Computer-assisted Clinical Guidelines For The Management Of Manifestations Of Anxiety, Aggression And Depression
Funder
National Health and Medical Research Council
Funding Amount
$354,032.00
Summary
This project focuses on creating a new approach to integration of clinical guidelines and the development of a computer-assisted tool to support medical reasoning in psychogeriatrics. The primary focus of this research is on helping medical practitioners to better manage dementia patients with symptoms of anxiety, aggression and depression living in nursing homes. It has the potential to fundamentally improve the way guidelines are utilised in clinical practice
Improving The Care For People With Acute Low Back Pain By Allied Health Professionals: Cluster RCT.
Funder
National Health and Medical Research Council
Funding Amount
$682,134.00
Summary
The project focuses on the NHMRC Clinical Practice Guidelines (CPG) for the management of acute low back pain, and more specifically the key messages of non-referral to x-ray and advising patients to stay active. A mixed design approach will be used in line with the framework for evaluating complex interventions (MRC 2000). A qualitative approach using semi-structured interviews with physiotherapists, chiropractors and the patients of both will be conducted to identify the barriers and enablers ....The project focuses on the NHMRC Clinical Practice Guidelines (CPG) for the management of acute low back pain, and more specifically the key messages of non-referral to x-ray and advising patients to stay active. A mixed design approach will be used in line with the framework for evaluating complex interventions (MRC 2000). A qualitative approach using semi-structured interviews with physiotherapists, chiropractors and the patients of both will be conducted to identify the barriers and enablers to implementation of the evidence-based clinical practice guideline. The interviews will be underpinned by a theoretical framework grounded in behavioural theory. Information from the interviews will be used to develop a survey to canvas views of a larger population of chiropractors and physiotherapists. The results of the interviews and survey will inform the development of a targeted implementation strategy suitable for use in private physiotherapy and chiropractic clinics. Potential interventions include educational strategies, patient and practitioner information via various media, reminder systems and peer leadership. A cluster randomised controlled trial (C-RCT) will then be conducted to determine the effects of the strategy. Practices will be randomised to receive either the developed implementation strategy, including strategies targeted at clinicians and patients, or to a control group receiving access to the guideline alone. The outcomes of the implementation strategy will be assessed at the level of the practitioner (did the strategy result in a change of practice?), and the patient (did the practice change result in improved patient outcomes?). Subgroup analyses will investigate effects specific to chiropractors and physiotherapists.Read moreRead less
A Cluster Randomised Controlled Trial Of Nurse And General Practitioner Partnership For Care Of COPD
Funder
National Health and Medical Research Council
Funding Amount
$449,377.00
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that can progress to severe disability and use of hospital services. It is an important cause of both death and disability in Australia. Specifically it is the third leading cause of disease burden after heart disease and stroke. Smoking is the most important cause of the disease and there is strong evidence that smoking cessation will largely prevent progression of COPD. National evidence based guidelines for management of COPD w ....Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that can progress to severe disability and use of hospital services. It is an important cause of both death and disability in Australia. Specifically it is the third leading cause of disease burden after heart disease and stroke. Smoking is the most important cause of the disease and there is strong evidence that smoking cessation will largely prevent progression of COPD. National evidence based guidelines for management of COPD were published in 2003 but these need to be implemented in the community. General practice is well placed to have a key role in early intervention and evidence based management of COPD. There is evidence that specialised nurses working in collaboration with GPs can improve the care the chronic illnesses including COPD. Care Plans with input from health professionals from a range of disciplines have been recommended for COPD but there are barriers to implementing these in general practice. This project brings together nurse assistance and care planning in a model of care designed to deliver best practice management of COPD in the community. The aim of this research is to evaluate the impact of anurse and GP partnership for care of COPD. We will examine the effect on quality of care and health outcomes at 6 and 12 months follow up. Our hypothesis is that the use of a nurse to work as a team with the patient and GP to develop and implement a care plan based on clinical practice guidelines will improve the quality of care received and have a beneficial effect on the patients' respiratory and overall health. This research will be of major significance for improving COPD care in the community and will have far reaching implications for both policy and practice. It will also define a new role for nurses and GPs working in partnership.Read moreRead less
A Randomized Comparison Evaluating The Value Of High-sensitivity Troponin In The Efficient Management Of Chest Pain Patients Across The Spectrum Of Risk For An Acute Coronary Syndrome
Funder
National Health and Medical Research Council
Funding Amount
$508,567.00
Summary
Chest pain patients are a large burden of emergency department demand. Their effective care requires timely risk assessment. High-sensitivity assays for cardiac muscle damage (troponin) increases the ability to detect patients with heart attacks, but may also lead to more abnormal results from other causes and more admissions. This randomized trial of current troponin versus a new troponin assays with robust initial evaluation of patient risk will provide a rationale for their use in modern care ....Chest pain patients are a large burden of emergency department demand. Their effective care requires timely risk assessment. High-sensitivity assays for cardiac muscle damage (troponin) increases the ability to detect patients with heart attacks, but may also lead to more abnormal results from other causes and more admissions. This randomized trial of current troponin versus a new troponin assays with robust initial evaluation of patient risk will provide a rationale for their use in modern care.Read 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
Methods For Evaluating The Therapeutic Impact Of Diagnostic Tests - Development Of Guidelines
Funder
National Health and Medical Research Council
Funding Amount
$132,325.00
Summary
New diagnostic tests are frequently adopted in clinical practice without any evidence that they improve patient outcomes. This project will produce the first guidelines about the role and optimal design of studies assessing the impact of a new test on therapeutic decisions for conclusions about its clinical value. This work will inform researchers and clinicians to improve evidence-based diagnostic practice and promote the more efficient use of limited health care resources.
Multicentre Evaluation Of A Clinical Pathway For Chronic Cough In Children- Can Its Use Improve Clinical Outcomes
Funder
National Health and Medical Research Council
Funding Amount
$971,362.00
Summary
Chronic cough is a common presenting symptom to doctors. It is associated with significant morbidity and may be a symptom of a serious underlying problem. This is especially pertinent to Aboriginal children. In this study we will examine the utility and efficacy of an evidence based clinical pathway for the management of chronic cough in Aboriginal and non-Aboriginal children. This study will contribute to clinical policy and improve clinical outcomes and early diagnosis of respiratory illnesses
A Randomised Controlled Trial Of Evidence Based Medicine In The Management Of Hypertension
Funder
National Health and Medical Research Council
Funding Amount
$319,475.00
Summary
Hypertension is a major condition managed in general practice. The condition is under diagnosed and under treated. Where hypertension is treated, it is often with drugs that are expensive rather than with equally efficacious inexpensive drugs. Hypertension is associated with higher risk of stroke, coronary artery disease, cardiac failure, renal disease and peripheral vascular disease. Clear evidence-based information has been available for some years that provide reasonably guidelines to practit ....Hypertension is a major condition managed in general practice. The condition is under diagnosed and under treated. Where hypertension is treated, it is often with drugs that are expensive rather than with equally efficacious inexpensive drugs. Hypertension is associated with higher risk of stroke, coronary artery disease, cardiac failure, renal disease and peripheral vascular disease. Clear evidence-based information has been available for some years that provide reasonably guidelines to practitioners of the treatment thresholds for hypertension. However, the incorporation of this evidence into general practice has been slow. This project will build upon extensive pilot work to create a system to collect diagnostic, treatment and outcome data from general practice patients. The use of peer-compared feedback, particularly related to a readily understandable health outcome measure such as blood pressure, can change clinical behaviour when provided to the treating clinician. The aim of this project is to show whether or not training in the use of an evidence-based guideline to assist doctors in the decision of whether or not to initiate antihypertensive treatment, and to provide guidance on the type of treatment, leads to better outcomes than that of feedback alone. A cost-benefit analysis will clarify the impact of guideline implementation on health care costs. The incorporation into the cost-benefit analysis of patients perceptions of treatment by doctors using a guideline will show how such practice, compared with standard care, is valued by patients. While the project will focus on hypertension, the database members will continue to develop the research capability of the database, and expand it to incorporate a range of evidence-based information to improve the quality of care for other conditions. The database could achieve an expanding and sustainable influence on the quality of primary health care.Read moreRead less
Improving Asthma Control: General Practice Strategies To Optimise Medication Adherence
Funder
National Health and Medical Research Council
Funding Amount
$460,820.00
Summary
Asthma is a major health problem for Australia. Many patients have frequent symptoms and need urgent health care because they do not use a preventer inhaler regularly. This may be intentional e.g. fear of side-effects, and-or unintentional e.g. forgetting. This real-life study will test two simple strategies for GPs to improve their patients' use of preventer medications, to improve asthma control. Innovative technology will allow GPs to tailor the approach to each patient during a normal visit.