Women's Evaluation Of A Randomised Controlled Trial For Abuse And Violence In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$679,718.00
Summary
Domestic violence or intimate partner abuse (physical, emotional or sexual) is a common hidden problem for women attending general practice. It has major emotional and physical consequences for abused women of child bearing age and as a result they use medical services more frequently than non abused women. Doctors are often the first professional person that abused women tell and women report that doctors who have good communication skills encourage disclosure. This study will evaluate a brief ....Domestic violence or intimate partner abuse (physical, emotional or sexual) is a common hidden problem for women attending general practice. It has major emotional and physical consequences for abused women of child bearing age and as a result they use medical services more frequently than non abused women. Doctors are often the first professional person that abused women tell and women report that doctors who have good communication skills encourage disclosure. This study will evaluate a brief counselling intervention for abused women in general practice using a randomised controlled trial. General practice staff (general practitioners and-or practice nurses) will be randomised either to be intensively trained to deliver the intervention and their practice systems improved for care of abused women or to be given information to ensure minimum safe practice and deliver 'usual care' to abused women. The primary aim of the intervention is to increase abused women's safety behaviours and planning and improve their mental health and quality of life. Secondary aims include increasing their readiness for change and action with regard to abuse, and their comfort to discuss abuse with general practitioners-practice nurses and general practitioners-practice nurses inquiry about safety. It is not expected that in a twelve month period that any intervention with women will be able to decrease the abuse women experience as women cannot control their partners' behaviour and to leave is not necessarily going to end the violence and abuse. Rather, the intervention and outcomes will look at women's pathway and decision making around seeking safety and non-violence. A cost effective analysis will also be undertaken using health service use by women and costs of the intervention.Read moreRead less
Diagnosis, Management And Outcomes Of Depression In Primary Care (DIAMOND) - A Longitudinal Study
Funder
National Health and Medical Research Council
Funding Amount
$463,125.00
Summary
Depression is the single largest cause of disability for people in Australia. It is mainly managed in general practice, yet many people experiencing depression go unrecognised by their family doctor or general practitioner (GP). Some people, even when given treatment, remain depressed. Guides on how to manage depression have been mainly based upon people attending psychiatrists and hospitals. In addition, there have been a number of large studies overseas testing new ways of helping people with ....Depression is the single largest cause of disability for people in Australia. It is mainly managed in general practice, yet many people experiencing depression go unrecognised by their family doctor or general practitioner (GP). Some people, even when given treatment, remain depressed. Guides on how to manage depression have been mainly based upon people attending psychiatrists and hospitals. In addition, there have been a number of large studies overseas testing new ways of helping people with depression. Unfortunately, they do not seem any better than usual care by a GP. The proposed DIAMOND study will follow, over time, 900 people who receive care in general practice to investigate the factors, from the patients' and doctors' point of view, that are likely to aid recovery from depression, and prevent further episodes. We will investigate in detail the way in which a patient is cared for in the primary health care system. We will be able to describe the care patients receive from both doctors and other professionals, including alternative practitioners. This information will be used to develop a new way to improve the care that GPs provide to people experiencing depression. DIAMOND will give us important information about the impact of new Government policies on care in general practice. This will help to inform health workers, consumers and policy makers about what factors are key for treatment and recovery from depression.Read moreRead less
PEACH: Patient Engagement And Coaching For Health: An Intensive Treatment Intervention For Patients With Type 2 Diabetes
Funder
National Health and Medical Research Council
Funding Amount
$304,300.00
Summary
Diabetes care is a partnership between health professionals and patients, but each faces difficulties in optimising medical care. The PEACH study exoplores how practice nurses can work with patients to empower them to manage their own condition and medicines better and be more active in working with their doctor to improve their diabetes control. The study could have important implications for patients and the way Governments fund primary care.
Quit In General Practice: A Cluster Randomised Trial Of Enhanced In-practice Support For Smoking Cessation
Funder
National Health and Medical Research Council
Funding Amount
$1,117,241.00
Summary
Tobacco smoking remains the most common preventable cause of death and illness in Australia today. Smoking cessation programs are some of the most effective and cost effective strategies that can be undertaken in health care settings, including general practice. This project will test a new approach to supporting smoking cessation in general practice. This involves the practice nurse, GP and Quitline working in partnership to provide a flexible program of suport to meet the needs of smokers.
This study proposes to examine the quality of procedural medical care provided by rural doctors who are not specialists. The disciplines of Anaesthetics, Surgery and Obstetrics will be included. Most of these services in rural Australia are not provided by specialist medical practitioners, but rather by rural general practitioners who have obtained additional training, albeit shorter than that undertaken by specialist trainees, and who are supported by skilled nurses and other health professiona ....This study proposes to examine the quality of procedural medical care provided by rural doctors who are not specialists. The disciplines of Anaesthetics, Surgery and Obstetrics will be included. Most of these services in rural Australia are not provided by specialist medical practitioners, but rather by rural general practitioners who have obtained additional training, albeit shorter than that undertaken by specialist trainees, and who are supported by skilled nurses and other health professionals in relatively small rural hospitals. Patients and rural doctors often have little choice but to manage urgent cases locally and in some cases experienced and skilled local teams are able to offer a wider range of services, including a limited number of elective procedures. Despite underlying assumptions that the quality of the services cannot match that of specialist care in larger hospitals, there is no agreement on what constitutes quality of rural procedural care and little evidence that the quality is different. This issue is important as substantial government funds are spent on recruiting, training and retaining a qualified rural medical workforce, and yet fewer rural doctors are providing these services and fewer rural hospitals have the facilities to support those rural doctors still providing the services. Further, measuring the quality of care is a complex issue on which different stakeholders may have different views. This study proposes a multi-perspective approach to assessing the quality of care through a number of case studies provided by rural doctors.Read moreRead less
DESPATCH: DElivering Stroke Prevention For Atrial Fibrillation: Assisting Evidence-based CHoice In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$561,447.00
Summary
Non-valvular atrial fibrillation (NVAF) is a common heart condition associated with a major risk of fatal and disabling stroke. Inexpensive anticoagulant medication has been proven to reduce all-causes of death and stroke in patients with NVAF. Anticoagulant treatment for NVAF is substantially under-used resulting in avoidable patient deaths and disabling stroke. The National Institute of Clinical Studies of Australia summarised the large, unrealised benefit of anticoagulation, stating that 'eac ....Non-valvular atrial fibrillation (NVAF) is a common heart condition associated with a major risk of fatal and disabling stroke. Inexpensive anticoagulant medication has been proven to reduce all-causes of death and stroke in patients with NVAF. Anticoagulant treatment for NVAF is substantially under-used resulting in avoidable patient deaths and disabling stroke. The National Institute of Clinical Studies of Australia summarised the large, unrealised benefit of anticoagulation, stating that 'each year, for every 1000 patients with NVAF given anticoagulants, we can assume that about 25 fewer people will experience a stroke and 12 fewer will die from a stroke than would be the case if they were not given them'. Despite this realisation, there is a lack of evidence to support any strategy to improve the care of patients with NVAF. This study seeks to optimise the management of NVAF in general practice. The DESPATCH study will employ a rigorous randomised design to evaluate an innovative educational intervention intended to overcome barriers to the best management of NVAF. If successful, DESPATCH will inform policy and practice aimed at overcoming barriers to best practice for the large and growing number of people with NVAF to reduce the risk of fatal and disabling stroke.Read moreRead less
Changing Decision-making Behaviour In General Practice By Providing Access To Online Evidence.
Funder
National Health and Medical Research Council
Funding Amount
$206,375.00
Summary
The case for a shift to evidence-based practice, and the substantial economic and health outcome benefits of that shift, have been repeatedly made. Despite the vision, significant barriers to evidence-based practice remain, and the demonstration of a positive role for on-line systems would result in a significant change in strategies for clinician behaviour change. This study will make a specific and significant contribution to our understanding of the efficacy and effectiveness of online eviden ....The case for a shift to evidence-based practice, and the substantial economic and health outcome benefits of that shift, have been repeatedly made. Despite the vision, significant barriers to evidence-based practice remain, and the demonstration of a positive role for on-line systems would result in a significant change in strategies for clinician behaviour change. This study will make a specific and significant contribution to our understanding of the efficacy and effectiveness of online evidence retrieval systems as a component in any evidence-based strategy, through a rigorous and controlled approach to the study of clinical behaviour change. It will also provide a powerful test of the value of search filters as a specific technology in support of evidence retrieval. The focus on prescribing patterns in NHMRC priority areas as an outcome measure will also provide a significant data set reflecting current practice in primary care.Read moreRead less
Evaluating The Effectiveness Of Comprehensive Primary Health Care In Local Communities
Funder
National Health and Medical Research Council
Funding Amount
$1,635,268.00
Summary
This research will develop and implement a program logic evaluation in order to assess the effectiveness of various models of primary heatlh care service delivery. Although comprehensive primary health care holds considerable promise to meet the growing demands on the health system, it has not been thoroughly evaluated. Comprehensive primary health care is a large and complex area, therefore part of the project focuses on services and client experiences in two chromic diseases: diabetes and depr ....This research will develop and implement a program logic evaluation in order to assess the effectiveness of various models of primary heatlh care service delivery. Although comprehensive primary health care holds considerable promise to meet the growing demands on the health system, it has not been thoroughly evaluated. Comprehensive primary health care is a large and complex area, therefore part of the project focuses on services and client experiences in two chromic diseases: diabetes and depressionRead moreRead less
People who have experienced a previous heart attack or stroke are at greatest risk of having another cardiovascular event. Drug treatment, with aspirin and medication to lower blood pressure and cholesterol, has been shown to substantially reduce this risk. Despite good evidence that these drugs are effective, and that their use is recommended in both Australian and international guidelines, many people who should be taking these medications on a long-term basis are not. This may partly be due t ....People who have experienced a previous heart attack or stroke are at greatest risk of having another cardiovascular event. Drug treatment, with aspirin and medication to lower blood pressure and cholesterol, has been shown to substantially reduce this risk. Despite good evidence that these drugs are effective, and that their use is recommended in both Australian and international guidelines, many people who should be taking these medications on a long-term basis are not. This may partly be due to under-prescribing by doctors, but it is also likely that asymptomatic patients are discouraged by the cost and inconvenience of taking many tablets. In the first study of its kind in this country, we will determine whether a strategy based on the provision of recommended treatments in a single pill (a polypill) will result in better use of these drugs, and as a consequence, will achieve optimum practice in patients with heart disease or stroke. Under the care of their general practitioner, 1000 such patients will be randomly allocated to the polypill, or to continuing their usual treatment. At the end of 2 years, both groups will be assessed for the proportion of people still prescribed and taking all recommended treatments. We will also collect information on the attitudes and experiences of those participating in the study of prescribing (by doctors), dispensing (by pharmacists) and taking (by patients) the polypill. As cardiovascular diseases are the leading causes of illness and death in Australia, finding new ways to ensure the maximum use of known, effective preventive treatments in patients with heart disease and stroke, particularly to those who have less access to health care, is of critical importance. The polypill represents a novel strategy with the potential to achieve this objective, and to improve the clinical care and well-being of many thousands of Australians.Read moreRead less
The Evidence-based Consumer: Making Informed Decisions About Menopause, Hormone Replacement And Complementary Therapies
Funder
National Health and Medical Research Council
Funding Amount
$97,750.00
Summary
This project aims to find out whether providing women with information about menopause, and therapies to treat the symptoms and effects of menopause will change their use of hormone replacement therapy (HRT) or complementary therapies. A menopause information kit or brochure(s) with information about the risks and benefits of therapies and treatments for the symptoms and effects of menopause, will be provided to a group of women between the ages of 40 and 64 years. The information will be based ....This project aims to find out whether providing women with information about menopause, and therapies to treat the symptoms and effects of menopause will change their use of hormone replacement therapy (HRT) or complementary therapies. A menopause information kit or brochure(s) with information about the risks and benefits of therapies and treatments for the symptoms and effects of menopause, will be provided to a group of women between the ages of 40 and 64 years. The information will be based on up-to-date medical evidence about conventional HRT along with evidence about complementary therapies such as wild yam cream and herbal medicines. The information will outline the risks and benefits of these and other therapies as well as the proper use of HRT to control symptoms and effects of menopause. Current knowledge about reduction in heart disease risk and prevention of osteoporosis with the use of HRT, and the current knowledge about risk of ovarian, breast and uterine cancer will also be included in the information kit or brochure(s). The sample of women living in the Southern metropolitan region of South Australia will be included in the trial. They will be asked to complete a questionnaire and then some of the women will be asked to study the information about menopause and HRT. All participants will be asked to complete further questionnaires 3 months and 12 months later. The results will show whether providing women with information about menopause, HRT and complementary therapy will result in: 1. the women being more informed and better equipped to make the right decisions about treatment of the symptoms and effects of menopause, and 2. a more appropriate use of hormone replacement and complementary therapies to meet the individual needs of the women.Read moreRead less