas, Anthea, Little, Paul, and Van Driel, Mieke L. (2018) Focus on early-career GPs: Qualitative evaluation of a multi-faceted educational intervention to improve antibiotic prescribing. Family Practice, 35 (1). pp. 99-104.
https://researchonline.jcu.edu.au/75243/
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oai:researchonline.jcu.edu.au:75244
2024-03-02T16:01:55Z
7374617475733D707562
74797065733D61727469636C65
Reducing early career general practitioners' antibiotic prescribing for respiratory tract infections: A pragmatic prospective non-randomised controlled trial
Magin, Parker
Tapley, Amanda
Morgan, Simon
Davis, Joshua S.
McElduff, Patrick
Yardley, Lucy
Henderson, Kim
Dallas, Anthea
McArthur, Lawrie
Mulquiney, Katie
Davey, Andrew
Little, Paul
Spike, Neil
Van Driel, Mieke L.
Background. Inappropriate antibiotic prescription and consequent antibacterial resistance is a major threat to healthcare.
Objectives. To evaluate the efficacy of a multifaceted intervention in reducing early career general practitioners' (GPs') antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis/bronchiolitis.
Methods. A pragmatic non-randomized trial employing a non-equivalent control group design nested within an existing cohort study of GP registrars' (trainees') clinical practice. The intervention included access to online modules (covering the rationale of current clinical guidelines recommending non-prescription of antibiotics for URTI and bronchitis/bronchiolitis, and communication skills in management of acute bronchitis) followed by a face-to-face educational session. The intervention was delivered to registrars (and their supervisors) in two of Australia's seventeen regional GP training providers (RTPs). Three other RTPs were the control group. Outcomes were proportion of registrars' URTI consultations and bronchitis/bronchiolitis consultations prescribed antibiotics. Intention-to-treat analyses employed logistic regression within a Generalised Estimating Equation framework, adjusted for relevant independent variables. The predictors of interest were time; treatment group; and an interaction term for time-by-treatment group. The P value associated with an interaction term determined statistically significant differences in antibiotic prescribing.
Results. Analyses include data of 217 intervention RTPs' and 311 control RTPs' registrars. There was no significant reduction in antibiotic prescribing for URTIs. For bronchitis/bronchiolitis, a significant reduction (interaction P value = 0.024) remained true for analysis adjusted for independent variables (P value = 0.040). The adjusted absolute reduction in prescribing was 15.8% (95% CI: 4.2%-27.5%). Conclusions. A multifaceted intervention reduced antibiotic prescribing for bronchitis/bronchiolitis but not URTIs.
Oxford University Press
2018
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75244/1/75244.pdf
https://doi.org/10.1093/fampra/cmx070
Magin, Parker, Tapley, Amanda, Morgan, Simon, Davis, Joshua S., McElduff, Patrick, Yardley, Lucy, Henderson, Kim, Dallas, Anthea, McArthur, Lawrie, Mulquiney, Katie, Davey, Andrew, Little, Paul, Spike, Neil, and Van Driel, Mieke L. (2018) Reducing early career general practitioners' antibiotic prescribing for respiratory tract infections: A pragmatic prospective non-randomised controlled trial. Family Practice, 35 (1). pp. 53-60.
https://researchonline.jcu.edu.au/75244/
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oai:researchonline.jcu.edu.au:75247
2024-03-02T16:01:57Z
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The pattern of anxiolytic and hypnotic management by Australian general practice trainees
Holliday, Simon M.
Morgan, Simon
Tapley, Amanda
Henderson, Kim M.
Dunlop, Adrian J.
van Driel, Mieke L.
Spike, Neil A.
McArthur, Lawrence A.
Ball, Jean
Oldmeadow, Christopher J.
Magin, Parker J.
Introduction and Aims: Guidelines recommend anxiolytics and hypnotics (A/H) as second-line, short-term medications. We aimed to establish prevalence and associations of A/H prescribing by Australian general practice (GP) trainees.
Design and Methods: A cross-sectional analysis from a cohort study of vocational trainees from four GP Regional Training Providers during 2010–2013. General practice trainees act as independent practitioners (including for prescribing purposes) while having recourse to advice from a GP supervisor. Practice and trainee demographic data were collected as well as patient, clinical and educational data from 60 consecutive consultations of each trainee each training term. Analysis was at the level of individual problem managed, with the outcome factor being prescription of any anxiolytic or hypnotic.
Results: Overall, 645 registrars (response rate 94.0%) prescribed 68 582 medications in 69 621 consultations (with 112 890 problems managed). A/Hs were prescribed for 1.3% of problems managed and comprised 2.2% of all prescriptions. They were prescribed particularly for insomnia (28.2%) or anxiety (21.8%), but also for many ‘off-label’ indications. Significant associations of A/H prescriptions were: patient-level (greater age, Aboriginal and Torres Strait Islander status, English-speaking background, being new to the trainee but not to the practice); trainee-level (male) and consultation-level (longer duration, pre-existing problem, specialist referral not being made). Prescribing was significantly lower in one of the four Regional Training Providers.
Discussion and Conclusions: GP trainees, inconsistent with most guideline recommendations, prescribe A/Hs mainly as maintenance therapy to unfamiliar and older patients. Our results suggest that changes in management approaches are needed which may be facilitated by support for psychotherapeutic training.
Wiley-Blackwell
2017
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75247/1/75247.pdf
https://doi.org/10.1111/dar.12404
Holliday, Simon M., Morgan, Simon, Tapley, Amanda, Henderson, Kim M., Dunlop, Adrian J., van Driel, Mieke L., Spike, Neil A., McArthur, Lawrence A., Ball, Jean, Oldmeadow, Christopher J., and Magin, Parker J. (2017) The pattern of anxiolytic and hypnotic management by Australian general practice trainees. Drug and Alcohol Review, 36 (2). pp. 261-269.
https://researchonline.jcu.edu.au/75247/
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oai:researchonline.jcu.edu.au:75248
2024-03-02T16:01:58Z
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Does brief chronic pain management education change opioid prescribing rates? A pragmatic trial in Australian early-career general practitioners
Holliday, Simon Mark
Hayes, Chris
Dunlop, Adrian J.
Morgan, Simon
Tapley, Amanda
Henderson, Kim M.
Van Driel, Mieke L.
Holliday, Elizabeth G.
Ball, Jean I.
Davey, Andrew
Spike, Neil Allan
McArthur, Lawrence Andrew
Magin, Parker John
We aimed to evaluate the effect of pain education on opioid prescribing by early-career general practitioners. A brief training workshop was delivered to general practice registrars of a single regional training provider. The workshop significantly reduced hypothetical opioid prescribing (in response to paper-based vignettes) in an earlier evaluation. The effect of the training on actual prescribing was evaluated using a nonequivalent control group design nested within the Registrar Clinical Encounters in Training (ReCEnT) cohort study: 4 other regional training providers were controls. In ReCEnT, registrars record detailed data (including prescribing) during 60 consecutive consultations, on 3 occasions. Analysis was at the level of individual problem managed, with the primary outcome factor being prescription of an opioid analgesic and the secondary outcome being opioid initiation. Between 2010 and 2015, 168,528 problems were recorded by 849 registrars. Of these, 71% were recorded by registrars in the nontraining group. Eighty-two percentages were before training. Opioid analgesics were prescribed in 4382 (2.5%, 95% confidence interval [CI]: 2.40-2.63) problems, with 1665 of these (0.97%, 95% CI: 0.91-1.04) representing a new prescription. There was no relationship between the training and total prescribing after training (interaction odds ratio: 1.01; 95% CI: 0.75-1.35; P value 0.96). There was some evidence of a reduction in initial opioid prescriptions in the training group (interaction odds ratio: 0.74; 95% CI: 0.48-1.16; P value 0.19). This brief training package failed to increase overall opioid cessation. The inconsistency of these actual prescribing results with hypothetical prescribing behavior suggests that reducing opioid prescribing in chronic noncancer pain requires more than changing knowledge and attitudes.
Lippincott Williams & Wilkins
2017
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75248/1/75248.pdf
https://doi.org/10.1097/j.pain.0000000000000755
Holliday, Simon Mark, Hayes, Chris, Dunlop, Adrian J., Morgan, Simon, Tapley, Amanda, Henderson, Kim M., Van Driel, Mieke L., Holliday, Elizabeth G., Ball, Jean I., Davey, Andrew, Spike, Neil Allan, McArthur, Lawrence Andrew, and Magin, Parker John (2017) Does brief chronic pain management education change opioid prescribing rates? A pragmatic trial in Australian early-career general practitioners. Pain, 158 (2). pp. 278-288.
https://researchonline.jcu.edu.au/75248/
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oai:researchonline.jcu.edu.au:75249
2024-03-02T16:01:59Z
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Clinical encounters of Australian general practice registrars with paediatric patients
Hiscock, Harriet
Freed, Gary
Morgan, Simon
Tapley, Amanda
Holliday, Elizabeth
Davey, Andrew
Ball, Jean
Van Driel, Mieke
Spike, Neil
McArthur, Lawrie
Magin, Parker
Background: Whether general practitioner (GP) registrars have adequate exposure to, and feel confident in, managing children's health during training is unknown. Objectives: To determine the prevalence and associations of GP registrars' paediatric vs. non-paediatric consultations.
Methods: Cross-sectional analysis from a cohort study of Australian GP registrars' 2010-2014 consultations.
Results: 889 registrars contributed details for 26,427 (21.8% (95% CI: 21.4-22.2) paediatric consultations. Paediatric patients were more likely to be male and new to the practice. Although paediatric patients were less likely to have a chronic disease (OR 0.38, 95% CI 0.36, 0.40) and presented with fewer problems (OR 0.59, 95% CI 0.57, 0.61), registrars were more likely to seek in-consultation advice (OR 1.25, 95% CI 1.19, 1.31) and generate learning goals (OR 1.12, 95% CI 1.07, 1.18) for paediatric consultations.
Discussion: GP registrars appear to feel less confident in managing paediatric compared with adult consultations, suggesting an unmet training need.
Taylor & Francis
2017
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75249/1/75249.pdf
https://doi.org/10.1080/14739879.2016.1266697
Hiscock, Harriet, Freed, Gary, Morgan, Simon, Tapley, Amanda, Holliday, Elizabeth, Davey, Andrew, Ball, Jean, Van Driel, Mieke, Spike, Neil, McArthur, Lawrie, and Magin, Parker (2017) Clinical encounters of Australian general practice registrars with paediatric patients. Education for Primary Care, 28 (2). pp. 75-80.
https://researchonline.jcu.edu.au/75249/
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oai:researchonline.jcu.edu.au:75251
2024-03-02T16:02:01Z
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Anticholinergic medicines in an older primary care population: a cross-sectional analysis of medicines’ levels of anticholinergic activity and clinical indications
Magin, P.J.
Morgan, S.
Tapley, A.
McCowan, C.
Parkinson, L.
Henderson, K.M.
Muth, C.
Hammer, M S.
Pond, D.
Mate, K.E.
Spike, N. A.
McArthur, L.A.
van Driel, M.L.
What is known and objectives: Adverse clinical outcomes have been associated with cumulative anticholinergic burden (to which low-potency as well as high-potency anticholinergic medicines contribute). The clinical indications for which anticholinergic medicines are prescribed (and thus the ‘phenotype’ of patients with anticholinergic burden) have not been established. We sought to establish the overall prevalence of prescribing of anticholinergic medicines, the prevalence of prescribing of low-, medium- and high-potency anticholinergic medicines, and the clinical indications for which the medicines were prescribed in an older primary care population.
Methods: This was a cross-sectional analysis of a cohort study of Australian early-career general practitioners’ (GPs’) clinical consultations – the Registrar Clinical Encounters in Training (ReCEnT) study. In ReCEnT, GPs collect detailed data (including medicines prescribed and their clinical indication) for 60 consecutive patients, on up to three occasions 6 months apart. Anticholinergic medicines were categorized as levels 1 (low-potency) to 3 (high-potency) using the Anticholinergic Drug Scale (ADS).
Results: During 2010–2014, 879 early-career GPs (across five of Australia's six states) conducted 20 555 consultations with patients aged 65 years or older, representing 35 506 problems/diagnoses. Anticholinergic medicines were prescribed in 10·4% [95% CIs 9·5–10·5] of consultations. Of the total anticholinergic load of prescribed medicines (‘community anticholinergic load’) 72·7% [95% CIs 71·0–74·3] was contributed by Level 1 medicines, 0·8% [95% CIs 0·5–1·3] by Level 2 medicines and 26·5% [95% CIs 24·8–28·1] by Level 3 medicines. Cardiac (40·0%), Musculoskeletal (16·9%) and Respiratory (10·6%) were the most common indications associated with Level 1 anticholinergic prescription. For Level 2 and 3 medicines (combined data), Psychological (16·1%), Neurological (16·1%), Musculoskeletal (15·7%) and Urological (11·1%) indications were most common.
What is new and conclusion: Anticholinergic medicines are frequently prescribed in Australian general practice, and the majority of the ‘community’ anticholinergic burden is contributed by ‘low’-anticholinergic potency medicines whose anticholinergic effects may be largely ‘invisible’ to prescribing GPs. Furthermore, the clinical ‘phenotype’ of the patient with high anticholinergic burden may be very different to common stereotypes (patients with urological, psychological or neurological problems), potentially making recognition of risk of anticholinergic adverse effects additionally problematic for GPs.
Wiley-Blackwell
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75251/1/75251.pdf
https://doi.org/10.1111/jcpt.12413
Magin, P.J., Morgan, S., Tapley, A., McCowan, C., Parkinson, L., Henderson, K.M., Muth, C., Hammer, M S., Pond, D., Mate, K.E., Spike, N. A., McArthur, L.A., and van Driel, M.L. (2016) Anticholinergic medicines in an older primary care population: a cross-sectional analysis of medicines’ levels of anticholinergic activity and clinical indications. Journal of Clinical Pharmacy and Therapeutics, 41 (5). pp. 486-492.
https://researchonline.jcu.edu.au/75251/
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oai:researchonline.jcu.edu.au:75252
2024-03-02T16:02:01Z
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Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis: A multicentre longitudinal study
Magin, Parker J.
Morgan, Simon
Tapley, Amanda
Henderson, Kim M.
Holliday, Elizabeth G.
Ball, Jean
Davis, Joshua S.
Dallas, Anthea
Davey, Andrew R.
Spike, Neil A.
McArthur, Lawrie
Stewart, Rebecca
Mulquiney, Katie J.
Van Driel, Mieke L.
Background. Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide. Objectives. We aimed to establish whether early-career 'apprenticeship-model' experience in family practice influences antibiotic prescribing for respiratory tract infections and to also establish other associations of antibiotic prescribing changes during this early-career experience.
Methods. A longitudinal analysis (2010-2014) of a cohort study of Australian GP registrars' (vocational trainees') consultations. Registrars from five regional training programs recorded data from 60 consecutive consultations, once each 6-month training Term, including the diagnoses managed and medications prescribed. The outcomes were whether an antibiotic was prescribed for the diagnoses 'upper respiratory tract infection (URTI)' and 'acute bronchitis/bronchiolitis'. Generalized linear mixed modelling was used to account for repeated measures on registrars and to include the time component: 'Term'.
Results. A total of 856 registrars recorded 108759 consultations, including 8715 'URTI' diagnoses (5.15% of diagnoses) and 2110 'acute bronchitis/bronchiolitis' diagnoses (1.25%). Antibiotics were prescribed in 16.3% [95% confidence interval (CI) 14.9-17.8] of URTI and 72.2% (95% CI 69.6-74.6) of acute bronchitis/bronchiolitis diagnoses. Moving from an earlier to later term did not significantly influence registrars' antibiotic prescribing for URTI [adjusted odds ratio (OR) 0.95; 95% CI 0.87, 1.04, P = 0.27] or acute bronchitis/bronchiolitis [OR 1.01 (95% CI 0.90-1.14), P = 0.86]. Significant associations of antibiotic prescribing for URTIs were the registrar being non-Australian educated, greater patient age, practices not privately billing patients, pathology being ordered, longer consultation duration and the registrar seeking in-consultation information or advice (including from their supervisor).
Conclusions. Early-career experience/training failed to produce rational antibiotic prescribing for URTI and acute bronchitis/bronchiolitis. Our findings suggest that prescribing interventions could target the registrar-supervisor dyad.
Oxford University Press
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75252/1/75252.pdf
https://doi.org/10.1093/fampra/cmw025
Magin, Parker J., Morgan, Simon, Tapley, Amanda, Henderson, Kim M., Holliday, Elizabeth G., Ball, Jean, Davis, Joshua S., Dallas, Anthea, Davey, Andrew R., Spike, Neil A., McArthur, Lawrie, Stewart, Rebecca, Mulquiney, Katie J., and Van Driel, Mieke L. (2016) Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis: A multicentre longitudinal study. Family Practice, 33 (4). pp. 360-367.
https://researchonline.jcu.edu.au/75252/
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oai:researchonline.jcu.edu.au:75253
2024-03-02T16:02:02Z
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Antibiotic prescribing for sore throat: A cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in family practice
Dallas, Anthea
Van Driel, Mieke
Morgan, Simon
Tapley, A.
Henderson, Kim
Ball, Jean
Oldmeadow, Christopher
Davey, Andrew
Mulquiney, Kate
Davis, Joshua
Spike, Neil
McArthur, Lawrie
Magin, Parker
Background: Acute sore throat is a common condition presenting to family practitioners. It is usually self-limiting, with antibiotic treatment recommended only for high-risk presentations. Overprescribing of antibiotics contributes to individual and community resistance. Learning to prescribe in the context of diagnostic uncertainty and patient pressures is a challenge for early-career doctors. Prescribing habits develop early and tend not to change with time. Objective: To establish the prevalence and associations of antibiotic prescribing for acute sore throat by Australian vocational trainees in family practice. Method: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. This ongoing, multicentre prospective cohort study documents the nature of trainees' consultation-based clinical experiences. Univariate and logistic regression analyses were conducted on data recorded in consultations for sore throat in nine collection periods during 2010-14. Results: Data from 856 individual trainees (response rate 95.2%) were analysed. Sore throat was managed in 2.3% encounters. Antibiotics were prescribed for 71.5% of sore throat diagnoses. The variables associated with prescribing were inner-regional location and higher socio-economic area. There was no significant association with younger age of patient or greater trainee experience. If an antibiotic was prescribed, the trainee was more likely to seek information from guidelines or a supervisor. Conclusions: The high frequency of antibiotic prescribing and the lack of attenuation in prescribing with increased experience suggest current educational interventions and the apprenticeship model of training is not fostering appropriate practice in this important clinical area. Targeted educational interventions, for supervisors as well as trainees, are indicated.
Oxford University Press
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75253/1/75253.pdf
https://doi.org/10.1093/fampra/cmw014
Dallas, Anthea, Van Driel, Mieke, Morgan, Simon, Tapley, A., Henderson, Kim, Ball, Jean, Oldmeadow, Christopher, Davey, Andrew, Mulquiney, Kate, Davis, Joshua, Spike, Neil, McArthur, Lawrie, and Magin, Parker (2016) Antibiotic prescribing for sore throat: A cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in family practice. Family Practice, 33 (3). pp. 302-308.
https://researchonline.jcu.edu.au/75253/
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oai:researchonline.jcu.edu.au:75257
2024-03-02T16:02:04Z
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Reducing general practice trainees' antibiotic prescribing for respiratory tract infections: An evaluation of a combined face-To-face workshop and online educational intervention
Magin, Parker J.
Morgan, Simon
Tapley, Amanda
Davis, Joshua S.
McArthur, Lawrie
Henderson, Kim M.
Mulquiney, Katie J.
Dallas, Anthea
Davey, Andrew R.
Scott, John
Van Driel, Mieke L.
Over-prescription of antibiotics for non-pneumonia respiratory tract infections (RTIs) is a major concern in general practice. Australian general practice registrars (trainees) have inappropriately high rates of prescription of antibiotics for RTIs. The 'apprenticeship' educational model and the trainee- trainer relationship are drivers of this inappropriate prescribing. We aimed to reduce registrars' non-pneumonia RTI antibiotic prescribing via an educational intervention (a 90-min face-To-face workshop supported by online modules), complemented by delivery of the same intervention, separately, to their trainers. We conducted a pre-and post-intervention comparison of the registrars' intention to prescribe antibiotics for common RTIs using McNemar's test. We similarly tested changes in supervisors' intended prescribing. Prescribing intentions were elicited by responses to six written clinical vignettes (upper respiratory tract infection, otitis media, sore throat and three acute bronchitis vignettes). We found that, for registrars, there were statistically significant reductions in antibiotic prescribing for the sore throat (24.0% absolute reduction), otitis media (17.5% absolute reduction) and two of the three acute bronchitis (12.0% and 18.0% absolute reduction) vignettes. There were significant reductions in supervisors' antibiotic prescribing intentions for the same four vignettes. We conclude that our intervention produced a significant change in registrars' intention to prescribe antibiotics for non-pneumonia RTIs.
Taylor & Francis
2016
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/75257/1/75257.pdf
https://doi.org/10.1080/14739879.2015.1106085
Magin, Parker J., Morgan, Simon, Tapley, Amanda, Davis, Joshua S., McArthur, Lawrie, Henderson, Kim M., Mulquiney, Katie J., Dallas, Anthea, Davey, Andrew R., Scott, John, and Van Driel, Mieke L. (2016) Reducing general practice trainees' antibiotic prescribing for respiratory tract infections: An evaluation of a combined face-To-face workshop and online educational intervention. Education for Primary Care, 27 (2). pp. 98-105.
https://researchonline.jcu.edu.au/75257/
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oai:researchonline.jcu.edu.au:76348
2024-02-28T15:08:24Z
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A comparison of patient appraisal of professional skills for GPs in training participating in differing education programs
Narayanan, Ajit
Vayro, Caitlin
Greco, Michael
Hanson, Dale
Hanson, Jan
Spike, Neil
Giddings, Pat
Mitchell, Ben
Stewart, Rebecca
Background: Medical boards and healthcare providers internationally are coming under increasing pressure to attract international medical graduates (IMGs) and overseas trained doctors (OTDs) to cope with predicted general practice (GP) doctor shortages. Various pathways to registration are made available for this purpose. There is very little understanding of the effects of different training pathways to licensing and registration on the ability of IMGs and OTDs, as well as locally trained doctors, to acquire the desirable professional skills deemed necessary for working effectively in the primary care sector.
Methods: Feedback from patients was collected at the end of their scheduled consultation with their doctor using a questionnaire consisting of 13 Likert scale items that asked them to rate their experience of the consultation. Feedback was obtained for doctors going through the Royal Australian College of General Practice (RACGP) Practice Experience Program (PEP) and the Australian General Practice Training Program (AGPT), with the former intended primarily for IMGs and OTDs, and the latter for local medical graduates including from New Zealand. Patient feedback was also obtained for patients visiting already Fellowed and experienced GPs for comparative purposes, resulting in data for three groups of doctors (two trainee, one already Fellowed). Rater consistency and agreement measures, analysis of variance, principal component analysis, t-tests and psychometric network analysis were undertaken between and within groups to identify similarities and differences in patient experience and professionalism of doctors.
Results: There was a small but significant difference in average patient raw scores given to PEP and AGPT doctors (90.25, 90.97%), with the highest scores for ‘Respect shown’ (92.24, 93.15%) and the lowest for ‘Reassurance’ 89.38, 89.84%). Male patients gave lower scores (89.56%) than female patients (91.23%) for both groups of doctors. In comparison, patients gave experienced GPs an average 91.38% score, with male patients giving a lower average score than female patients (90.62, 91.93%). Two components were found in the patient data (interpersonal communication, caring/empathy) that account for over 80% of the variance. When patient scores were aggregated by doctor, the average PEP and AGPT doctor scores received were 90.27 and 90.99%, in comparison to the average experienced GP score of 91.43%. Network analysis revealed differences in the connectedness of items between these two groups as well as in comparison with experienced GPs, suggesting that PEP doctors’ skills are less cohesively developed in the areas of listening ability, explaining and providing reassurance.
Conclusions: The small but statistically significant differences between doctor groups reported in this preliminary study are supplemented by percentile analysis, network analysis and principal component analysis to identify areas for further exploration and study. There is scope for improving the integration of interpersonal communication skills of GPs in Training with their caring and empathy skills, when compared with experienced GPs as a benchmark. Suggestions are made for enhancing professional skills from a patients’ perspective in future training programs.
BioMed Central
2022
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/76348/1/76348.pdf
https://doi.org/10.1186/s12909-022-03733-9
Narayanan, Ajit, Vayro, Caitlin, Greco, Michael, Hanson, Dale, Hanson, Jan, Spike, Neil, Giddings, Pat, Mitchell, Ben, and Stewart, Rebecca (2022) A comparison of patient appraisal of professional skills for GPs in training participating in differing education programs. BMC Medical Education, 22 (1). 669.
https://researchonline.jcu.edu.au/76348/
open
oai:researchonline.jcu.edu.au:76460
2024-02-28T15:09:35Z
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Cost impact of undertaking detection and management of familial hypercholesterolaemia in Australian general practice
Li, Ian W.
Watts, Rory
Brett, Tom
Radford, Jan
Heal, Clare
Gill, Gerard
Hespe, Charlotte
Vargas-Garcia, Cristian
Sullivan, David R.
Vickery, Alistair W.
Pang, Jing
Arnold-reed, Diane E.
Chan, Dick C.
Watts, Gerald F.
Background and Objectives: Familial hypercholesterolaemia (FH) can be effectively detected and managed in primary care, but the health economic evidence for this is scarce. The aim of this study was to examine management pathways and cost implications of FH screening and management in Australian general practice.
Methods: Cost-effectiveness outcomes were projected using a life table model. Data was used from 133 patients in 15 Australian general practice clinics from an earlier screening and management study. Costing and mortality data were sourced from governmental sources and published literature.
Results: Most patients had a regular general practice consultation at baseline (82%), though the proportion seen under a chronic disease management item at follow-up increased to 23%. The median cost of management was $275 per annum in the first year of management. Managing patients with statins up to the age of 60 years yielded an increase of 248,954 life-years at a cost of $759 million, representing a cost per life-year gained of $3047.
Discussion: Screening and management of FH in general practice has the potential for substantial health benefits while requiring relatively modest investments from the health system.
Royal Australian College of General Practitioners
2022
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/76460/1/76460.pdf
https://doi.org/10.31128/AJGP-09-21-6172
Li, Ian W., Watts, Rory, Brett, Tom, Radford, Jan, Heal, Clare, Gill, Gerard, Hespe, Charlotte, Vargas-Garcia, Cristian, Sullivan, David R., Vickery, Alistair W., Pang, Jing, Arnold-reed, Diane E., Chan, Dick C., and Watts, Gerald F. (2022) Cost impact of undertaking detection and management of familial hypercholesterolaemia in Australian general practice. Australian Journal of General Practice, 51 (8). pp. 604-609.
https://researchonline.jcu.edu.au/76460/
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oai:researchonline.jcu.edu.au:76461
2024-02-28T15:09:35Z
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Lifestyle interventions in the management of substance use disorder
Naren, Thileepan
Cook, Jon
Armstrong, Ferghal
Manger, Sam
BACKGROUND: Substance use disorder (SUD) is a persistent problem within society and an issue of increasing community awareness and concern. SUD is often comorbid with significant mental health challenges, trauma and negative social determinants of health. SUDs contribute to increased burden of chronic disease and can lead to increased mortality and shorter life expectancy, not just through overdose but also through increased rates of mental and physical chronic disease.
OBJECTIVE: The aim of this article is to explore the evidence regarding lifestyle interventions as either primary interventions or adjuncts to existing treatments for individuals with SUD.
DISCUSSION: Lifestyle interventions can play a significant part in the management of people with SUD. These interventions play a part in SUD treatment and relapse prevention as well as improving physical and mental health and quality of life. These interventions ideally can be instituted and managed through community services and primary care.
Royal Australian College of General Practitioners
2022
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/76461/1/76461.pdf
https://doi.org/10.31128/AJGP-02-22-6331
Naren, Thileepan, Cook, Jon, Armstrong, Ferghal, and Manger, Sam (2022) Lifestyle interventions in the management of substance use disorder. Australian Journal of General Practice, 51 (8). pp. 560-564.
https://researchonline.jcu.edu.au/76461/
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oai:researchonline.jcu.edu.au:76939
2022-12-05T23:22:51Z
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Patients reaching treatment targets with once-weekly semaglutide in real‑world practice: pooled analysis of four SURE studies
Rasalam, Roy
Rudofsky, Gottfried
Bodholdt, Ulrik
Catarig, Andrea-Mircea
Ekberg, Neda
Erhan, Umut
Liutkus, Joanne
Tariq, Mohd
Holmes, Patrick
Once weekly (OW) subcutaneous (s.c.) semaglutide is a glucagon‑like peptide-1 receptor agonist (GLP-1RA) approved for type 2 diabetes (T2D) treatment. Real-world evidence studies are important to understand the use of a drug in routine clinical practice and in diverse patient populations. This pooled post hoc analysis of four SURE studies (N=1,212) evaluated patients achieving HbA1c and weight-loss targets.These results from a real-world setting in five countries support the use of OW semaglutide in routine clinical practice in a broad range of adults with T2D.
Novo Nordisk
2022
Conference Item
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/76939/1/Patients%20reaching%20treatment%20targets%20with%20once-weekly%20semaglutide%20in%20real%E2%80%91world%20practice-%20pooled%20analysis%20of%20four%20SURE%20studies.pdf
Rasalam, Roy, Rudofsky, Gottfried, Bodholdt, Ulrik, Catarig, Andrea-Mircea, Ekberg, Neda, Erhan, Umut, Liutkus, Joanne, Tariq, Mohd, and Holmes, Patrick (2022) Patients reaching treatment targets with once-weekly semaglutide in real‑world practice: pooled analysis of four SURE studies. In: [Presented at the Australasian Diabetes Congress 2022]. From: Australasian Diabetes Congress 2022, 8-10 August 2022, Brisbane, QLD, Australia.
https://researchonline.jcu.edu.au/76939/
open
oai:researchonline.jcu.edu.au:76940
2024-03-02T14:58:54Z
7374617475733D707562
74797065733D61727469636C65
Effective primary care management of type 2 diabetes for indigenous populations: A systematic review
Chopra, Sahil
Lahiff, Tahne Joseph
Franklin, Richard
Brown, Alex
Rasalam, Roy
Background:
Indigenous peoples in high income countries are disproportionately affected by Type 2 Diabetes. Socioeconomic disadvantages and inadequate access to appropriate healthcare are important contributors.
Objectives:
This systematic review investigates effective designs of primary care management of Type 2 Diabetes for Indigenous adults in Australia, Canada, New Zealand, and the United States. Primary outcome was change in mean glycated haemoglobin. Secondary outcomes were diabetes-related hospital admission rates, treatment compliance, and change in weight or Body Mass Index.
Methods:
Included studies were critically appraised using Joanna Briggs Institute appraisal checklists. A mixed-method systematic review was undertaken. Quantitative findings were compared by narrative synthesis, meta-aggregation of qualitative factors was performed.
Results:
Seven studies were included. Three reported statistically significant reductions in means HbA1c following their intervention. Seven components of effective interventions were identified. These were: a need to reduce health system barriers to facilitate access to primary care (which the other six components work towards), an essential role for Indigenous community consultation in intervention planning and implementation, a need for primary care programs to account for and adapt to changes with time in barriers to primary care posed by the health system and community members, the key role of community-based health workers, Indigenous empowerment to facilitate community and self-management, benefit of short-intensive programs, and benefit of group-based programs.
Conclusions:
This study synthesises a decade of data from communities with a high burden of Type 2 Diabetes and limited research regarding health system approaches to improve diabetes-related outcomes. Policymakers should consider applying the seven identified components of effective primary care interventions when designing primary care approaches to mitigate the impact of Type 2 Diabetes in Indigenous populations. More robust and culturally appropriate studies of Type 2 Diabetes management in Indigenous groups are needed.
Public Library of Science
2022
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/76940/1/76940.pdf
https://doi.org/10.1371/journal.pone.0276396
Chopra, Sahil, Lahiff, Tahne Joseph, Franklin, Richard, Brown, Alex, and Rasalam, Roy (2022) Effective primary care management of type 2 diabetes for indigenous populations: A systematic review. PLoS ONE, 17 (11). e0276396.
https://researchonline.jcu.edu.au/76940/
open
oai:researchonline.jcu.edu.au:77088
2023-12-08T06:04:20Z
7374617475733D707562
74797065733D61727469636C65
Evaluation of Social Work Student Placements in General Practice
Zuchowski, Ines
McLennan, Simoane
Sen Gupta, Tarun
Social work and social work student placements in general practice [GP] can contribute to wholistic healthcare. The overall aims of this research were to develop, implement and evaluate a field education placement curriculum for social work student placements in GP clinics. Between December 2021 and June 2022, six students completed their social work placements in four GP practices in North Queensland. Data collection included student records and an online survey that invited students, field educators, task supervisors, mentors, allied health professionals and GPs to provide feedback about the usefulness of the developed materials, the benefits and challenges of the placements, the services provided by the students, patient outcomes and feedback, social work learning, service delivery overall and the value of, and satisfaction with, the social work GP placements. Social work student placements in GP practices offer a valuable broadening of field education learning opportunities for social work and can benefit GP settings. Such placements need to be particularly carefully scaffolded and supported through a comprehensive curriculum, supervision, and a welcoming GP setting. Students interested in embarking in such a learning journey need to be highly confident and competent in social work practice.
Oxford University Press
2023
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/77088/1/77088.pdf
https://doi.org/10.1093/bjsw/bcac244
Zuchowski, Ines, McLennan, Simoane, and Sen Gupta, Tarun (2023) Evaluation of Social Work Student Placements in General Practice. British Journal of Social Work, 53 (5). pp. 2762-2783.
https://researchonline.jcu.edu.au/77088/
open
oai:researchonline.jcu.edu.au:77203
2023-03-21T19:30:16Z
7374617475733D707562
74797065733D61727469636C65
Primary care and the older person with complex needs: reflections on the implementation of a primary–secondary model of integrated care
Mann, Jennifer
Devine, Sue
Strivens, Edward
The demand and complexity of the health needs of older people is growing. Traditionally siloed, condition-centric care is no longer appropriate. It is costly to the Australian health system and life-threatening to the individual. In parallel to demographic change is increasing global awareness of the impact of social, behavioural, and environmental factors on health outcomes. Although significant when not addressed, the amenable nature of many personal contextual factors is an opportunity to improve health and quality of life. A move away from reactive, episodic models of health care delivery towards patient focussed integrated care is required to meet the changing demands of an aging population. This forum article provides a reflection on the current state of integration for older people with complex needs through the lens of a local community facing model: OPEN ARCH. Australia still has some way to go to establishing system level enablers for an integrated approach to care. However, the OPEN ARCH experience furthers the evidence for ground-up approaches of integrated care that can meet the increasing demand and complexity of older people’s needs.
CSIRO Publishing
2022
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/77203/1/PY21236
https://doi.org/10.1071/PY21236
Mann, Jennifer, Devine, Sue, and Strivens, Edward (2022) Primary care and the older person with complex needs: reflections on the implementation of a primary–secondary model of integrated care. Australian Journal of Primary Health, 28 (6). pp. 469-473.
https://researchonline.jcu.edu.au/77203/
restricted
oai:researchonline.jcu.edu.au:78262
2024-02-28T14:26:01Z
7374617475733D707562
74797065733D61727469636C65
The COVID-19-forced transformation of general practitioner training from face-to-face to online delivery: A qualitative study of participants' experiences
Smith, Jane
Luhach, Ruchika
Sheldrake, Michelle
McArthur, Lawrie
Anderson, Emma
Dick, Marie Louise
BACKGROUND AND OBJECTIVES: Outside the clinical space, face-to-face education essentially stopped when the COVID-19 pandemic started, largely substituted by online education. This provided an opportunity to explore general practice registrar and educator views about the benefits, challenges and enablers of both types of educational delivery.
METHOD: This qualitative study included 45 registrars and medical educators from across Queensland, Australia. Transcripts of five focus groups and 22 semi-structured interviews were analysed thematically using the Framework Method.
RESULTS: Major themes focused on social connection, learning engagement, content delivery, and time and space in relation to education. Other themes included technology, unplanned learning, learning safety and pastoral care. Face-to-face education was viewed more positively than online education, but many suggested ways to enhance online education.
DISCUSSION: The importance of social connection dominated and underpinned many other themes identified as central to achieving safe and effective vocational general practitioner education.
Royal Australian College of General Practitioners
2022
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/78262/1/78262.pdf
https://doi.org/10.31128/AJGP-04-22-6385
Smith, Jane, Luhach, Ruchika, Sheldrake, Michelle, McArthur, Lawrie, Anderson, Emma, and Dick, Marie Louise (2022) The COVID-19-forced transformation of general practitioner training from face-to-face to online delivery: A qualitative study of participants' experiences. Australian Journal of General Practice, 51 (12). pp. 939-944.
https://researchonline.jcu.edu.au/78262/
restricted
oai:researchonline.jcu.edu.au:78422
2024-02-29T14:27:35Z
7374617475733D707562
74797065733D61727469636C65
Point-of-care ultrasound in general practice: an exploratory study in rural South Australia
Phillips, Hamish
Sukheja, Nitya
Williams, Susan
La Forgia, Adina
Nixon, Garry
McArthur, Lawrence A.
Gonzalez-Chica, David A.
Walters, Lucie
Introduction: Access to ultrasound imaging services is limited in rural areas and point-of-care ultrasound (POCUS) has the potential to address this gap. We aimed to examine how POCUS is utilised by doctors in contemporary Australian rural general practice.
Methods: A portable ultrasound machine and access to a training course were provided to four general practices in rural South Australia, and the type and frequency of POCUS scans were recorded, along with user information, between July 2020 and June 2021. Participating general practitioners (GPs) completed a survey at the commencement of the study regarding their previous experience and confidence in using POCUS for specific assessments and procedures.
Results: Of the 472 scans recorded, most (95%) were for clinical indications, 3% for teaching activities and 2% for self-learning. Overall, 69% were obstetric scans, followed by abdominal (12%), gynaecological procedures (10%), other procedural (7%) and thoracic exams (1.5%). Users reported higher confidence for lower complexity POCUS.
Conclusion: Although POCUS has diverse potential applications in rural practice, GPs reported limited confidence for certain scans and used POCUS predominantly for obstetric indications. Further studies should examine the barriers to POCUS utilisation, with particular attention to training requirements, reimbursement for use and access to machines.
James Cook University
2023
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/78422/1/78422.pdf
https://doi.org/10.22605/RRH7627
Phillips, Hamish, Sukheja, Nitya, Williams, Susan, La Forgia, Adina, Nixon, Garry, McArthur, Lawrence A., Gonzalez-Chica, David A., and Walters, Lucie (2023) Point-of-care ultrasound in general practice: an exploratory study in rural South Australia. Rural and Remote Health, 23. 7627.
https://researchonline.jcu.edu.au/78422/
open
oai:researchonline.jcu.edu.au:78529
2024-02-29T14:28:38Z
7374617475733D707562
74797065733D61727469636C65
A meta aggregation of qualitative research on retention of general practitioners in remote Canada and Australia
Wieland, Lara
Ayton, Jennifer E.
Abernethy, Gail
OBJECTIVE: Our aim was to systematically review qualitative evidence regarding the experiences and perceptions of general practitioners and what factors influence their retention in remote areas of Canada and Australia. The objectives were to identify gaps and inform policy to improve retention of remote general practitioners, which should in turn improve the health of our marginalised remote communities.
DESIGN: Meta-aggregation of qualitative studies.
SETTING: Remote general practice in Canada and Australia.
PARTICIPANTS: General practitioners and general practice registrars who had worked in a remote area for a minimum of one year and/or were intending to stay remote long term in their current placement.
RESULTS: Twenty-four studies were included in the final analysis. A total of 811 participants made up the sample with a length of retention ranging from 2 to 40 years. Six synthesised findings were identified from a total of 401 findings; these were around peer and professional support, organisational support, uniqueness of remote lifestyle and work, burnout and time off, personal family issues and cultural and gender issues.
CONCLUSIONS: Long term retention of doctors in remote areas of Australia and Canada is influenced by a range of negative and positive perceptions, and experiences with key factors being professional, organisational, or personal. All six factors span a spectrum of policy domains and service responsibilities and therefore a central coordinating body could be well placed to implement a multifactorial retention strategy.
Australian Rural Health Education Network
2023
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/78529/1/78529.pdf
https://doi.org/10.22605/RRH8149
Wieland, Lara, Ayton, Jennifer E., and Abernethy, Gail (2023) A meta aggregation of qualitative research on retention of general practitioners in remote Canada and Australia. Rural and Remote Health, 23 (1). 8149.
https://researchonline.jcu.edu.au/78529/
open
oai:researchonline.jcu.edu.au:79215
2023-07-08T19:30:03Z
7374617475733D707562
74797065733D61727469636C65
Enhancing the Detection and Care of Heterozygous Familial Hypercholesterolemia in Primary Care: Cost-Effectiveness and Return on Investment
Marquina, Clara
Morton, Jedidiah
Brett, Tom
Lloyd, Melanie
Radford, Jan
Heal, Clare
Hespe, Charlotte
Gill, Gerard
Sullivan, David
Zomer, Ella
Li, Ian
Pang, Jing
Watts, Gerald F.
Ademi, Zanfina
Background: Heterozygous familial hypercholesterolemia (HeFH) is under-detected and undertreated. A general practitioner-led screening and care program for HeFH effectively identified and managed patients with HeFH. We evaluated the cost-effectiveness and the return on investment of an enhanced-care strategy for HeFH in primary care in Australia.
Methods: We developed a multistate Markov model to estimate the outcomes and costs of a general practitioner-led detection and management strategy for HeFH in primary care compared with the standard of care in Australia. The population comprised individuals aged 50 to 80 years, of which 44% had prior cardiovascular disease. Cardiovascular risk, HeFH prevalence, treatment effects, and acute and chronic health care costs were derived from published sources. The study involved screening for HeFH using a validated data-extraction tool (TARB-Ex), followed by a consultation to improve care. The detection rate of HeFH was 16%, and 74% of the patients achieved target LDL-C (low-density lipoprotein cholesterol). Quality-adjusted life years, health care costs, productivity losses, incremental cost-effectiveness ratio, and return on investment ratio were evaluated, outcomes discounted by 5% annually, adopting a health care and a societal perspective.
Results: Over the lifetime horizon, the model estimated a gain of 870 years of life lived and 1033 quality-adjusted life years when the general practitioner-led program was employed compared with standard of care. This resulted in an incremental cost-effectiveness ratio of AU$14 664/quality-adjusted life year gained from a health care perspective. From a societal perspective, this strategy, compared with standard of care was cost-saving, with a return on investment of AU$5.64 per dollar invested.
Conclusions: An enhanced general practitioner-led model of care for HeFH is likely to be cost-effective.
Lippincott Williams & Wilkins
2023
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/79215/1/79215.pdf
https://doi.org/10.1161/CIRCGEN.122.003842
Marquina, Clara, Morton, Jedidiah, Brett, Tom, Lloyd, Melanie, Radford, Jan, Heal, Clare, Hespe, Charlotte, Gill, Gerard, Sullivan, David, Zomer, Ella, Li, Ian, Pang, Jing, Watts, Gerald F., and Ademi, Zanfina (2023) Enhancing the Detection and Care of Heterozygous Familial Hypercholesterolemia in Primary Care: Cost-Effectiveness and Return on Investment. Circulation: Genomic and Precision Medicine, 16. e003842. pp. 267-274.
https://researchonline.jcu.edu.au/79215/
restricted
oai:researchonline.jcu.edu.au:79533
2024-03-13T19:30:12Z
7374617475733D707562
74797065733D61727469636C65
Australian general practitioners' views on qualities that make effective discharge communication: a scoping review
Gusmeroli, Melinda
Perks, Stephen
Lanskey, Cassie
Bates, Nicole
Transitions of patient care between hospital discharge and primary care are known to be an area of high-risk where communication is imperative for patient safety. Discharge summaries are known to often be incomplete, delayed and unhelpful for community healthcare providers. The aim of this review was to identify and map the literature which discusses Australian general practitioners' (GPs) views on the qualities that make up effective discharge communication. Medline, Scopus and the Cochrane register of controlled drug trails and systematic reviews were searched for publications until October 2021 that discussed Australian GPs' views on discharge communication from hospital to general practice. Of 1696 articles identified, 18 met inclusion and critical appraisal criteria. Five studies identified that GPs view timeliness of discharge summary receipt to be a problem. Communication of medication information in the discharge summary was discussed in six studies, with two reporting that GPs view reasons for medication changes to be essential. Five studies noted GPs would prefer to receive clinical discipline or diagnosis specific information. Four studies identified that GPs viewed the format and readability of discharge summaries to be problematic, with difficulties finding salient information. The findings of this scoping review indicate that GPs view timeliness, completeness, readability, medication related information and diagnosis/clinical discipline specific information to be qualities that make up effective discharge communication from hospital to the community. There are opportunities for further research in perspectives of effective discharge communication, and future studies on interventions to improve discharge communication, patient safety and policy in transfers of care.
CSIRO Publishing
2023
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/79533/1/79533.pdf
https://doi.org/10.1071/PY22231
Gusmeroli, Melinda, Perks, Stephen, Lanskey, Cassie, and Bates, Nicole (2023) Australian general practitioners' views on qualities that make effective discharge communication: a scoping review. Australian Journal of Primary Health, 29 (5). pp. 405-415.
https://researchonline.jcu.edu.au/79533/
open
oai:researchonline.jcu.edu.au:80361
2024-03-13T19:30:15Z
7374617475733D707562
74797065733D61727469636C65
Medication reconciliation and discharge communication from hospital to general practice: A quantitative analysis
Gusmeroli, Melinda
Perks, Stephen
Bates, Nicole
Background: The aim of this study was to assess the quality of effective discharge communication to primary practice from a hospital that uses ieMR (integrated electronic Medical Record), a complete electronic prescribing/medical record platform.
Methods: A retrospective quantitative analysis of 232 discharge encounters from a major tertiary hospital assessed the discharge summary quality; timeliness, completeness and medication information.
Results: Median time to discharge summary was 1 day. 22.0% of discharge summaries were incomplete at 30 days post discharge and 44.5% of discharge summaries were incomplete at 30 days post discharge if discharged on a weekend compared to weekday (P-value = 0.001). Rates of medication reconciliation were completed at approximately 35% at each point of the patient stay and 56.9% of patients had a GP discharge summary listing discharge medications. However, if certain progressive steps were completed (i.e. Home Medications recorded in ieMR, Discharge Reconciliation in ieMR, and Patient Discharge Medication Record in eLMs (Enterprise-wide Liaison Medication System)), then, the 'Medications on Discharge' was significantly more likely to be present in the discharge summary, at rates of 70.1%, 85.9%, and 98.6% respectively (P-value = 0.007, <0.001, <0.001). Conversely not doing these steps dropped rates of having medications listed in the discharge summary to 50.0%, 40.3% and 34.1% respectively.
Conclusions: This study assessed current discharge summary quality since the introduction of electronic medical records. It demonstrated the significant value of correct use of electronic programs, including performing all crucial steps of reconciliation. Targeted interventions in future studies that rectify the shortfalls in discharge communication are warranted.
CSIRO Publishing
2023
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/80361/1/80361.pdf
https://doi.org/10.1071/PY22232
Gusmeroli, Melinda, Perks, Stephen, and Bates, Nicole (2023) Medication reconciliation and discharge communication from hospital to general practice: A quantitative analysis. Australian Journal of Primary Health, 29 (6). pp. 679-685.
https://researchonline.jcu.edu.au/80361/
open
oai:researchonline.jcu.edu.au:82036
2024-03-04T14:52:58Z
7374617475733D707562
74797065733D61727469636C65
Does use of GP and specialist services vary across areas and according to individual socioeconomic position? A multilevel analysis using linked data in Australia
Butler, Danielle C.
Larkins, Sarah
Jorm, Louisa
Korda, Rosemary J.
Objective Timely access to primary care and supporting specialist care relative to need is essential for health equity. However, use of services can vary according to an individual's socioeconomic circumstances or where they live. This study aimed to quantify individual socioeconomic variation in general practitioner (GP) and specialist use in New South Wales (NSW), accounting for area-level variation in use.
Design Outcomes were GP use and quality-of-care and specialist use. Multilevel logistic regression was used to estimate: (1) median ORs (MORs) to quantify small area variation in outcomes, which gives the median increased risk of moving to an area of higher risk of an outcome, and (2) ORs to quantify associations between outcomes and individual education level, our main exposure variable. Analyses were adjusted for individual sociodemographic and health characteristics and performed separately by remoteness categories. Setting Baseline data (2006-2009) from the 45 and Up Study, NSW, Australia, linked to Medicare Benefits Schedule and death data (to December 2012). Participants 267 153 adults aged 45 years and older.
Results GP (MOR=1.32-1.35) and specialist use (1.16-1.18) varied between areas, accounting for individual characteristics. For a given level of need and accounting for area variation, low education-level individuals were more likely to be frequent users of GP services (no school certificate vs university, OR=1.63-1.91, depending on remoteness category) and have continuity of care (OR=1.14-1.24), but were less likely to see a specialist (OR=0.85-0.95).
onclusion GP and specialist use varied across small areas in NSW, independent of individual characteristics. Use of GP care was equitable, but specialist care was not. Failure to address inequitable specialist use may undermine equity gains within the primary care system. Policies should also focus on local variation.
BMJ Group
2024
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/82036/1/82036.pdf
https://doi.org/10.1136/bmjopen-2023-074624
Butler, Danielle C., Larkins, Sarah, Jorm, Louisa, and Korda, Rosemary J. (2024) Does use of GP and specialist services vary across areas and according to individual socioeconomic position? A multilevel analysis using linked data in Australia. BMJ Open, 14 (1). e074624.
https://researchonline.jcu.edu.au/82036/
open
oai:researchonline.jcu.edu.au:82193
2024-03-12T01:43:39Z
7374617475733D707562
74797065733D61727469636C65
Evaluating an audit and feedback intervention for reducing overuse of pathology test requesting by Australian general practitioners: Protocol for a factorial cluster randomised controlled trial
O'Connor, Denise A.
Glasziou, Paul
Schram, Dina
Gorelik, Alexandra
Elwick, Amelia
McCaffery, Kirsten
Thomas, Rae
Buchbinder, Rachelle
Introduction Consistent evidence shows pathology services are overused worldwide and that about one-third of testing is unnecessary. Audit and feedback (AF) is effective for improving care but few trials evaluating AF to reduce pathology test requesting in primary care have been conducted. The aim of this trial is to estimate the effectiveness of AF for reducing requests for commonly overused pathology test combinations by high-requesting Australian general practitioners (GPs) compared with no intervention control. A secondary aim is to evaluate which forms of AF are most effective.
Methods and analysis This is a factorial cluster randomised trial conducted in Australian general practice. It uses routinely collected Medicare Benefits Schedule data to identify the study population, apply eligibility criteria, generate the interventions and analyse outcomes. On 12 May 2022, all eligible GPs were simultaneously randomised to either no intervention control or to one of eight intervention groups. GPs allocated to an intervention group received individualised AF on their rate of requesting of pathology test combinations compared with their GP peers. Three separate elements of the AF intervention will be evaluated when outcome data become available on 11 August 2023: (1) invitation to participate in continuing professional development-accredited education on appropriate pathology requesting, (2) provision of cost information on pathology test combinations and (3) format of feedback. The primary outcome is the overall rate of requesting of any of the displayed combinations of pathology tests of GPs over 6 months following intervention delivery. With 3371 clusters, assuming no interaction and similar effects for each intervention, we anticipate over 95% power to detect a difference of 4.4 requests in the mean rate of pathology test combination requests between the control and intervention groups.
Ethics and dissemination Ethics approval was received from the Bond University Human Research Ethics Committee (#JH03507; approved 30 November 2021). The results of this study will be published in a peer-reviewed journal and presented at conferences. Reporting will adhere to Consolidated Standards of Reporting Trials. Trial registration number ACTRN12622000566730.
BMJ Group
2023
Article
PeerReviewed
application/pdf
https://researchonline.jcu.edu.au/82193/1/82193.pdf
https://doi.org/10.1136/bmjopen-2023-072248
O'Connor, Denise A., Glasziou, Paul, Schram, Dina, Gorelik, Alexandra, Elwick, Amelia, McCaffery, Kirsten, Thomas, Rae, and Buchbinder, Rachelle (2023) Evaluating an audit and feedback intervention for reducing overuse of pathology test requesting by Australian general practitioners: Protocol for a factorial cluster randomised controlled trial. BMJ Open, 13 (5). e072248.
https://researchonline.jcu.edu.au/82193/
open