Stepping Up To Insulin: A Cluster Randomised Trial Of Team-based Transition To Insulin In Primary Care For Patients With Poorly Controlled Type 2 Diabetes
Funder
National Health and Medical Research Council
Funding Amount
$796,751.00
Summary
Helping people control their diabetes through the best possible medical care is important. Most people with diabetes eventually need insulin yet this is a step in treatment that is often resisted by patients and GPs. This study will help GPs and Practice Nurses work with patients who have reached this stage make the change to insulin treatment in a safe, effective, convenient and timely way. This will have enormous benefits through reduced diabetes complications and improved quality of life.
Measuring The Productive Efficiency Of Hospitals - A Comparison Of Parametric And Non-parametric Approaches
Funder
National Health and Medical Research Council
Funding Amount
$61,815.00
Summary
In the face of rising health service costs, an ageing population, and falling private health insurance rates, the efficient use of scarce health service resources has become a central theme in health system reform. Productive (or technical) efficiency is a key aspect of health system reform - that given health services are produced with the minimum feasible amount of resources. Despite the importance of technical efficiency there have been few published studies in Australia which measure technic ....In the face of rising health service costs, an ageing population, and falling private health insurance rates, the efficient use of scarce health service resources has become a central theme in health system reform. Productive (or technical) efficiency is a key aspect of health system reform - that given health services are produced with the minimum feasible amount of resources. Despite the importance of technical efficiency there have been few published studies in Australia which measure technical efficiency in the health sector. This study will develop theoretical and empirical approaches to measuring technical efficiency in the production of hospital services using data from Victoria. Measures of hospital technical efficiency will be developed using two quantitative modelling approaches: stochastic frontier modelling and data envelopment analysis. Results will be used to investigate the impact of patient and hospital characteristics on efficiency, and to identify economies of scale and scope in the provision of hospital services. The robustness of results to changes in variables, the sample of hospitals studied, and model assumptions will be tested, and two techniques will be compared to assess their appropriateness in the health services context which has not previously been done. Criteria for assessing the approaches include the degree to which: assumptions affect the robustness of results; the techniques capture the salient features of health services production; and the techniques produce similar rankings and estimates of inefficiency. The methods used will represent a significant contribution to international knowledge of hospital efficiency measurement, and the relationships between hospital characteristics, casemix, and efficiency. The study wil provide improved measures of hospital efficiency in Victoria, and will inform debate on hospital funding policy.Read moreRead less
Sedation Practice In Intensive Care Evaluation (SPICE) Randomised Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$2,752,725.00
Summary
Almost every patient in intensive care needs sedating drugs for comfort and provision of life-saving treatment. However, sedation causes side effects including coma, delirium and agitation. There is no high-level evidence to help doctors decide which sedatives to choose and the best way to administer them. The SPICE trial will test a new approach called Early Goal-Directed Sedation based on an alternative sedative agent to see whether it delivers safer, targeted light sedation with less delirium ....Almost every patient in intensive care needs sedating drugs for comfort and provision of life-saving treatment. However, sedation causes side effects including coma, delirium and agitation. There is no high-level evidence to help doctors decide which sedatives to choose and the best way to administer them. The SPICE trial will test a new approach called Early Goal-Directed Sedation based on an alternative sedative agent to see whether it delivers safer, targeted light sedation with less delirium.Read moreRead less
Primary Health Care Errors Study: Qualification And Quantification Of Errors Occurring In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$191,000.00
Summary
The General Practice Errors Study (GPES) is a project that aims to examine errors that GPs notice in their daily practice, that affect patient well-being or care. Very little work has been done on this subject in General Practice in any other country, and Australia is the only country with previous research that has attempted to describe GP errors with the Quality in Australia Health Care Study (QAHCS). However, we have so far not had any research that has been done on a representative sample of ....The General Practice Errors Study (GPES) is a project that aims to examine errors that GPs notice in their daily practice, that affect patient well-being or care. Very little work has been done on this subject in General Practice in any other country, and Australia is the only country with previous research that has attempted to describe GP errors with the Quality in Australia Health Care Study (QAHCS). However, we have so far not had any research that has been done on a representative sample of GPs, or been able to quantify the frequency with which different types of errors occur. This study plans to ask a representative sample of GPs in both urban and rural areas to report their errors, so that we can try to quantify the incidence and prevalence of these different error types. No previous work has been done in Primary care which has attempted to determine the rate of recognized errors that occur in the community. In addition, since the last major work on this topic was done between 1993 and 1998, there have been many changes to General Practice, especially in the area of computerisation, and the types of problems that GPs face now may have changed significantly. Anonymous reporting is very important in order to encourage health professionals to admit to their mistakes, and in the past, projects have used paper based reporting forms, making it difficult to offer anonymity and requiring protection for participants under a Commonwealth Act of Parliament. However the GPES project will be the first major study of General Practice errors that uses an on-line anonymous reporting form, and high level encryption, located on a secure web-site, to encourage honest reporting. The reporting form was trialled in the 2001 pilot study. By analysing the types of errors occurring, and their contributing factors, we can target at-risk population groups and develop strategies to improve patient care and prevent future harm.Read moreRead less
The number of Australians with dementia is increasing and so therefore is the frequency of people with dementia presenting to general practice. There is a recent evidence based clinical practice guideline to inform the diagnosis and management of people with dementia and the support of their carers. Many of the recommendations from this guideline are relevant to Australian general practitioners. Strategies to implement guidelines into practice are needed in all areas of health care, but changing ....The number of Australians with dementia is increasing and so therefore is the frequency of people with dementia presenting to general practice. There is a recent evidence based clinical practice guideline to inform the diagnosis and management of people with dementia and the support of their carers. Many of the recommendations from this guideline are relevant to Australian general practitioners. Strategies to implement guidelines into practice are needed in all areas of health care, but changing clinical practice is complex and a body of research developing methods of identifying barriers to specific practice changes is emerging. This project aims to support GPs in improving the general practice based care of people with dementia, and so improve their quality of life. In addition we aim to contribute to the body of knowledge about how to bring about practice change and implement a clinical practice guideline. We plan to design a strategy for implementing this new guideline into practice, working with GPs to change their practice where needed. We will test the effect of this strategy on the care of people with dementia, on their quality of life and on that of their carers.Read moreRead less
This Investigator Grant will transform the way follow-up care is delivered to thousands of cancer survivors who have completed treatment by using a shared-care approach between cancer specialists and GPs. This Grant will shift the paradigm of follow-up survivorship care from predominantly acute to primary care by maximising the involvement of GPs and reduce fragmentation of care. This approach is key to enhancing patient-centred care and system sustainability.
Trial Of Structured Support To Enhance The Role Of Non-GP Staff In Chronic Disease Management In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$780,625.00
Summary
Chronic disease presents a significant burden to individuals and the health care system , contributing to both an increasing proportion of the work of primary health care practitioners and to health expenditure. A number of interventions have been shown to result in sustained improvement of health outcomes for people with chronic diseases, including: more effective use of non-physician providers of care and nurse case management; integration of self-management support programs with guideline bas ....Chronic disease presents a significant burden to individuals and the health care system , contributing to both an increasing proportion of the work of primary health care practitioners and to health expenditure. A number of interventions have been shown to result in sustained improvement of health outcomes for people with chronic diseases, including: more effective use of non-physician providers of care and nurse case management; integration of self-management support programs with guideline based treatment plans; more intensive follow up and registries that provide reminders and feedback. While some of these approaches have been pursued within the Coordinated Care Trials and the Enhanced Primary Care (EPC) program in Australia, the role of non medical staff within general practice in chronic disease care has not been systematically investigated. In 2001 the Commonwealth introduced a number of initiatives to support better quality of care for diabetes and asthma in general practice and $104.2 million over four years was provided for general practices in areas of high workforce pressure to employ more Nurses. The roles of the Practice Manager and Receptionist have received much less attention. They include faclitating access to care, supporting the delivery of quality clinical care by the practitioners through the provision of expert management services (primarily information technology, staff, financial and facilities management) to the practice. With recent government initiatives expanding the role of general practice in Australia, effective management structures and processes within general practices are vital. Non-GP general practice staff may be the means by which more effective chronic disease management can be achieved at a time of increasing workforce pressure. This project aims to evaluate the impact of a program in which non-GP staff are trained and facilitated to be involved in the management of patients with chronic disease.Read moreRead less