The Effect Of Glucosamine Sulphate On Structural Disease Progression In Knee Osteoarthritis
Funder
National Health and Medical Research Council
Funding Amount
$1,250,214.00
Summary
Osteoarthritis (OA) is a joint disease characterized by a progressive loss of cartilage and joint space resulting in increasing pain and difficulty performing usual daily activities. OA is the leading health problem amongst older Australians and a National Health Priority area. There is no known cure for OA and no intervention demonstrated to slow disease progression or delay time to joint replacement surgery. Currently patients are managed symptomatically with all clinical guidelines recommendi ....Osteoarthritis (OA) is a joint disease characterized by a progressive loss of cartilage and joint space resulting in increasing pain and difficulty performing usual daily activities. OA is the leading health problem amongst older Australians and a National Health Priority area. There is no known cure for OA and no intervention demonstrated to slow disease progression or delay time to joint replacement surgery. Currently patients are managed symptomatically with all clinical guidelines recommending paracetamol as 'the preferred long term oral analgesic'. This recommendation is based on the increased risk of serious gastrointestinal, cardiovascular and renal diseases with long-term NSAIDs use in older people. However, NSAIDs appear to provide better pain relief for patients with more than mild joint pain. Amongst patients with OA, there is much demand for the dietary supplement glucosamine sulphate. Product marketing has led to the belief that glucosamine is able to slow the rate of joint destruction and cartilage loss and help ease joint pain with, in contrast to NSAIDs, little risk of side effects. However, the few trials conducted to date have been inconclusive. If the marketing claims are unjustified, many older people are wasting limited financial resources and due to unrealistic expectations of the benefit of glucosamine, placing a lower priority on lifestyle changes of proven effectiveness, such as regular exercise and weight loss. A total of 900 patients with knee OA will be randomly allocated to glucosamine sulphate or matching placebo capsules for two years. The main outcomes will be the rate of joint space narrowing, use of NSAIDs and physical disability. If glucosamine results in slowing disease progression or in reducing NSAIDs consumption, the widespread use of this product would effectively decrease pain, disability and NSAIDs-related illnesses amongst the increasing number of people with OA.Read moreRead less
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.
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.
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.
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
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.
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