ORCID Profile
0000-0001-9028-1835
Current Organisation
University of Adelaide
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Publisher: AMPCo
Date: 07-2009
Publisher: AMPCo
Date: 06-2011
DOI: 10.5694/J.1326-5377.2011.TB03133.X
Abstract: To examine vertical integration of teaching and clinical training in general practice and describe practical ex les being undertaken by Australian general practice regional training providers (RTPs). A qualitative study of all RTPs in Australia, mid 2010. All 17 RTPs in Australia responded. Eleven had developed some vertical integration initiatives. Several encouraged registrars to teach junior doctors and medical students, others encouraged general practitioner supervisors to run multilevel educational sessions, a few coordinated placements, linkages and support across their region. Three RTPs provided case studies of vertical integration. Many RTPs in Australia use vertical integration of teaching in their training programs. RTPs with close associations with universities and rural clinical schools seem to be leading these initiatives.
Publisher: Springer Science and Business Media LLC
Date: 16-06-2008
Publisher: Springer Science and Business Media LLC
Date: 08-06-2012
Publisher: Elsevier BV
Date: 11-2013
Publisher: Springer Science and Business Media LLC
Date: 26-05-2011
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/PY13133
Publisher: Therapeutic Guidelines Limited
Date: 04-06-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2018
Publisher: Springer Science and Business Media LLC
Date: 18-11-2021
DOI: 10.1186/S12913-021-07274-7
Abstract: The high and increasing demand for obstructive sleep apnea (OSA) care has exceeded the capacity of specialist sleep services prompting consideration of whether general practitioners could have an enhanced role in service delivery. However, little is known about the current involvement, experiences and attitudes of Australian general practitioners towards OSA. The purpose of this study was to provide an in-depth analysis of Australian general practitioners’ experiences and opinions regarding their care of patients with OSA to inform the design and implementation of new general practice models of care. Purposive s ling was used to recruit participants with maximum variation in age, experience and location. Semi-structured interviews were conducted and were analysed using Thematic Analysis. Three major themes were identified: (1) General practitioners are important in recognising symptoms of OSA and facilitating a diagnosis by others (2) Inequities in access to the assessment and management of OSA and (3) General practitioners currently have a limited role in the management of OSA. When consulting with patients with symptoms of OSA, general practitioners see their primary responsibility as providing a referral for diagnosis by others. General practitioners working with patients in areas of greater need, such as rural/remote areas and those of socio-economic disadvantage, demonstrated interest in being more involved in OSA management. Inequities in access to assessment and management are potential drivers for change in future models of care for OSA in general practice.
Publisher: Springer Science and Business Media LLC
Date: 21-11-2012
Publisher: Annals of Family Medicine
Date: 05-2017
DOI: 10.1370/AFM.2066
Publisher: Massachusetts Medical Society
Date: 18-10-2018
Publisher: Massachusetts Medical Society
Date: 18-10-2018
Publisher: Wiley
Date: 26-03-2010
DOI: 10.1111/J.1753-6405.1989.TB00706.X
Abstract: Systematic screening of patients for areas of health risk in their lifestyle has much potential for primary health care clinicians as a cost-effective and time saving means to identify 'at risk' in iduals. In the area of alcohol and drug problems, such early identification increases the likelihood of successful intervention. The present study, conducted at a general practice unit, compared the use of a computer to screen for alcohol and drug use with the two more traditional assessment methods of face-to-face interview and paper and pencil questionnaire. It was found that levels of reported consumption were similar across assessment methods. Although the interview method was strongly preferred overall, patients' preference for the computer increased significantly after use. The computer was also found to be more acceptable to patients reporting non-medical drug use, a potentially threatening and sensitive issue. There was a low refusal rate and most patients were willing to allow their doctor to see the assessment results. This indicates that screening for alcohol and drug use is acceptable to general practice patients, and that the computer can play a useful role as a prevention aid.
Publisher: Massachusetts Medical Society
Date: 18-10-2018
Publisher: Springer Science and Business Media LLC
Date: 22-07-2021
DOI: 10.1186/S12875-021-01510-Z
Abstract: Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. A descriptive, pragmatic qualitative study. Purposive s ling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using thematic analysis. Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care 2) Complexities in managing insomnia and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited. General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners. Greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services, such as benzodiazepine withdrawal support and psychologists, would benefit insomnia management within general practice.
Publisher: CSIRO Publishing
Date: 28-04-2022
DOI: 10.1071/PY21204
Abstract: Despite the importance of prevention in general practice, electronic clinical record systems used in Australian general practice do not present a comprehensive overview of each patient’s preventive care status to general practitioners or patients. Data relevant to prevention is scattered between different parts of the patient’s record. On-screen reminders to general practitioners are simplistic and easily overlooked, and no reminders are sent automatically to patients. There is no structured means to note a patient’s refusal or ineligibility for a particular preventive activity. Electronic clinical record systems should be enhanced to allow patients to be invited automatically, at appropriate times, to review and respond to comprehensive information and advice about preventive care that is recommended for them. Users of electronic clinical record systems will need to lobby their software vendors to have the proposed enhancements made.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/PY20115
Abstract: Diagnostic uncertainty when considering prescription of antimicrobials (‘antibiotics’) in primary care contributes to the major problem of microbial resistance. We conducted a feasibility evaluation of rapid testing for leucocyte and differential count in two urban general practices, surveying the GPs online and interviewing them. GPs reported that the machines were easy to use, the test results influenced their care and they would adopt the system if costs were off-set. Feasibility, acceptability and perceived benefit justify a randomised trial to test the effect on antibiotic prescribing rates and quality of care, with an economic evaluation to inform the cost-benefit.
Publisher: Research Square Platform LLC
Date: 10-12-2020
DOI: 10.21203/RS.3.RS-119933/V1
Abstract: Background Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as first line treatment for insomnia however, research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. Methods A descriptive, pragmatic qualitative study. Purposive s ling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using Thematic Analysis. Results Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care 2) Complexities in managing insomnia and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited. Conclusions General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners, and greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services would benefit insomnia management within general practice.
Publisher: Springer Science and Business Media LLC
Date: 08-07-2009
Publisher: Wiley
Date: 12-2012
DOI: 10.1111/JPC.12004
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.MATURITAS.2010.06.001
Abstract: To assess the effect, tolerability and acceptability of aged garlic extract as an adjunct treatment to existing antihypertensive medication in patients with treated, but uncontrolled, hypertension. A double-blind parallel randomised placebo-controlled trial involving 50 patients whose routine clinical records in general practice documented treated but uncontrolled hypertension. The active treatment group received four capsules of aged garlic extract (960 mg containing 2.4 mg S-allylcysteine) daily for 12 weeks, and the control group received matching placebos. The primary outcome measures were systolic and diastolic blood pressure at baseline, 4, 8 and 12 weeks, and change over time. We also assessed tolerability during the trial and acceptability at 12 weeks. In patients with uncontrolled hypertension (SBP ≥ 140 mmHg at baseline), systolic blood pressure was on average 10.2 ± 4.3 mmHg (p=0.03) lower in the garlic group compared with controls over the 12-week treatment period. Changes in blood pressure between the groups were not significant in patients with SBP<140 mmHg at baseline. Aged garlic extract was generally well tolerated and acceptability of trial treatment was high (92%). Our trial suggests that aged garlic extract is superior to placebo in lowering systolic blood pressure similarly to current first line medications in patients with treated but uncontrolled hypertension.
Publisher: Informa UK Limited
Date: 17-01-2020
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/PY19181
Abstract: Primary health care (PHC) plays a vital support role in organised colorectal cancer (CRC) screening programs by encouraging patient participation and ensuring timely referral for diagnostic assessment follow up. A systematic scoping review of the current evidence was conducted to inform strategies that better engage the PHC sector in organised CRC screening programs. Articles published from 2005 to November 2019 were searched across five databases. Evidence was synthesised and interventions that specifically require PHC involvement were mapped to stages of the CRC screening pathway. Fifty-seven unique studies were identified in which patient, provider and system-level interventions align with defined stages of the CRC screening pathway: namely, identifying/reminding patients who have not responded to CRC screening (non-adherence) (n=46) and follow up of a positive screen referral (n=11). Self-management support initiatives (patient level) and improvement initiatives (system level) demonstrate consistent benefits along the CRC screening pathway. Interventions evaluated as part of a quality-improvement process tended to report effectiveness however, the variation in reporting makes it difficult to determine which elements contributed to the overall study outcomes. To maximise the benefits of population-based screening programs, better integration into existing primary care services can be achieved through targeting preventive and quality care interventions along the entire screening pathway.
Publisher: Wiley
Date: 07-08-2023
DOI: 10.1002/HPJA.786
Abstract: While the links between sun exposure and skin cancer are well known, the benefits of sun exposure, particularly as a source of vitamin D, are less well known. This paper reports on a deliberative study exploring public perspectives about sun exposure harms and benefits. Two citizens' juries were conducted in Brisbane and Adelaide to consider questions about sun exposure, vitamin D and health promotion. Members of the general population (jurors) listened to evidence from expert witnesses about the harms and benefits of sun exposure. Most witness sessions extended for 60 min, with 6 sessions over 2 days. At each citizens' jury, jurors were asked to listen to expert testimony, consider the evidence and make policy recommendations. The planning and design of the citizens' juries were informed by well‐established citizens' jury methods. Jurors proposed that Australia needs improved public information about the harms and benefits of sun exposure. They argued for information that supports personal decision‐making that accounts for differences in skin tone and geographical region. Jurors agreed that Australia needs an updated sun safety c aign that reflects new research and addresses ersity. A one‐size‐fits‐all approach to sun protection may no longer be appropriate. While a new c aign should address both harms and benefits, jurors felt the need for skin cancer prevention outweighs the desirability of generating vitamin D through sun exposure. More nuanced public health messages are needed, which balance the need for skin protection and vitamin D, and acknowledge the ersity of Australia's population. Previous research studies are typically siloed into the separate areas of vitamin D or skin cancer research. This study incorporated both topics and pooled the views of participants in two citizens' juries who agreed on the need for improved information about the harms and benefits of sun exposure to reflect a modern Australian population.
Publisher: Hindawi Limited
Date: 13-06-2015
DOI: 10.1111/JCPT.12294
Abstract: Hot days are increasingly common and are often associated with increased morbidity and mortality, especially in the elderly. Most heat-related illness and heat-related deaths are preventable. Medicines may accentuate the risk of dehydration and heat-related illness, especially in elderly people taking multiple medicines, through the following mechanisms: diuresis and electrolyte imbalance, sedation and cognitive impairment, changed thermoregulation, reduced thirst recognition, reduced sweat production, and hypotension and reduced cardiac output. Commonly used medicines that may significantly increase the risk include diuretics, especially when combined with an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), anticholinergics and psychotropics. Initiation of in idualized preventive measures prior to the start of the hot weather season, which includes a review of the patient and their medicines to identify thermoregulatory issues, may reduce the risk of heat-related illness or death.
Publisher: EpiSmart Science Vector Ltd
Date: 07-2020
Publisher: Wiley
Date: 03-09-2021
DOI: 10.1111/AJCO.13428
Publisher: Wiley
Date: 09-2014
DOI: 10.1002/JPPR.1022
Publisher: Therapeutic Guidelines Limited
Date: 02-2021
Publisher: AMPCo
Date: 10-2007
Publisher: Wiley
Date: 23-12-2015
DOI: 10.1111/JGH.12792
Abstract: The average age at diagnosis for colorectal cancer (CRC) in Australia is 69, and the age-specific incidence rises rapidly after age 50 years. The incidence has stabilized or is declining in older age groups in Australia during recent decades, possibly related to the increased uptake of screening and high-risk surveillance. In the same time frame, a rising incidence of CRC in younger adults has been well-documented in the United States. This rise in incidence in the young has not been reported from other countries that share long-term exposure to westernised urban lifestyles. Using data from the Australian Institute of Health and Welfare, we examined trends in national incidence rates for CRC under age 50 years and observed that rates in people under age 40 years have been rising for the last two decades. We further performed a review of the literature regarding CRC in young adults to outline the extent of current understanding, explore potential risk factors such as obesity, alcohol, and sedentary lifestyles, and to identify the questions remaining to be addressed. Although absolute numbers might not justify a population screening approach, the dispersal of young adults with CRC across the primary health-care system decreases probability of their recognition. Patient and physician awareness, aided by stool and emerging blood-screening tests and risk profiling tools, have the potential to aid in identification of those young adults who would most benefit from a colonoscopy through early detection of CRCs or by removal of advanced polyps.
Publisher: Springer Science and Business Media LLC
Date: 28-06-2010
Publisher: The Royal Australian College of General Practitioners
Date: 06-2018
Publisher: The Sax Institute
Date: 2016
DOI: 10.17061/PHRP2621623
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.IJMEDINF.2017.06.002
Abstract: Integrated primary care requires systems and service integration along with financial incentives to promote downward substitution to a single entry point to care. Integrated Primary Care Centres (IPCCs) aim to improve integration by co-location of health services. The Informatics Capability Maturity (ICM) describes how well health organisations collect, manage and share information manage eHealth technology, implementation, change, data quality and governance and use "intelligence" to improve care. Describe associations of ICM with systems and service integration in IPCCs. Mixed methods evaluation of IPCCs in metropolitan and rural Australia: an enhanced general practice, four GP Super Clinics, a "HealthOne" (private-public partnership) and a Community Health Centre. Data collection methods included self-assessed ICM, document review, interviews, observations in practice and assessment of electronic health record data. Data was analysed and compared across IPCCs. The IPCCs demonstrated a range of funding models, ownership, leadership, organisation and ICM. Digital tools were used with varying effectiveness to collect, use and share data. Connectivity was problematic, requiring "work-arounds" to communicate and share information. The lack of technical, data and software interoperability standards, clinical coding and secure messaging were barriers to data collection, integration and sharing. Strong leadership and governance was important for successful implementation of robust and secure eHealth systems. Patient engagement with eHealth tools was suboptimal. ICM is positively associated with integration of data, systems and care. Improved ICM requires a health workforce with eHealth competencies technical, semantic and software standards adequate privacy and security and good governance and leadership.
Publisher: AMPCo
Date: 03-2015
DOI: 10.5694/MJA14.01547
Publisher: Cambridge University Press (CUP)
Date: 2015
DOI: 10.1017/S0266462315000331
Abstract: Objectives: Health technology reassessment and disinvestment can be difficult due to uncertainties regarding available evidence. Pathology testing to investigate cobalamin (vitamin B 12 ) deficiency is a strong case in point. We conducted a 3-month economic evaluation of five strategies for diagnosing and treating cobalamin deficiency in adult patients hypothetically presenting with new unexplained fatigue in the primary care setting. The first consultation per patient was considered. Screening tests other than serum cobalamin were not included. Methods : A cost-effectiveness analysis was undertaken using a decision tree to represent the diagnostic / treatment pathways, with relevant cost and utility scores assigned to different stages in the evaluation process. Input parameter values were estimated from published evidence, supplemented by expert opinion, with sensitivity analysis undertaken to represent parameter uncertainty. Results: Ordering serum vitamin B 12 to assess cobalamin deficiency among patients with unexplained fatigue was not cost-effective in any patient population, irrespective of pretest prevalence of this deficiency. For patients with a pretest prevalence above 1 percent, treating all with oral vitamin B 12 supplements without testing was most cost-effective, whereas watchful waiting with symptoms monitoring was most cost-effective for patients with lower pretest prevalence probabilities. Conclusions: Substantial evidence gaps exist for parameter estimation: questionable cobalamin deficiency levels in the fatigued debatable treatment methods unknown natural history of the condition. Despite this, we reveal a robust path for disinvestment decision making in the face of a paradox between the evidence required to inform disinvestment compared with its paucity in informing initial funding decisions.
Publisher: John Wiley & Sons, Ltd
Date: 15-08-2012
Publisher: The Sax Institute
Date: 09-2021
No related grants have been discovered for Oliver Frank.