ORCID Profile
0000-0002-4582-7728
Current Organisation
University of Notre Dame Australia
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Publisher: Bentham Science Publishers Ltd.
Date: 03-2023
DOI: 10.2174/1573403X18666220512160737
Abstract: Heart failure (CHF) is predominately a chronic disease. There are overlaps in HF and chronic disease research and care. Chronic disease and HF research is conducted with multiple goals. The overarching goal is “optimized patient outcomes at maximum cost-effectiveness”. Observations and patients, however, can come with many variables thus, we see gaps in clinical translation. This document discusses an argument for three important gaps common to HF and chronic disease, i.e., screening, self-management, and patient-reported outcomes (PRO), and provides a glance of how it could fit into the evidence tree with a focus. Pertinent arguments for a framework for health services and models of care are provided as a prelude to future consensus. 1) A preliminary literature review to identify a taxonomy for cardiovascular research and 2) a review of the published literature describing the translation of research studies into clinical practice for cardiovascular disorders. We identified a spectrum from observational to large randomized controlled trials to post-marketing studies. Research design in context to the above gaps are discussed.We then propose 6 steps to facilitate this: 1) Research design 2) Research application (translation) i. routine ii. challenges 3. Transforming research to translational level 4. Funding and infrastructure 5. CCRE and collaboration 6. Governance and cost-efficacy. 1. Implementation research is a neglected area that aims to link research findings to improved patient outcomes, in an efficient and effective way. 2. Skills required to perform implementation research include a complex interplay of factors. 3. Ways to maximize translational impacts for chronic disease research to clinical practice are described in a CHF context.
Publisher: The Korean Society of Cardiology
Date: 2019
Publisher: The Royal Australian College of General Practitioners
Date: 09-2021
Publisher: Elsevier BV
Date: 08-2021
Publisher: The Royal Australian College of General Practitioners
Date: 12-2020
Publisher: Springer Science and Business Media LLC
Date: 16-04-2018
Publisher: The Royal Australian College of General Practitioners
Date: 08-2022
Publisher: Wiley
Date: 17-02-2019
DOI: 10.1111/AJO.12962
Abstract: Preconception care ( PCC ) defines health interventions prior to conception aimed at improving pregnancy and infant outcomes. To explore the understanding and provision of PCC by general practitioners ( GP s) within the Sydney Local Health District. A questionnaire developed with GP s assessed structure and content of PCC provided, attitudes toward PCC and perceived barriers and facilitators. One hundred and ten GP s completed the survey: 84% reported that GP s should be the main providers of PCC however, only 53% were aware of PCC guidelines. Seventy‐five percent of responders initiated PCC discussion with women of reproductive age, 56% provided PCC to women at higher risk of adverse outcomes and 16% waited for the discussion to be initiated by the patient. Smoking, vaccination, alcohol and supplements/medication use were the most discussed PCC components, while serology, full blood count and blood pressure were the most performed assessments. Most respondents stated that PCC is essential for women with pre‐existing diabetes, previous pregnancy complications or chronic illness. However, only 45% stated PCC was essential for women years and 39% for women who were overweight. Importantly, weight and mental health were among the least discussed PCC components. General practitioners are key providers of PCC however, only half are aware of PCC guidelines and most do not recognise overweight to be a significant preconception issue. The most common barriers to PCC delivery were time constraints, lack of knowledge and lack of resources for patients. Improved resources and education are required to support adequate PCC provision.
Publisher: Inishmore Laser Scientific Publishing Ltd
Date: 10-08-2020
DOI: 10.29392/001C.14149
Abstract: Cervical cancer is the second leading cause of cancer death among women in the Philippines. This study is the first clinical audit of a cervical cancer screening program in a socioeconomically deprived community in rural Philippines. The aim of this study was to quantify the proportion of women screened who were identified as having no cervical abnormality, low-grade squamous intraepithelial lesion (LSIL/CIN 1), high grade squamous intraepithelial lesion (HSIL/CIN 2) or carcinoma in situ (CIS) and to measure the proportion of women who received appropriate follow-up. Retrospective audit of data from medical records collected between 2013-2017 in Santo Tomas, Luzon, Philippines. 625 women presented for screening and 615 satisfactory screening tests were conducted. 88.4% of women had a normal result (95% confidence interval, CI=85.8-90.9), 10.2% had low-grade changes (95% CI=7.8-12.6), 0.3 % had high-grade changes (95% CI=0.0-1.0) and 0.5% were diagnosed with cervical cancer (95% CI=0.0-1.0). Follow-up was poor for women with normal (26.1% 95% CI=21.6-31.1) and abnormal (27.1% 95% CI=15.3-41.8) results. Our experience confirms previous studies surrounding barriers to follow up and treatment within developing countries and should be complemented with qualitative research to further explore these barriers. Given low rates of follow-up, a screen-and-treat approach and/or human papilloma virus (HPV) vaccination may be more appropriate within this community.
Publisher: Elsevier BV
Date: 10-2021
DOI: 10.1016/J.HLC.2021.04.005
Abstract: Cardiovascular disease (CVD) and risk factors remains a major burden in terms of disease, disability, and death in the Australian population and mental health is considered as an important risk factor affecting cardiovascular disease. A multidisciplinary collaborative approach in primary care is required to ensure an optimal outcome for managing cardiovascular patients with mental health issues. Medicare introduced numerous primary care health services and medications that are subsidised by the Australian government in order to provide a more structured approach to reduce and manage CVD. However, the utilisation of these services nor gender comparison for CVD management in primary care has been explored. Therefore, the aim is to compare the provision of subsidised chronic disease management plans (CDMPs), mental health care and prescription of guideline-indicated medications to men and women with CVD in primary care practices for secondary prevention. De-identified data for all active patients with CVD were extracted from 50 Australian primary care practices. Outcomes included the frequency of receipt of CDMPs, mental health care and prescription of evidence-based medications. Analyses adjusted for demography and clinical characteristics, stratified by gender, were performed using logistic regression and accounted for clustering effects by practices. Data for 14,601 patients with CVD (39.4% women) were collected. The odds of receiving the CDMPs was significantly greater amongst women than men (preparation of general practice management plan [GPMP]: (46% vs 43% adjusted OR [95% CI]: 1.22 [1.12, 1.34]). Women were more likely to have diagnosed with mental health issues (32% vs 20%, p<0.0001), however, the adjusted odds of men and women receiving any government-subsidised mental health care were similar. Women were less often prescribed blood pressure, lipid-lowering and antiplatelet medications. After adjustment, only an antiplatelet medication or agent was less likely to be prescribed to women than men (44% vs 51% adjusted OR [95% CI]: 0.84 [0.76, 0.94]). Women were more likely to receive CDMPs but less likely to receive antiplatelet medications than men, no gender difference was observed in the receipt of mental health care. However, the receipt of the CDMPs and the mental health treatment consultations were suboptimal and better use of these existing services could improve ongoing CVD management.
Publisher: Elsevier BV
Date: 07-2022
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/SH08013_CO
Abstract: Background: The brief period of viral replication in recurrent genital herpes lesions suggests shorter therapeutic regimens may be as effective as standard 5-day courses. Objective: To demonstrate that a 2-day course of famciclovir 500 mg statim, then 250 mg twice daily was non-inferior to the standard 5-day course of 125 mg twice daily. Methods: Patients were randomly assigned either the 2-day or 5-day famciclovir course and initiated therapy within 12 h of onset of prodromal symptoms. They were instructed to complete daily questionnaires on herpes-related symptoms and functioning and to attend the clinic for assessment of healing 5.5 days after initiating therapy. Results: A total of 873 patients were randomised at least once and 1038 recurrences were treated. The proportion of evaluable recurrences with lesions present at 5.5 days was less in the 2-day arm (24%) than in the 5-day (28%) arm. The upper 97.5% confidence limit (CL) for this difference in favour of the 2-day arm was 2% in favour of the 5-day arm, well within the 10% predefined for non-inferiority. The upper 97.5% CL was similar in the intent-to-treat, evaluable and per-protocol recurrence populations and when adjusted for baseline differences (in gender, age, herpes history and HIV infection) or for clustering of recurrences within patients. Both treatments had similar side-effects proportion of lesions aborted time to next recurrence patient-reported symptoms and impact on daily functioning. Conclusions: The 2-day course was as safe and effective as the standard 5-day course and can only enhance patient convenience and compliance.
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2020-043054
Abstract: To evaluate existing evidence for the use of probiotics in preventing antibiotic-associated diarrhoea (AAD) in adults. Systematic review and meta-analysis of randomised controlled trials (RCTs). We performed a literature search of the electronic databases CINAHL Plus, EMBASE, MEDLINE (Ovid) and Web of Science from database inception to May 2021 as well as hand searching of trial registries and reference lists of related reviews. Two reviewers identified whether RCTs met the following inclusion criteria: adult population to whom antibiotics were administered a probiotic intervention a placebo, alternative dose, alternative probiotic strain or no treatment control and incidence of AAD as the outcome. Two reviewers independently collected data and assessed risk of bias using preconstructed data extraction forms. We used a random effects model for all analyses. Subgroup analyses were performed to evaluate species-specific and dose-specific response. Forty-two studies (11,305 participants) were included in this review. The pooled analysis suggests that co-administration of probiotics with antibiotics reduces the risk of AAD in adults by 37% (risk ratio (RR)=0.63 (95% CI 0.54 to 0.73), p .00001). The overall quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria was found to be moderate. In subgroup analyses, high dose compared with low dose of the same probiotic demonstrated a positive protective effect (RR 0.54 (95% CI 0.38 to 0.76), p .01), and only certain species, mainly of the lactobacillus and bifidobacteria genera, were found to be effective. Studies with a low baseline AAD risk did not show any difference in risk but studies with moderate or high baseline AAD risk demonstrated a significant risk reduction. Probiotics are effective for preventing AAD. Secondary analyses of higher dosages and certain species have shown increased effectiveness. Our results may not be applicable in clinical scenarios of lower baseline AAD risk.
Publisher: Springer Science and Business Media LLC
Date: 10-10-2020
DOI: 10.1007/S41030-020-00131-8
Abstract: Generic substitution of inhaler devices is a relatively new phenomenon. The best patient outcomes associated with generic substitution occur when prescribers obtain consent from their patients to prescribe a generic inhaler and also teach their patient how to correctly use the new device. To date, no prospective observational study has assessed the level of training required for general practitioners (GPs) to demonstrate correct inhaler technique using two dry powder inhaler devices delivering fixed-dose combination budesonide/formoterol therapy. This study aims to (1) determine the level of training required for GPs to master and maintain correct IT when using two different dry powder inhalers that are able to be substituted in clinical practice and (2) determine the number and types of errors made by GPs on each device and inhaler device preference at each training visit. A randomized, parallel-group cross-over study design was used to compare the inhaler technique of participants with a Spiromax ® placebo device and a Turbuhaler ® placebo device. This study consisted of two visits with each participant over a period of 4 ± 1 weeks (visit 1 and visit 2). A total of six levels of assessment and five levels of training were implemented as required. Level 1, no instruction level 2, following use of written instruction level 3, following viewing of instructional video level 4, expert tuition from the researcher level 5/level 6, repeats of expert tuition from the researcher when required. Participants progressed through each level and stopped at the point at which they demonstrated device mastery. At each level, trained researchers assessed the inhaler technique of the participants. Participants were also surveyed about their previous inhaler use and training. In total, 228 GPs participated in this study by demonstrating their ability to use a Turbuhaler ® and a Spiromax ® device. There was no significant difference between the proportion of participants who demonstrated device mastery with the Turbuhaler ® compared with the Spiromax ® at level 1, (no instruction), (119/228 (52%) versus 131/228 (57%), respectively, n = 228, p = 0.323 (McNemar’s test of paired data). All but one participant had demonstrated correct inhaler technique for both devices by level 3(instructional video). There was a significant difference between the proportion of participants who demonstrated maintenance of device mastery with the Turbuhaler ® compared with the Spiromax ® at visit 2, level 1 (127/177 (72%) versus 151/177 (85%) respectively, p = 0.003 McNemar’s test of paired data). All but two participants achieved device mastery by level 3, visit 2. More participants reported previous training with the Turbuhaler ® than with Spiromax ® . This study demonstrates that GPs are able to equally demonstrate correct use of the Turbuhaler ® and Spiromax ® devices, even though most had not received training on a Spiromax ® device prior to this study. The significance of being able to demonstrate correct technique on these two devices equally has ramifications on practice and supported generic substitution of inhaler devices at the point of prescribing, as the most impactful measure a GP can take to ensure effective use of inhaled medicine is the correct demonstration of inhaler technique.
Publisher: Wiley
Date: 18-03-2019
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.AMEPRE.2017.06.016
Abstract: Primary care physicians are well placed to offer physical activity counseling, but insufficient time is a barrier. Referral to an exercise specialist is an alternative. In Australia, exercise specialists are publicly funded to provide face-to-face counseling to patients who have an existing chronic illness. This trial aimed to (1) determine the efficacy of primary care physicians' referral of insufficiently active patients for counseling to increase physical activity, compared with usual care, and (2) compare the efficacy of face-to-face counseling with counseling predominantly via telephone. Three-arm pragmatic RCT. Two hundred three insufficiently active (<7,000 steps/day) primary care practice patients (mean age 57 years 70% female) recruited in New South Wales, Australia, in 2011-2014. (1) Five face-to-face counseling sessions by an exercise specialist, (2) one face-to-face counseling session followed by four telephone calls by an exercise specialist, or (3) a generic mailed physical activity brochure (usual care). The counseling sessions operationalized social cognitive theory via a behavior change counseling framework. Change in average daily step counts between baseline and 12 months. Data were analyzed in 2016. Forty (20%) participants formally withdrew completion rates at 3 and 6 months were 64% and 58%, respectively. Intervention attendance was high (75% received five sessions). The estimated mean difference between usual care and the combined intervention groups at 12 months was 1,002 steps/day (95% CI=244, 1,759, p=0.01). When comparing face-to-face with predominantly telephone counseling, the telephone group had a non-significant higher mean daily step count (by 619 steps) at 12 months. Provision of expert physical activity counseling to insufficiently active primary care patients resulted in a significant increase in physical activity (approximately 70 minutes of walking per week) at 12 months. Face-to-face only and counseling conducted predominantly via telephone were both effective. This trial provides evidence to expand public funding for expert physical activity counseling and for delivery via telephone in addition to face-to-face consultations. This trial is registered at www.anzctr.org.au/ ACTRN12611000884909.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2012
Publisher: Springer Science and Business Media LLC
Date: 14-02-2020
DOI: 10.1186/S12875-020-01105-0
Abstract: Cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, is the leading cause of death and disability globally. A large proportion of mortality occurs in people with prior CHD and effective and scalable strategies are needed to prevent associated deaths and hospitalisations. The aim of this study is to determine if a practice-level collaborative quality improvement program, focused on patients with CHD, reduces the rate of unplanned CVD hospitalisations and major adverse cardiovascular events, and increases the proportion of patients achieving risk factor targets at 24 months. Cluster randomised controlled trial (cRCT) to evaluate the effectiveness of a primary care quality improvement program in 50 primary care practices (n~ 10,000 patients) with 24-month follow-up. Eligible practices will be randomised (1:1) to participate in either the intervention (collaborative quality improvement program) or control (standard care) regimens. Outcomes will be assessed based on randomised allocation, according to intention-to-treat. The primary outcome is the proportion of patients with unplanned CVD hospitalisations at 2 years. Secondary outcomes are proportion of patients with major adverse cardiovascular events, proportion of patients who received prescriptions for guideline-recommended medicines, proportion of patients achieving national risk factor targets and proportion with a chronic disease management plan or review. Differences in the proportion of patients who are hospitalised (as well as binary secondary outcomes) will be analysed using log-binomial regression or robust Poisson regression, if necessary. Despite extensive research with surrogate outcomes, to the authors’ knowledge, this is the first randomised controlled trial to evaluate the effectiveness of a data-driven collaborative quality improvement intervention on hospitalisations, CVD events and cardiovascular risk amongst patients with CHD in the primary care setting. The use of data linkage for collection of outcomes will enable evaluation of this potentially efficient strategy for improving management of risk and outcomes for people with heart disease. Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134 (dated 20th December 2019).
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2020-038870
Abstract: Cross-sectional, observational survey to describe the impact of allergic rhinitis (AR) on Australian children (2 to 15 years). Participants (n=1541), parents of children aged 2 to 15 years, provided information on behalf of themselves and one eligible child in their household using a custom-built online questionnaire. Children were allocated to case (AR) or control (No AR) analysis groups based on a validated screening questionnaire. The study s le was stratified on age: primary analysis population (6 to 15 years, n=1111 AR=797, No AR=314) exploratory population (2 to 5 years). The primary endpoint, parent-perceived burden, was quantified using a validated measure of health status and analysed via comparison of means. The majority of AR cases were treated (730/797 90.3%) and classified as having moderate-severe, intermittent AR (549/797 68.9%). Half reported adequate symptom control in the prior 2 weeks (389/797 48.8% OR=4.04 95% CI (CI) 2.24 to 7.31). Having AR was associated with worse overall health status (7.4 vs 8.4, mean difference (least squares mean difference (LSMD))=−0.99 95% CI −1.18 to −0.79), fewer days being happy (22.2 vs 25.9, LSMD=−3.68 95% CI −4.82 to −2.54) and more days of poor physical (2.82 vs 0.78, LSMD=2.04 95% CI 1.61 to 2.47) and emotional (2.14 vs 0.67, LSMD=1.47 95% CI 1.02 to −1.92) health compared with not having AR. All of these outcomes were significantly (p .05) worse in children who reported inadequate symptom control. Having AR negatively impacted on schoolwork, sleep and other activities, and increased the likelihood of having comorbidities. The parent-perceived burden of AR in Australian children is high and it impacts many areas of day-to-day living. Inadequate symptom control is a key driver of the extent of this impact. Opportunities to optimise the management of AR in children include the adoption of self-assessment tools to gauge and monitor adequacy of symptom control.
Publisher: Springer Science and Business Media LLC
Date: 30-07-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-09-2020
Abstract: Internationally, most atrial fibrillation (AF) management guidelines recommend opportunistic screening for AF in people ≥65 years of age and oral anticoagulant treatment for those at high stroke risk (CHA₂DS₂‐VA≥2). However, gaps remain in screening and treatment. General practitioners/nurses at practices in rural Australia (n=8) screened eligible patients (≥65 years of age without AF) using a smartphone ECG during practice visits. eHealth tools included electronic prompts, guideline‐based electronic decision support, and regular data reports. Clinical audit tools extracted de‐identified data. Results were compared with an earlier study in metropolitan practices (n=8) and nonrandomized control practices (n=69). Cost‐effectiveness analysis compared population‐based screening with no screening and included screening, treatment, and hospitalization costs for stroke and serious bleeding events. Patients (n=3103, 34%) were screened (mean age, 75.1±6.8 years 47% men) and 36 (1.2%) new AF cases were confirmed (mean age, 77.0 years 64% men mean CHA₂DS₂‐VA, 3.2). Oral anticoagulant treatment rates for patients with CHA₂DS₂‐VA≥2 were 82% (screen detected) versus 74% (preexisting AF)( P =NS), similar to metropolitan and nonrandomized control practices. The incremental cost‐effectiveness ratio for population‐based screening was AU$16 578 per quality‐adjusted life year gained and AU$84 383 per stroke prevented compared with no screening. National implementation would prevent 147 strokes per year. Increasing the proportion screened to 75% would prevent 177 additional strokes per year. An AF screening program in rural practices, supported by eHealth tools, screened 34% of eligible patients and was cost‐effective. Oral anticoagulant treatment rates were relatively high at baseline, trending upward during the study. Increasing the proportion screened would prevent many more strokes with minimal incremental cost‐effectiveness ratio change. eHealth tools, including data reports, may be a valuable addition to future programs. URL: www.anzctr.org.au . Unique identifier: ACTRN12618000004268.
Publisher: Wiley
Date: 20-05-2016
Abstract: Our primary aim was to analyse the quality of letters from general practitioners (GPs) to the ED as defined by two checklists: the authors' own nine-item list and a template published in 2013 by the New South Wales Agency for Clinical Innovation. The secondary aim was to determine if referral quality was influenced by letter format (handwritten or computer-generated) or urgency of the patient's condition (defined by triage category). The present study is a retrospective audit of records of patients presenting to Royal Prince Alfred Hospital ED from a GP during February and March 2014. Out of 12 199 ED presentations, 575 (4.7%) were recommended by a GP and 414 (72.0%) had a letter. Greater than 60% completion was achieved in 80.9% of letters compared to our own checklist, and in 6.3% compared to the Agency for Clinical Innovation checklist. Computer-generated letters were more likely to be fully legible and include an accurate medical history and medication list. Handwritten letters were less frequent (11.9%) but of poorer quality and legibility. Overall, less than half of letters contained results, psychosocial history or vaccination history. Referrals for patients assigned an urgent triage category were more likely to contain examination findings, but there was otherwise no difference in quality. Referral quality was influenced by letter format but not by urgency of the patient's condition. Omission of information from referral letters potentially risks patient safety. Handwritten referrals should be abandoned. Comprehensive electronic letter templates and regular updating of medications, comorbidities and allergies are encouraged.
Publisher: Wiley
Date: 03-10-2022
DOI: 10.1111/IMJ.15929
Abstract: Type 2 diabetes (T2D) is a well‐recognised cardiovascular disease (CVD) risk factor, and recent guidelines for the management of T2D include consideration of CVD risk. To assess whether contemporary clinical management of Australians with T2D is in accord with recent national and international guidelines. This Australia‐specific analysis of the CAPTURE study, a non‐interventional, cross‐sectional study included adults diagnosed with T2D ≥180 days prior to providing informed consent and visiting primary or specialist care. Main outcome measures were the use of blood glucose‐lowering medications (BGLMs), BGLMs with proven cardiovascular benefits and other CVD medications, stratified by CVD status and care setting. Of 824 Australian participants in the CAPTURE s le, 332 (40.3%) had CVD. Oral BGLMs were used by 83.9% of all participants, most commonly metformin (76.0%), dipeptidyl peptidase‐4 inhibitors (28.8%), sodium‐glucose cotransporter‐2 inhibitors (SGLT2is 21.8%) and sulfonylureas (21.7%). Insulin was used by 29.2% of participants. BGLMs with proven CV benefit were used by 22.6% glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) were less commonly used than SGLT2is in all CVD groups, but these drug classes were more often prescribed in specialist than primary care (SGLT2is 25.4 vs 20.7%, GLP‐1 RAs 3.2 vs 0.8% respectively). Use of non‐BGLMs for CVD risk reduction appeared consistent with guidelines. Use of BGLMs with CVD benefits appears low in Australia, irrespective of CVD status. This likely reflects the delay in translation of clinical evidence into contemporary care and prescribing restrictions.
Publisher: Elsevier BV
Date: 11-2023
Publisher: IMR Press
Date: 12-04-2022
Publisher: AMPCo
Date: 26-04-2021
DOI: 10.5694/MJA2.51030
Publisher: Wiley
Date: 06-2017
DOI: 10.1111/JPC.13557
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: Wiley
Date: 21-07-2021
DOI: 10.5694/MJA2.51190
Publisher: The Royal Australian College of General Practitioners
Date: 09-2022
Publisher: Oxford University Press (OUP)
Date: 03-01-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2012
Publisher: Elsevier BV
Date: 10-2018
Publisher: BMJ
Date: 10-2018
DOI: 10.1136/BMJOPEN-2018-023130
Abstract: Screening for atrial fibrillation (AF) in people ≥65 years is now recommended by guidelines and expert consensus. While AF is often asymptomatic, it is the most common heart arrhythmia and is associated with increased risk of stroke. Early identification and treatment with oral anticoagulants can substantially reduce stroke risk. The general practice setting is ideal for opportunistic screening and provides a natural pathway for treatment for those identified. This study aims to investigate the feasibility of implementing screening for AF in rural general practice using novel electronic tools. It will assess whether screening will fit within an existing workflow to quickly and accurately identify AF, and will potentially inform a generalisable, scalable approach. Screening with a smartphone ECG will be conducted by general practitioners and practice nurses in rural general practices in New South Wales, Australia for 3–4 months during 2018–2019. Up to 10 practices will be recruited, and we aim to screen 2000 patients aged ≥65 years. Practices will be given an electronic screening prompt and electronic decision support to guide evidence-based treatment for those with AF. De-identified data will be collected using a clinical audit tool and qualitative interviews will be conducted with selected practice staff. A process evaluation and cost-effectiveness analysis will also be undertaken. Outcomes include implementation success (proportion of eligible patients screened, fidelity to protocol), proportion of people screened identified with new AF and rates of treatment with anticoagulants and antiplatelets at baseline and completion. Results will be compared against an earlier metropolitan study and a ‘control’ dataset of practices. Ethics approval was received from the University of Sydney Human Research Ethics Committee on 27 February 2018 (Project no.: 2017/1017). Results will be disseminated through various forums, including peer-reviewed publication and conference presentations. ACTRN12618000004268 Pre-results.
Publisher: BMJ
Date: 20-05-2021
DOI: 10.1136/HEARTJNL-2020-318813
Abstract: Familial hypercholesterolaemia (FH) is characterised by elevated low-density lipoprotein (LDL)-cholesterol and increased risk of cardiovascular disease. However, FH remains substantially underdiagnosed and undertreated. We employed a two-stage pragmatic approach to identify and manage patients with FH in primary healthcare. Medical records for 232 139 patients who attended 15 general practices at least once in the previous 2 years across five Australian States were first screened for potential risk of FH using an electronic tool (TARB-Ex) and confirmed by general practitioner (GP) clinical assessment based on phenotypic Dutch Lipid Clinic Network Criteria (DLCNC) score. Follow-up GP consultation and management was provided for patients with phenotypic FH. A total of 1843 patients were identified by TARB-Ex as at potential risk of FH (DLCNC score ≥5). After GP medical record review, 900 of these patients (49%) were confirmed with DLCNC score ≥5 and classified as high-risk of FH. From 556 patients subsequently clinically assessed by GPs, 147 (26%) were diagnosed with phenotypic FH (DLCNC score 6). Follow-up GP consultation and management for 77 patients resulted in a significant reduction in LDL-cholesterol (−16%, p .01). A higher proportion of these patients attained the treatment target of 50% reduction in LDL-cholesterol (74% vs 62%, p .001) and absolute levels of LDL-cholesterol goals compared with baseline (26% vs 12%, p .05). A pragmatic approach integrating electronic medical record tools and clinical GP follow-up consultation is a feasible method to identify and better manage patients with FH in the primary healthcare setting. 12616000630415.
Publisher: Elsevier BV
Date: 10-2022
Publisher: AMPCo
Date: 02-09-2020
DOI: 10.5694/MJA2.50756
Publisher: Elsevier BV
Date: 2015
Publisher: Elsevier BV
Date: 02-2021
Publisher: Springer Science and Business Media LLC
Date: 14-04-2022
DOI: 10.1186/S12875-022-01692-0
Abstract: Quality improvement collaborative projects aim to reduce gaps in clinical care provided in the healthcare system. This study evaluated the experience of key participants from a Quality Improvement Program (QPulse) that focussed on cardiovascular disease assessment and management. The study goal was to identify critical barriers and factors enabling the implementation of a quality improvement framework in Australian general practice. This qualitative study examined in-depth semi-structured interviews with nineteen purposively-selected participants of the QPulse project. Interviewees were from General Practices and the local supporting organisation, a Primary Health Network. Interviews were analysed thematically using the Complex Systems Improvement framework, focusing on five domains: strategy, culture, structure, workforce and technology. Despite reported engagement with QPulse objectives to improve cardiovascular preventive care, implementation barriers associated with this program were considerable for all interviewees. Adoption of the quality improvement process was reliant on designated leadership, aligned practice culture, organised systems for clear communication, tailored education and utilisation of clinical audit and review processes. Rather than practice size and location, practice culture and governance alignment to quality improvement predicted successful implementation. Financial incentives for both general practice and the Primary Health Network were also identified as prerequisites for systematised quality improvement projects in the future, along with in idualised support and education for each general practice. Technology was both an enabler and a barrier, and the Primary Health Network was seen as key to assisting the successful utilisation of the available tools. Implementation of Quality Improvement programs remains a potential tool for achieving better health outcomes in General Practice. However, enablers such as financial incentives, in idualised education and support provided via a supporting organisation, and IT tools and support are crucial if the full potential of Quality Improvement programs are to be realised in the Australian healthcare setting. ACTRN12615000108516 , UTN U1111-1163–7995.
Publisher: Wiley
Date: 09-12-2023
DOI: 10.5694/MJA2.51803
Publisher: MDPI AG
Date: 29-08-2022
Abstract: As population aging progresses, demands of patients with cardiovascular diseases (CVD) on the primary care services is inevitably increased. However, the utilisation of primary care services across varying age groups is unknown. The study aims to explore age-related variations in provision of chronic disease management plans, mental health care, guideline-indicated cardiovascular medications and influenza vaccination among patients with CVD over differing ages presenting to primary care. Data for patients with CVD were extracted from 50 Australian general practices. Logistic regression, accounting for covariates and clustering effects by practices, was used for statistical analysis. Of the 14,602 patients with CVD (mean age, 72.5 years), patients aged 65–74, 75–84 and ≥85 years were significantly more likely to have a GP management plan prepared (adjusted odds ratio (aOR): 1.6, 1.88 and 1.55, respectively, p 0.05), have a formal team care arrangement (aOR: 1.49, 1.8, 1.65, respectively, p 0.05) and have a review of either (aOR: 1.63, 2.09, 1.93, respectively, p 0.05) than those 65 years. Patients aged ≥ 65 years were more likely to be prescribed blood-pressure-lowering medications and to be vaccinated for influenza. However, the adjusted odds of being prescribed lipid-lowering and antiplatelet medications and receiving mental health care were significantly lowest among patients ≥ 85 years. There are age-related variations in provision of primary care services and pharmacological therapy. GPs are targeting care plans to older people who are more likely to have long-term conditions and complex needs.
Publisher: AMPCo
Date: 02-08-2018
DOI: 10.5694/MJA18.00646
Abstract: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work-up acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies stroke prevention and optimal use of anticoagulants and integrated multidisciplinary care. Changes in management as a result of the guideline: Opportunistic screening in the clinic or community is recommended for patients over 65 years of age. The importance of deciding between a rate and rhythm control strategy at the time of diagnosis and periodically thereafter is highlighted. β-Blockers or non-dihydropyridine calcium channel antagonists remain the first line choice for acute and chronic rate control. Cardioversion remains first line choice for acute rhythm control when clinically indicated. Flecainide is preferable to amiodarone for acute and chronic rhythm control. Failure of rate or rhythm control should prompt consideration of percutaneous or surgical ablation. The sexless CHA2DS2-VA score is recommended to assess stroke risk, which standardises thresholds across men and women anticoagulation is not recommended for a score of 0, and is recommended for a score of ≥ 2. If anticoagulation is indicated, non-vitamin K oral anticoagulants are recommended in preference to warfarin. An integrated care approach should be adopted, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available. Regular monitoring and feedback of risk factor control, treatment adherence and persistence should occur.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2023
DOI: 10.1161/CIRCGEN.122.003842
Abstract: Heterozygous familial hypercholesterolemia (HeFH) is under-detected and undertreated. A general practitioner-led screening and care program for HeFH effectively identified and managed patients with HeFH. We evaluated the cost-effectiveness and the return on investment of an enhanced-care strategy for HeFH in primary care in Australia. We developed a multistate Markov model to estimate the outcomes and costs of a general practitioner-led detection and management strategy for HeFH in primary care compared with the standard of care in Australia. The population comprised in iduals aged 50 to 80 years, of which 44% had prior cardiovascular disease. Cardiovascular risk, HeFH prevalence, treatment effects, and acute and chronic health care costs were derived from published sources. The study involved screening for HeFH using a validated data-extraction tool (TARB-Ex), followed by a consultation to improve care. The detection rate of HeFH was 16%, and 74% of the patients achieved target LDL-C (low-density lipoprotein cholesterol). Quality-adjusted life years, health care costs, productivity losses, incremental cost-effectiveness ratio, and return on investment ratio were evaluated, outcomes discounted by 5% annually, adopting a health care and a societal perspective. Over the lifetime horizon, the model estimated a gain of 870 years of life lived and 1033 quality-adjusted life years when the general practitioner-led program was employed compared with standard of care. This resulted in an incremental cost-effectiveness ratio of AU$14 664/quality-adjusted life year gained from a health care perspective. From a societal perspective, this strategy, compared with standard of care was cost-saving, with a return on investment of AU$5.64 per dollar invested. An enhanced general practitioner-led model of care for HeFH is likely to be cost-effective.
Publisher: JMIR Publications Inc.
Date: 07-01-2015
DOI: 10.2196/RESPROT.3613
No related grants have been discovered for Charlotte M Hespe.