Increasing The Use Of Long-acting Reversible Contraception: The Australian Contraceptive ChOice PRoject (ACCORd)
Funder
National Health and Medical Research Council
Funding Amount
$726,144.00
Summary
Of all reversible contraceptive methods, long-acting reversible contraceptives (LARCs), such as intrauterine devices and hormone implants, are by far the most highly effective at preventing pregnancy. However, the prescription and use of LARCs amongst Australian women who are at risk of pregnancy is very low. To increase the uptake of LARCs, our study will trial a complex intervention that involves providing counselling to women and developing rapid referral pathways to LARC insertion.
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 Perntership Intervention Trial To Redress TreatmentDelay And Improve Outcomes In Rural Cancer Patients
Funder
National Health and Medical Research Council
Funding Amount
$1,258,784.00
Summary
Improving the poor outcomes in Australian cancer patients living in rural and remote areas is a national priority, but there is as yet insufficient evidence on how the problem is best tackled. In this project, partner organisations that deliver cancer services in non-metropolitan WA will team with experienced researchers to develop a ‘best prospects’ package of interventions targeting the community, medical and other health practitioners and patients with cancer; and to evaluate the effectivenes ....Improving the poor outcomes in Australian cancer patients living in rural and remote areas is a national priority, but there is as yet insufficient evidence on how the problem is best tackled. In this project, partner organisations that deliver cancer services in non-metropolitan WA will team with experienced researchers to develop a ‘best prospects’ package of interventions targeting the community, medical and other health practitioners and patients with cancer; and to evaluate the effectiveness of the package using a scientifically valid randomised controlled trial.Read moreRead less
Women's Evaluation Of Abuse And Violence Care Randomised Controlled Trial- Long Term Outcomes
Funder
National Health and Medical Research Council
Funding Amount
$284,391.00
Summary
Domestic violence has major health consequences and is a common hidden problem for women attending general practice. The project evaluates if a general practice intervention involving screening women for partner abuse, health provider education and brief counselling for women decreases partner abuse experienced and improves women's mental, physical health, parenting skills & quality of life long term (2 & 3 years after intervention). Further, to understand long term whether it is cost effective.
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
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
MOSAIC: A GP Cluster Randomised Trial To Reduce Partner Violence Among Pregnant Women And Women With Pre-school Children
Funder
National Health and Medical Research Council
Funding Amount
$432,250.00
Summary
Intimate partner abuse or domestic violence is common and damaging for women in the early childbearing years. It has a negative effect on the mental and physical health of women and their children. Because of poor health, victimised women and children are frequent attenders to family doctors (GPs), but doctors face many barriers in making an effective response. One of these barriers is the critical absence of evidence for what would help women attending GPs in dealing with partner abuse. This is ....Intimate partner abuse or domestic violence is common and damaging for women in the early childbearing years. It has a negative effect on the mental and physical health of women and their children. Because of poor health, victimised women and children are frequent attenders to family doctors (GPs), but doctors face many barriers in making an effective response. One of these barriers is the critical absence of evidence for what would help women attending GPs in dealing with partner abuse. This is vital to inform both GP training and clinical practice. There is sound evidence that home visiting or support by peers improves the health of disadvantaged mothers and children. Similarly, advocacy improves the health and wellbeing of abused women. The MOSAIC community intervention trial combines these two elements: home visiting-peer support and domestic violence advocacy and this strategy will be evaluated in a randomised trial. The trial aims to reduce partner abuse and depression among women pregnant or with children under 5 attending GPs. It also aims to strengthen mother-child bonds. Trained and supported GPs from 40 participating practices will identify 700 abused or at risk women over a 40 week period. Women in the intervention arm of the trial, identified as abused or at risk by their GPs will be offered the support of trained para-professional 'mentor mothers' for up to a year, while the comparison arm will be offered standard GP care. Recent funding allows a pilot study of mentor mother recruitment and training to be undertaken in 2003. The study will strengthen GP support for this difficult issue and build a 'critical mass' of GPs interested in partner abuse management in the 5 participating divisions. The MOSAIC study will assess the value to GPs and women of an enhanced support system for victims' care and provide much needed evidence of an intervention embedded in general practice to reduce partner abuse of pregnant women and women with young children.Read moreRead less
A Family-centred Intervention To Reduce Challenging Behaviours In Children With Acquired Brain Injury
Funder
National Health and Medical Research Council
Funding Amount
$87,926.00
Summary
Children with acquired brain injury (ABI) are at risk of behavioural and social difficulties. Parental distress compromises parenting abilities, with adverse effects for the child with ABI. This project investigates the applicability of a family-centred program for parents to manage the difficult behaviour of their children. It is expected that parents of children with ABI will benefit from the parenting skills taught in the program, and prevent difficult behaviour occurring in the future.
Can Preventive Care Activities In General Practice Be Sustained When Financial Incentives And External Audit Plus Feedback Are Removed? A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$1,201,443.00
Summary
There is increasing debate about the effectiveness of incentive payments and audit plus feedback on the clinical behaviour of general practitioners (GPs). Governments both in Australia and the UK are raising the threshold targets for payment eligibility making it more difficult for GPs to get payments. We will conduct a trial that will investigate the impact of removing financial incentives and/or external audit plus feedback on the preventive care activities of GPs.
The Diamond Cohort Study - Better Management Of Those At Risk Of Persistent And Disabling Depression
Funder
National Health and Medical Research Council
Funding Amount
$1,563,309.00
Summary
Diamond began in 2005 to follow over 500 people with depressive symptoms to document and describe the nature and course of depression and its’ management over a decade of a participant’s life. Our findings will help us to understand the factors associated with depression recovery, relapse and persistence. We will inform clinical practice by developing a tool to assist GPs to identify those at risk of persistent and disabling depression, to enable better treatments.