A Randomised Trial Of A Clinical Prediction Tool For Targeting Depression Care (Target-D)
Funder
National Health and Medical Research Council
Funding Amount
$944,774.00
Summary
The Target-D Study uses a novel clinical prediction tool to test a new approach to depression care in general practice based upon sub-grouping patients into low, medium and high risk of ongoing depression. Participants will be randomly allocated to targeted treatments based upon their risk profile or to usual general practice care. We will measure whether the new approach results in greater improvements in depressive symptoms, quality of life and functioning and whether there are cost benefits.
A Randomised Controlled Trial To Evaluate The Effectiveness And Cost-effectiveness Of Chlamydia Testing In General Practice.
Funder
National Health and Medical Research Council
Funding Amount
$1,377,557.00
Summary
Chlamydia is a very common sexually transmissible infection in Australia that can lead to infertility in women. About 4% of young adults have it. Most people with chlamydia do not have any symptoms and will be unaware they have it. Chlamydia is easy to diagnose and treat, but it is not known whether regular testing can reduce its spread. We propose to conduct a trial to evaluate whether annual testing for 16 to 29 year olds works and whether it would be a good use of public health funds.
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.
The Role Of Spirometry In Managing Chronic Respiratory Diseases In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$487,427.00
Summary
This study will compare the use of spirometry (a lung function test) in general practice, with and without feedback of results, against the delivery of usual medical care without spirometry. If positive, the trial will result in better health outcomes for patients with chronic respiratory disease.
Implementing Clinical Practice Guidelines In General Practice: A Cluster Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$426,000.00
Summary
Evidence based clinical practice guidelines have the potential to improve clinical practice through providing health care workers with the most reliable information on which to base their treatment decisions. Many governments and organisations are investing significantly in the development of guidelines for common and important clinical disorders. To date, however, we do not fully understand how to increase the uptake of guidelines and facilitate health care workers to change their practice in l ....Evidence based clinical practice guidelines have the potential to improve clinical practice through providing health care workers with the most reliable information on which to base their treatment decisions. Many governments and organisations are investing significantly in the development of guidelines for common and important clinical disorders. To date, however, we do not fully understand how to increase the uptake of guidelines and facilitate health care workers to change their practice in line with the guideline's recommendations. This project aims to work with general practitioners to develop a method or strategy to increase the uptake of guidelines for the treatment of acute low back pain, particularly to reduce the number of patients who are unnecessarily x-rayed, and to increase advice to stay active. The effectiveness of the developed strategy will be tested by randomly assigning general practice clinics to either receive the intervention or to have access to the guidelines without any extra interventions (such as training and reminders) to help doctors change their practice. Both the doctor's practice, and patient outcomes of pain and disability will be measured to determine not only if the doctors followed the guidelines, but whether this resulted in an improvement in patient outcome. The findings of this study will help us understand the best ways to improve adhesion to guidelines and so has the potential to be applied to other conditions presenting to general practice where there are recommendations not currently being implemented into practice.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
Randomised Controlled Trial Of A Brief GP Intervention To Reduce Overweight In Victorian Primary School Children
Funder
National Health and Medical Research Council
Funding Amount
$662,600.00
Summary
Childhood overweight and obesity is one of the most pressing public health problems of our time. The aim of this study is to lower the levels of overweight and mild obesity in children aged 5-9 years, through sustainable family and child nutritional and-or physical activity behavioural choices that can be implemented by general practitioners (GPs). This trial addresses the urgent need identified in the 2003 NHMRC Clinical Practice Guidelines for the Management of Overweight and Obesity in Childr ....Childhood overweight and obesity is one of the most pressing public health problems of our time. The aim of this study is to lower the levels of overweight and mild obesity in children aged 5-9 years, through sustainable family and child nutritional and-or physical activity behavioural choices that can be implemented by general practitioners (GPs). This trial addresses the urgent need identified in the 2003 NHMRC Clinical Practice Guidelines for the Management of Overweight and Obesity in Children and Adolescents for simple, well-designed intervention studies which can be translated into usual clinical practice. Effective and coordinated universal prevention, secondary prevention and management services will all be needed to reduce the problem, and a great deal of research is needed in all of these. This proposal addresses the most neglected area of research - secondary prevention in the primary care sector. Through our previous research, we have already showed that this approach is feasible and acceptable to families and GPs. Our multidisciplinary research team is well-established, and we are not aware of any other research team in Australia that has the capacity and expertise to conduct this research at this point in time. In this randomised controlled trial, we expect a halving in the rate of gain in BMI over 6 and 12 months. This would equate to the average participant achieving a BMI of 25 (verging on overweight) rather than 30 (obese) by adulthood. If effective, we expect the following outcomes: 1) The adoption and maintenance of healthy lifestyle behaviours in that segment of the population which has most to gain over a lifetime - overweight and obese children 2) Documentation that general practitioners can make a significant contribution to combating the childhood obesity epidemic 3) A replicable, feasible, cost-effective primary care approach to childhood overweight-obesity tailored to the Australian health care system.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
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
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.