ORCID Profile
0000-0001-6462-9121
Current Organisation
Bond University
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Public Health and Health Services | Preventive Medicine | Law | Primary Health Care | Epidemiology | Law and Society | Aged Health Care | Public Health and Health Services not elsewhere classified | Developmental Psychology and Ageing
ANZSRC Socio-Economic Objective (SEO)
Behaviour and Health | Preventive Medicine | Public health not elsewhere classified | Preventive medicine | Ageing and Older People | Evaluation of health outcomes | Health status (e.g. indicators of “well-being”) | Health Related to Specific Ethnic Groups | Behaviour and health | Legal Processes |
Related Links
Publications
A systematic review of chronic disease management interventions in primary care
Publisher: Springer Science and Business Media LLC
Date: 09-01-2018
GASP - An integrated approach to managing asthma patients
Publisher: Wiley
Date: 06-2020
DOI: 10.1111/RESP.13777
RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice
Publisher: Springer Science and Business Media LLC
Date: 28-09-2023
eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline-recommended therapy in metropolitan general practice: The AF-SMART study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-01-2019
Abstract: This eH ealth implementation study aimed to evaluate strategies to promote opportunistic atrial fibrillation ( AF ) screening using electronic screening prompts and improve treatment using electronic decision support ( EDS ) software. An electronic screening prompt appeared whenever an eligible patient's (aged ≥65 years, no AF diagnosis) medical record was opened in participating general practices. General practitioners and practice nurses offered screening using a smartphone ECG, with validated AF algorithm. Guideline‐based EDS was provided to assist treatment decisions. Deidentified data were collected from practices using a data extraction tool. General practices (n=8) across Sydney, Australia, screened for a median of 6 months. A total of 1805 of 11 476 (16%) eligible patients who attended were screened (44% men, mean age 75.7 years). Screening identified 19 (1.1%) new cases of AF (mean age, 79 years mean CHA 2 DS 2 ‐ VAS c, 3.7 53% men). General practitioners (n=30) performed 70% of all screenings (range 1–448 patients per general practitioner). The proportion of patients with AF who had CHA 2 DS 2 ‐ VAS c ≥2 for men or ≥3 for women prescribed oral anticoagulants was higher for those diagnosed during the study: 15 of 18 (83%) for screen‐detected and 39 of 46 (85%) for clinically detected, compared with 933 of 1306 (71%) patients diagnosed before the study ( P .001). The EDS was accessed 111 times for patients with AF and for 4 of 19 screen‐detected patients. The eH ealth tools showed promise. Adherence to guideline‐based oral anticoagulant prescription was significantly higher in patients diagnosed during the study period, although the EDS was only used in a minority. While the proportion of eligible patients screened and EDS use was relatively low, further refinements may improve uptake in clinical practice. URL : www.anzctr.org.au . Unique identifier: ACTRN 12616000850471.
Sleep health management within primary care: Knowledge, experiences and attitudes of Australian general practice nurses
Publisher: Wiley
Date: 10-2019
Does a Patient-Directed Financial Incentive Affect Patient Choices About Controller Medicines for Asthma? A Discrete Choice Experiment and Financial Impact Analysis
Publisher: Springer Science and Business Media LLC
Date: 27-10-2019
DOI: 10.1007/S40273-018-0731-5
Abstract: In Australia, many patients who are initiated on asthma controller inhalers receive combination inhaled corticosteroid/long-acting beta We conducted a discrete choice experiment (DCE) in a nationally representative s le of adults (n = 792) and parents of children (n = 609) with asthma. Mixed multinomial models were estimated and calibrated to reflect the estimated market shares of ICS-alone, ICS/LABA and no controller. We then simulated the impact of varying patient co-payment on demand and the financial impact on government pharmaceutical expenditure. Preference for inhaler decreased with increasing costs to the patient or government, increasing chance of a repeat visit to the doctor, and if fewer symptoms were present. Adults preferred high-strength controllers, but parents preferred low-strength inhalers for children (general beneficiaries only). The DCE predicted a higher proportion choosing controller treatment (89%) compared to current levels (57%) at the current co-payment level, with proportionately higher uptake of ICS-alone and a lower average cost per patient [32.73 Australian dollars (AU$) c.f. AU$38.54]. Reducing the co-payment on ICS-alone by 50% would increase its market share to 50%, whilst completely removing the co-payment would only have a small marginal impact on market share, but increased average cost of treatment to the government to AU$41.04 per person. Patient-directed financial incentives are unlikely to encourage much switching of medicines, and current levels of under-treatment are not explained by patient preferences. Interventions directed at prescribers are more likely to promote better use of asthma medicines.
Conversations about preventers in pharmacy
Publisher: Wiley
Date: 06-2020
DOI: 10.1111/RESP.13778
Diagnosing COPD and supporting smoking cessation in general practice: Evidenceepractice gaps
Publisher: AMPCo
Date: 2018
DOI: 10.5694/MJA17.00664
Abstract: To review the accuracy of diagnoses of chronic obstructive pulmonary disease (COPD) in primary care in Australia, and to describe smokers' experiences with and preferences for smoking cessation. Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months, reported being current or ex-smokers with a smoking history of at least 10 pack-years, or were being managed for COPD. Interviews based on a structured questionnaire and case finding (FEV1/FEV6 measurement) were followed, when appropriate, by spirometry testing and assessment of health-related quality of life, dyspnoea and symptoms. 1050 patients attended baseline interviews (February 2015 - April 2017) at 41 practices. Of 245 participants managed for COPD, 130 (53.1%) met the spirometry-based definition (post-bronchodilator FEV1/FVC < 0.7) or had a clinical correlation in 37% of cases COPD was not confirmed, and no definitive result was obtained for 9.8% of patients. Case finding and subsequent spirometry testing identified 142 new COPD cases (17.6% of participants without prior diagnosis 95% CI, 15.1-20.5%). 690 participants (65.7%) were current smokers, of whom 360 had attempted quitting during the previous 12 months 286 (81.0% of those attempting to quit) reported difficulties during previous quit attempts. Nicotine replacement therapy (205, 57.4%) and varenicline (110, 30.8%) were the most frequently employed pharmacological treatments side effects were common. Hypnotherapy was the most popular non-pharmacological option (62 smokers, 17%) e-cigarettes were tried by 38 (11%). 187 current smokers (27.6%) would consider using e-cigarettes in future attempts to quit. COPD was both misdiagnosed and missed. Case finding and effective use of spirometry testing could improve diagnosis. Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common. Health professionals should emphasise evidence-based treatments, and closely monitor quitting difficulties and side effects of cessation aids. Australian New Zealand Clinical Trials Registry ACTRN12614001155684.
A digital health intervention for cardiovascular disease management in primary care (CONNECT) randomized controlled trial
Publisher: Springer Science and Business Media LLC
Date: 10-09-2020
DOI: 10.1038/S41746-020-00325-Z
Abstract: Digital health applications (apps) have the potential to improve health behaviors and outcomes. We aimed to examine the effectiveness of a consumer web-based app linked to primary care electronic health records (EHRs). CONNECT was a multicenter randomized controlled trial involving patients with or at risk of cardiovascular disease (CVD) recruited from primary care (Clinical Trial registration ACTRN12613000715774). Intervention participants received an interactive app which was pre-populated and refreshed with EHR risk factor data, diagnoses and, medications. Interactive risk calculators, motivational messages and lifestyle goal tracking were also included. Control group received usual health care. Primary outcome was adherence to guideline-recommended medications (≥80% of days covered for blood pressure (BP) and statin medications). Secondary outcomes included attainment of risk factor targets and eHealth literacy. In total, 934 patients were recruited mean age 67.6 (±8.1) years. At 12 months, the proportion with % days covered with recommended medicines was low overall and there was no difference between the groups (32.8% vs. 29.9% relative risk [RR] 1.07 [95% CI, 0.88–1.20] p = 0.49). There was borderline improvement in the proportion meeting BP and LDL targets in intervention vs. control (17.1% vs. 12.1% RR 1.40 [95% CI, 0.97–2.03] p = 0.07). The intervention was associated with increased attainment of physical activity targets (87.0% intervention vs. 79.7% control, p = 0.02) and e-health literacy scores (72.6% intervention vs. 64.0% control, p = 0.02). In conclusion, a consumer app integrated with primary health care EHRs was not effective in increasing medication adherence. Borderline improvements in risk factors and modest behavior changes were observed.
Attitudes and barriers to involvement in palliative care by Australian urban general practitioners
Publisher: Mary Ann Liebert Inc
Date: 09-2008
Abstract: Despite being ideally placed to provide care to patients with terminal illness, many general practitioners (GPs) are not involved in palliative care. This study aimed to determine the level of participation of Australian urban GPs in palliative care, and to determine the main barriers facing them in providing this care. Cross-sectional postal survey. Between March and May 2007 a random s le of 500 GPs from southwestern and northern regions of Sydney were surveyed. Involvement in palliative care personal and professional characteristics of the GPs related to the provision of palliative care GPs' views on barriers to their involvement in palliative care GPs' confidence levels across different issues in palliative medicine. Response rate was 61% and of these 25% of GPs were not involved in palliative care. GPs not providing palliative care were more likely to be younger, have less GP experience, work less hours, be an employee rather than a practice owner, and educated overseas. Main barriers to GPs' involvement in palliative care were lack of interest and knowledge, home visits, problems with after-hours care due to family and personal commitments. GPs felt least confident about psychosocial problems and technical aspects of palliative medicine. About one quarter of GPs surveyed are not involved in palliative care. Strategies to increase GPs' involvement should aim at increasing their knowledge and interest in palliative care. Innovations in service provider models are required to overcome the barriers to provision of after-hours care.
Smoking cessation intervention in Australian general practice: a secondary analysis of a cluster randomised controlled trial
Publisher: Royal College of General Practitioners
Date: 20-01-2021
Abstract: GPs have limited capacity to routinely provide smoking cessation support. New strategies are needed to reach all smokers within this setting. To evaluate the effect of a pharmacist-coordinated interdisciplinary smoking cessation intervention delivered in Australian general practice. Secondary analysis of a cluster randomised controlled trial (RCT) conducted in 41 Australian general practices. In all, 690 current smokers were included in this study: 373 from intervention clinics ( n = 21) and 317 from control clinics ( n = 18). A total of 166 current smokers had spirometry-confirmed chronic obstructive pulmonary disease (COPD). In the intervention clinics, trained pharmacists provided smoking cessation support plus Quitline referral. Control clinics provided usual care plus Quitline referral. Those with COPD in the intervention group ( n = 84) were referred for home medicines review (HMR) and home-based pulmonary rehabilitation (HomeBase), which included further smoking cessation support. Outcomes included carbon monoxide (CO)-validated smoking abstinence, self-reported use of smoking cessation aids, and differences between groups in readiness-to-quit score at 6 months. Intention-to-treat analysis showed similar CO-validated abstinence rates at 6 months in the intervention (4.0%) and control clinics (3.5%). No differences were observed in readiness-to-quit scores between groups at 6 months. CO-validated abstinence rates were similar in those who completed HMR and at least six sessions of HomeBase to those with COPD in usual care. A pharmacist-coordinated interdisciplinary smoking cessation intervention when integrated in a general practice setting had no advantages over usual care. Further research is needed to evaluate the effect of HMR and home-based pulmonary rehabilitation on smoking abstinence in smokers with COPD.
Risk of Exposure to Hepatitis B and Other Blood‐Borne Viruses Among Australians Who Travel Abroad
Publisher: Oxford University Press (OUP)
Date: 11-2006
DOI: 10.1111/J.1708-8305.2006.00069.X
Abstract: European studies indicate that up to 67% of travelers traveling abroad participate in activities that put them at risk of exposure to hepatitis B. Australians are increasingly traveling to destinations where hepatitis B is highly endemic, such as Asia, and are likely to have similar levels of involvement in activities with an associated risk of hepatitis B exposure. A series of annual telephone surveys of approximately 500 randomly selected Australian overseas travelers have been conducted under the auspice of the Travel Health Advisory Group over the years 2001 to 2003. The surveys examined the extent to which travelers seek pretravel health advice, what immunizations they receive and what risks they are exposed to during travel including the risk of hepatitis B and other blood-borne virus acquisition. In the 2003 survey, 281 (56%) of the 503 people interviewed had visited at least one country with high or medium hepatitis B endemicity on their most recent overseas trip in the past two years. Approximately a third of travelers undertook one or more activities that were considered to be associated with increased risk of potential hepatitis B exposure. Less than half the travelers (46%) had been vaccinated against hepatitis B. The results have implications for the in idual traveler, as well as to the broader community. Infected travelers can be an important source of hepatitis B into their own home communities. Improved advice and clear recommendations for hepatitis B vaccination are needed to avoid infection.
General practitioners' views on the influence of cost on the prescribing of asthma preventer medicines: A qualitative study
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/AH17030
Abstract: Objective Out-of-pocket costs strongly affect patient adherence with medicines. For asthma, guidelines recommend that most patients should be prescribed regular low-dose inhaled corticosteroids (ICS) alone, but in Australia most are prescribed combination ICS–long-acting β2-agonists (LABA), which cost more to patients and government. The present qualitative study among general practitioners (GPs) explored the acceptability, and likely effect on prescribing, of lower patient copayments for ICS alone. Methods Semistructured telephone interviews were conducted with 15 GPs from the greater Sydney area the interviews were transcribed and thematically analysed. Results GPs reported that their main criteria for selecting medicines were appropriateness and effectiveness. They did not usually discuss costs with patients, had low awareness of out-of-pocket costs and considered that these were seldom prohibitive for asthma patients. GPs strongly believed that patient care should not be compromised to reduce cost to government. They favoured ICS–LABA combinations over ICS alone because they perceived that ICS–LABA combinations enhanced adherence and reduced costs for patients. GPs did not consider that lower patient copayments for ICS alone would affect their prescribing. Conclusion The results suggest that financial incentives, such as lower patient copayments, would be unlikely to encourage GPs to preferentially prescribe ICS alone, unless accompanied by other strategies, including evidence for clinical effectiveness. GPs should be encouraged to discuss cost barriers to treatment with patients when considering treatment choices. What is known about the topic? Australian guidelines recommend that most patients with asthma should be treated with low-dose ICS alone to minimise symptom burden and risk of flare ups. However, most patients in Australian general practice are instead prescribed combination ICS–LABA preventers, which are indicated if asthma remains uncontrolled despite treatment with ICS alone. It is not known whether GPs are aware that the combination preventers have a higher patient copayment and a higher cost to government. What does this paper add? This qualitative study found that GPs favoured combination ICS–LABA inhalers over ICS alone because they perceived ICS–LABA combinations to have greater effectiveness and promote patient adherence. This aligned with GPs’ views that their primary responsibility was patient care rather than generating cost savings for government. However, it emerged that GPs rarely discussed medicine costs with patients, had low knowledge of medicine costs to patients and the health system and reported that patients rarely volunteered cost concerns. GPs believed that lower patient copayments for asthma preventer medicines would have little effect on their prescribing practices. What are the implications for practitioners? This study suggests that, when considering asthma treatment choices, GPs should empathically explore with the patient whether cost-related medication underuse is an issue, and should be aware of the option of lower out-of-pocket costs with guideline-recommended ICS alone treatment. Policy makers must be aware that differential patient copayments for ICS preventer medicines are unlikely to act as an incentive for GPs to preferentially prescribe ICS alone preventers, unless the position of these preventers in guidelines and evidence for their clinical effectiveness are also reiterated.
Improving blood pressure control in primary care: The ImPress study
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.IJNURSTU.2019.03.019
Abstract: Hypertension is a preventable risk factor for cardiovascular disease, the leading cause of death globally. When hypertension is present with tobacco smoking, poor nutrition, physical inactivity or excessive alcohol consumption, risk of cardiovascular disease is increased. Given the prolonged engagement and ongoing relationship with patients, general practice nurses are ideally situated to actively engage with patients about optimal blood pressure control and lifestyle risk reduction. This study will test the effectiveness of a nurse-led intervention to reduce blood pressure in adults with hypertension and high cardiovascular risk. A multi-site, cluster randomised control trial where the general practice is the unit of randomisation. General Practices (n = 20) will be block randomised to the intervention or usual care group. Adults with hypertension and high cardiovascular risk will be identified through an audit of electronic medical records and invited to attend an assessment visit. Eligible consenting patients will be recruited to the study. The intervention involves three face-to-face consultations and two telephone consultations with the nurse to assess lifestyle risk and develop an action plan. An appointment with the general practitioner will optimise pharmacotherapy. The primary outcome is blood pressure, with secondary outcomes of lifestyle risk factors smoking, nutrition, alcohol and physical activity body mass index and medication adherence. Patients will have outcome measures evaluated at 6 and 12 months. ImPress is innovative in its proactive approach of identifying those at greatest risk of cardiovascular disease in combination with the emerging role of the general practice nurse to target care towards improved blood pressure control. If successful, findings from this trial could enhance the nursing role, improve health outcomes, inform health policy and provide an evidence base from which to transform blood pressure management in general practice. This trial has been registered with the Australian and New Zealand Clinical Trials Registry as ACTRN12618000169246.
Supporting Treatment decision making to Optimise the Prevention of STROKE in Atrial Fibrillation
Publisher: Springer Science and Business Media LLC
Date: 06-07-2012
Abstract: Suboptimal uptake of anticoagulation for stroke prevention in atrial fibrillation has persisted for over 20 years, despite high-level evidence demonstrating its effectiveness in reducing the risk of fatal and disabling stroke. The STOP STROKE in AF study is a national, cluster randomised controlled trial designed to improve the uptake of anticoagulation in primary care. General practitioners from around Australia enrolling in this ‘distance education’ program are mailed written educational materials, followed by an academic detailing session delivered via telephone by a medical peer, during which participants discuss patient de-identified cases. General practitioners are then randomised to receive written specialist feedback about the patient de-identified cases either before or after completing a three-month posttest audit. Specialist feedback is designed to provide participants with support and confidence to prescribe anticoagulation. The primary outcome is the proportion of patients with atrial fibrillation receiving oral anticoagulation at the time of the posttest audit. The STOP STROKE in AF study aims to evaluate a feasible intervention via distance education to prevent avoidable stroke due to atrial fibrillation. It provides a systematic test of augmenting academic detailing with expert feedback about patient management. Australian Clinical Trials Registry Registration Number: ACTRN12611000076976.
Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: The treatment of cardiovascular risk using electronic decision support cluster-randomized trial
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
DOI: 10.1161/CIRCOUTCOMES.114.001235
Abstract: Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited. Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2) guideline-indicated medications for those at high cardiovascular disease risk. Centers had to use a compatible software system, and eligible patients were regular attendees (Aboriginal and Torres Strait Islander people aged ≥35 years and others aged ≥45 years). Patient-level analyses were conducted using generalized estimating equations to account for clustering. Median follow-up for 38 725 patients (mean age, 61.0 years 42% men) was 17.5 months. Mean monthly staff support was hour/site. For the coprimary outcomes, the intervention was associated with improved overall risk factor measurements (62.8% versus 53.4% risk ratio 1.25 95% confidence interval, 1.04–1.50 P =0.02), but there was no significant differences in recommended prescriptions for the high-risk cohort (n=10 308 56.8% versus 51.2% P =0.12). There were significant treatment escalations (new prescriptions or increased numbers of medicines) for antiplatelet (17.9% versus 2.7% P .001), lipid-lowering (19.2% versus 4.8% P .001), and blood pressure–lowering medications (23.3% versus 12.1% P =0.02). In Australian primary healthcare settings, a computer-guided quality improvement intervention, requiring minimal support, improved cardiovascular disease risk measurement but did not increase prescription rates in the high-risk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management. URL: www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630 . Australian New Zealand Clinical Trials Registry No. 12611000478910.
How I would manage a man with COPD who has few symptoms and is at low risk of an exacerbation: a primary care perspective from Australia
Publisher: Springer Science and Business Media LLC
Date: 16-11-2012
What evidence is there to support skill mix changes between GPs, pharmacists and practice nurses in the care of elderly people living in the community?
Publisher: Springer Science and Business Media LLC
Date: 11-09-2009
Psychometric Evaluation and Validation of an Urdu Version of the Summary of Diabetes Self-Care Activities Measure (U-SDSCA)
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2021
The contribution of travellers visiting friends and relatives to notified infectious diseases in Australia: state-based enhanced surveillance
Publisher: Cambridge University Press (CUP)
Date: 30-08-2016
DOI: 10.1017/S0950268816001734
Abstract: Immigrants and their children who return to their country of origin to visit friends and relatives (VFR) are at increased risk of acquiring infectious diseases compared to other travellers. VFR travel is an important disease control issue, as one quarter of Australia's population are foreign-born and one quarter of departing Australian international travellers are visiting friends and relatives. We conducted a 1-year prospective enhanced surveillance study in New South Wales and Victoria, Australia to determine the contribution of VFR travel to notifiable diseases associated with travel, including typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya. Additional data on characteristics of international travel were collected. Recent international travel was reported by 180/222 (81%) enhanced surveillance cases, including all malaria, chikungunya and paratyphoid cases. The majority of cases who acquired infections during travel were immigrant Australians (96, 53%) or their Australian-born children (43, 24%). VFR travel was reported by 117 (65%) travel-associated cases, highest for typhoid (31/32, 97%). Cases of children (aged years) (86%) were more frequently VFR travellers compared to adult travellers (57%, P 0·001). VFR travel is an important contributor to imported disease in Australia. Communicable disease control strategies targeting these travellers, such as targeted health promotion, are likely to impact importation of these travel-related infections.
Atrial Fibrillation Screen, Management and Guideline Recommended Therapy (AF SMART II) in the rural primary care setting: An implementation study protocol
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.
An aged care liaison nurse can facilitate care planning using the Enhanced Primary Care items
Publisher: Wiley
Date: 06-2005
A complexity perspective on health care improvement and reform in general practice and primary health care
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/PY10003
Abstract: Health care improvement is always on the planning agenda but can prove frustrating when ‘the system’ seems to have a life of its own and responds in unpredictable ways to reform initiatives. Looking back over 20 years of general practice and primary health care in Australia, there has been plenty of planning and plenty of change, but not always a direct cause and effect relationship between the two. This article explores in detail an alternative view to the current orthodoxy of design, control and predictability in organisational change. The language of complexity is increasingly fashionable in talking about the dynamics of organisational behaviour and health care improvement, but its popular use often ignores challenging implications. However, when interpreted through human sociology and psychology, a complexity perspective offers a better match with everyday human experience of change. As such, it offers some suggestions for leaders, policy makers and managers in health care: that uncertainty and paradox are inherent in organisational change that health care reform must pay attention to the constraints and politics of the everyday and that change in health systems results from the complex processes of relating among those involved and that neither ‘the system’ nor a few in iduals can be accountable for overall performance and outcomes.
IPCRG Consensus statement: Tackling the smoking epidemic — practical guidance for primary care
Publisher: Springer Science and Business Media LLC
Date: 05-09-2008
Effectiveness of a new model of primary care management on knee pain and function in patients with knee osteoarthritis: Protocol for the PARTNER STUDY
Publisher: Springer Science and Business Media LLC
Date: 30-04-2018
Application of two versions of the WHO/international society of hypertension absolute cardiovascular risk assessment tools in a rural Bangladeshi population
Publisher: BMJ
Date: 10-2015
Reducing cardiovascular disease risk in diabetes
Publisher: AMPCo
Date: 06-2017
DOI: 10.5694/MJA16.00332
Abstract: To describe the management of cardiovascular disease (CVD) risk in Australian patients with diabetes to compare the effectiveness of a quality improvement initiative for people with and without diabetes. Subgroup analyses of patients with and without diabetes participating in a cluster randomised trial. Indigenous people (≥ 35 years old) and non-Indigenous people (≥ 45 years old) who had attended one of 60 Australian primary health care services at least three times during the preceding 24 months and at least once during the past 6 months. Quality improvement initiative comprising point-of-care electronic decision support with audit and feedback tools. Adherence to CVD risk screening and prescribing guidelines. Baseline rates of guideline-recommended screening were higher for 8829 patients with diabetes than for 44 335 without diabetes (62.0% v 39.5% P < 0.001). Baseline rates of guideline-recommended prescribing were greater for patients with diabetes than for other patients at high risk of CVD (55.5% v 39.6% P < 0.001). The proportions of patients with diabetes not attaining recommended treatment targets for blood pressure, low-density lipoprotein-cholesterol or HbA1c levels who were not prescribed the corresponding therapy at baseline were 28%, 44% and 24% respectively. The intervention was associated with improved screening rates, but the effect was smaller for patients with diabetes than for those without diabetes (rate ratio [RR], 1.14 v 1.28 P = 0.01). It was associated with improved guideline-recommended prescribing only for undertreated in iduals at high risk the effect size was similar for those with and without diabetes (RR, 1.63 v 1.53 P = 0.28). Adherence to CVD risk management guidelines was better for people with diabetes, but there is room for improvement. The intervention was modestly effective in people with diabetes, but further strategies are needed to close evidence-practice gaps.Australian and New Zealand Clinical Trials Registry number: ACTRN12611000478910.
Influencing antibiotic prescribing by prescriber feedback and management guidelines: a 5-year follow-up
Publisher: Oxford University Press (OUP)
Date: 02-2002
Abstract: The extent of use of antibiotics for upper respiratory tract infection (URTI) prompted a previous study of an educational intervention based on prescriber feedback and management guidelines. This study demonstrated a reduction in antibiotic prescribing for URTI and a more appropriate choice of antibiotic for tonsillitis/streptococcal pharyngitis. There are few long-term follow-up studies of educational programmes of this kind. This follow-up study aimed to examine if the reduction in antibiotic prescribing observed in the intervention group of the original study remained present after 5 years, and how the prescribing behaviour of the GPs involved in the follow-up differed from a large national survey of GP prescribing. Attempts were made to contact the 157 GPs involved in the original study. Of these, 121 were both located and currently working in general practice. Ninety-six consented to take part and, of these, 79 completed a morbidity and treatment survey of 100 patient encounters (response rate 65.3%). The intervention group (n = 37) maintained their pattern of prescribing of antibiotics for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis, with no significant change between the completion of the original study and the 5-year follow-up. The control group (n = 42) showed a downward trend in antibiotic prescribing for URTI, with the effect that no significant differences remained between groups at the 5-year follow-up. At the 5-year follow-up, both groups prescribed significantly fewer antibiotics for URTI and showed greater adherence to prescribing guidelines for tonsillitis/streptococcal pharyngitis than participants in a large national GP survey (n = 984). This study demonstrated maintenance of prescribing behaviour in the intervention group in the long term. However, the changes in prescribing observed in the control group and the power limitations of the study make it uncertain whether this was the result of a sustained effect of the educational intervention. The differences in both groups from the large national GP survey suggest that other influences on prescribing (such as participation in vocational training for general practice) were also having an important effect.
A picture speaks a thousand words: evaluation of a pictorial post-vaccination care resource in Australia
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/PY10002
Abstract: Evaluating the ‘Common Reactions to Vaccination’ post-vaccination care resource was seen as an opportunity to contribute to the limited literature base in this important area, learn from the strengths and weaknesses of the resource and gain insight into post-vaccination care practices. Semi-structured in-depth interviews were conducted with 12 general practitioners and 29 practice nurses in New South Wales and Australian Capital Territory, Australia. Structured interview guides were used and data was analysed thematically. A self-administered survey was also distributed to parents or guardians during routine childhood vaccination visits. When compared with previous resources, participants felt the new resource was more appropriate as it had a simple layout it was colourful, incorporated pictures and had basic and practical information. Information about post-vaccination care and common reactions to vaccination must be provided in written form accompanied by a verbal reinforcement so that patients can revisit the information at a later stage if required. The ‘Common Reactions to Vaccination’ post-vaccination care resource provides comprehensive information in an easy-to-understand pictorial way and was appreciated by both vaccination providers and patients.
Protocol for the process and feasibility evaluations of a new model of primary care service delivery for managing pain and function in patients with knee osteoarthritis (PARTNER) using a mixed methods approach
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-034526
Abstract: This protocol outlines the rationale, design and methods for the process and feasibility evaluations of the primary care management on knee pain and function in patients with knee osteoarthritis (PARTNER) study. PARTNER is a randomised controlled trial to evaluate a new model of service delivery (the PARTNER model) against ‘usual care’. PARTNER is designed to encourage greater uptake of key evidence-based non-surgical treatments for knee osteoarthritis (OA) in primary care. The intervention supports general practitioners (GPs) to gain an understanding of the best management options available through online professional development. Their patients receive telephone advice and support for OA management by a centralised, multidisciplinary ‘Care Support Team’. We will conduct concurrent process and feasibility evaluations to understand the implementation of this new complex health intervention, identify issues for consideration when interpreting the effectiveness outcomes and develop recommendations for future implementation, cost effectiveness and scalability. The UK Medical Research Council Framework for undertaking a process evaluation of complex interventions and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) frameworks inform the design of these evaluations. We use a mixed-methods approach including analysis of survey data, administrative records, consultation records and semistructured interviews with GPs and their enrolled patients. The analysis will examine fidelity and dose of the intervention, observations of trial setup and implementation and the quality of the care provided. We will also examine details of ‘usual care’. The semistructured interviews will be analysed using thematic and content analysis to draw out themes around implementation and acceptability of the model. The primary and substudy protocols have been approved by the Human Research Ethics Committee of The University of Sydney (2016/959 and 2019/503). Our findings will be disseminated to national and international partners and stakeholders, who will also assist with wider dissemination of our results across all levels of healthcare. Specific findings will be disseminated via peer-reviewed journals and conferences, and via training for healthcare professionals delivering OA management programmes. This evaluation is crucial to explaining the PARTNER study results, and will be used to determine the feasibility of rolling-out the intervention in an Australian healthcare context. ACTRN12617001595303 Pre-results.
Finding common ground? Evaluating an intervention to improve teamwork among primary health-care professionals
Publisher: Oxford University Press (OUP)
Date: 17-10-2010
Abstract: Multidisciplinary care has been shown as the most effective option for chronic disease. The aim of the Team-link study was to assess the effectiveness of an intervention to improve teamwork among general practitioners (GPs), practice staff and allied health professionals (AHPs). This paper describes changes to teamwork using qualitative data collected in the study. Qualitative data about changes in internal and external professional collaboration were collected from facilitators' observations, GPs' reports and responses to a survey of AHPs assessing multidisciplinary teamwork. Multidisciplinary teams within general practices and external collaborations with AHPs including dietitians, diabetic educators, exercise physiologists, podiatrists, psychologists and physiotherapists. GPs, practice nurses, practice staff, AHPs. A 6-month intervention consisting of an educational workshop and structured facilitation using specially designed materials, backed up by informal telephone support, was delivered to 26 practices. Data were analysed thematically using an approach based on identifying actors and associated collaborative actions. New and enhanced communication pathways were observed between GPs, practice staff, patients and AHPs following the intervention. The enhanced information sharing expedited communication and improved interprofessional collaboration within general practices and with AHPs. There was evidence of increased patient participation and empowerment in the care process and improved collaboration by practice staff and allied health providers. The Team-link intervention improved professional collaboration among GPs, practice staff, AHPs and patients, increasing understanding and trust and enhancing multidisciplinary teamwork for chronic disease care in primary care settings.
Influence of cardiovascular absolute risk assessment on prescribing of antihypertensive and lipid-lowering medications: A cluster randomized controlled trial
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.AHJ.2013.10.002
Abstract: Guidelines for management of hypertension and lipids recommend using cardiovascular absolute risk (CVAR) to manage patients. This randomized controlled trial investigated the impact of CVAR assessment in family practice on management of cardiovascular risk, including prescription of antihypertensive and lipid-lowering medication. A cluster randomized controlled trial was conducted from 2008 to 2010 in Sydney, Australia. Family practices were randomized, and patients aged 45 to 69 years were invited to participate. Intervention family physicians (FP) were trained in use of CVAR, provided with an electronic CVAR calculator, and assessed their patients' absolute risk in a dedicated consultation. Control practice patients received a general health check. Primary outcome analyzed was the proportion of patients in each group on antihypertensive and/or lipid-lowering medication at 12 months. Multilevel logistic regression was performed to explore variables influencing changes in pharmacologic therapy. The study recruited 36 FPs from 34 practices and 1,074 patients, of which 906 (84.4%) completed 12-month follow-up. At 12 months, there was no significant difference between the intervention and control groups in proportion of patients on antihypertensives (31.2% vs 34.3%, P = .31), but control group patients were more likely to be on lipid-lowering medications (30.2% vs 22.7%, P = .01). After multilevel analysis, this difference was not present. Intensification or reduction of pharmacologic therapy was associated with meeting treatment targets for blood pressure and lipids but not with the CVAR or intervention group. Single-risk factor management remains a strong influence on FP prescribing practices. Shifting to an approach based on CVAR will require more intensive intervention.
A step-by-step model for a brief behavioural treatment for insomnia in Australian general practice
Publisher: The Royal Australian College of General Practitioners
Date: 05-2021
Diarrhö-Diagnostik bei einem Indien-Rückkehrer
Publisher: Hogrefe Publishing Group
Date: 02-2012
Exploratory and Confirmatory Factor Analysis of an Urdu-version of the summary of Diabetes self-care Activities Measure (U-sDsCA)
Publisher: Diva Enterprises Private Limited
Date: 2018
COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry: a cross-sectional study in Australian general practice
Publisher: Springer Science and Business Media LLC
Date: 10-07-2014
Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: A study protocol for a randomised controlled trial
Publisher: BMJ
Date: 2019
DOI: 10.1136/BMJOPEN-2018-023107
Abstract: It is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being. Pragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia. Participants will be ≥18 years screened as potentially having palliative care needs and at risk of dying in 6–12 months. The patients will be randomised to intervention or control group. Intervention group will undertake ACP discussions facilitated by a trained health professional. The control group will receive written information on ACP, representing the current standard of care. The primary outcome is the number of unplanned hospital admissions at the 6-month follow-up. Secondary outcomes include: (i) patient’s health-related quality-of-life and quality of chronic disease care (ii) caregiver’s health-related quality-of-life and caregiver burden and (iii) other health outcomes including ambulance usage, emergency department presentations, hospital admissions, resuscitation attempts, intensive care unit admissions, deaths, documentation of patient wishes in patient records and audit of ACP discussions and documents. The staff’s self-reported attitudes and knowledge of ACP will also be measured. The data will be collected using self-report questionnaires, hospital records audit, audit of ACP documentation and data linkage analysis. Semistructured interviews and focus group discussions with patients, caregivers and healthcare professionals will explore the acceptability and feasibility of the intervention. Approved by South-East Sydney Local Health District Human Research Ethics Committee and NSW Population and Health Services Research Ethics Committee. Results will be disseminated via conference presentations, journal publications, seminars and invited talks. ACTRN12617000280303.
A cluster randomised controlled trial of nurse and GP partnership for care of chronic obstructive pulmonary disease
Publisher: Springer Science and Business Media LLC
Date: 03-06-2008
Implementation of advance care planning for patients with advanced illnesses attending hospital outpatient clinics
Publisher: Wiley
Date: 05-2019
DOI: 10.1111/AJAG.12661
The experiences of smoking cessation among patients with chronic obstructive pulmonary disease in Australian general practice: a qualitative descriptive study
Publisher: Oxford University Press (OUP)
Date: 27-08-2016
Abstract: It is important to understand the experiences surrounding smoking cessation among patients with chronic obstructive pulmonary disease (COPD) to improve the likely success of future smoking cessation programs. To explore the personal experiences surrounding smoking cessation among general practice patients with COPD. A purposive s le of 33 general practice patients with COPD, 28 ex-smokers and 5 smokers, participated in the semi-structured telephone interviews. Thematic analysis was conducted using a predominantly deductive approach guided by the Behaviour Change Wheel framework. Three inter-related themes were generated: the motivation, opportunities and capabilities among the participants to quit and maintain smoking cessation. Most quit attempts occurred without explanation or prior planning, though some attempts were motivated by the participants' family, peers or GP. Internet-based smoking cessation support programs led by general practices and involving the practice nurse were perceived as opportunities to engage in quit attempts. Most participants, both ex-smokers and smokers, demonstrated capacity to engage in multiple quit attempts. However, for many smokers, boredom, mood disturbances, the strong sense of identity as a smoker, peer reinforcement, irritability, cravings, hunger and weight gain limited capability to maintain smoking cessation. Patients with COPD have motivation to quit and have demonstrated capacity to engage in multiple quit attempts. GPs and other primary care practitioners need to recognize the patients' spontaneity around quit attempts and to meet the needs of the in idual patient by being ready to offer support for each attempt once the patient has made their decision to quit.
Routine use of clinical management guidelines in Australian general practice
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/PY12078
Abstract: Significant gaps remain between recommendations of evidence-based guidelines and primary health care practice in Australia. This paper aims to evaluate factors associated with the use of guidelines reported by Australian GPs. Secondary analysis was performed on a survey of primary care practitioners which was conducted by the Commonwealth Fund in 2009: 1016 general practitioners responded in Australia (response rate 52%). Two-thirds of Australian GPs reported that they routinely used evidence-based treatment guidelines for the management of four conditions: diabetes, depression, asthma or chronic obstructive pulmonary disease and hypertension – a higher proportion than in most other countries. Having non-medical staff educating patients about self-management, and a system of GP reminders to provide patients with test results or guideline-based intervention or screening tests, were associated with a higher probability of guidelines use. Older GP age was associated with lower probability of guideline usage. The negative association with age of the doctor may reflect a tendency to rely on experience rather than evidence-based guidelines. The association with greater use of reminders and self-management is consistent with the chronic illness model.
Short-term predictive ability of selected cardiovascular risk prediction models in a rural Bangladeshi population
Publisher: Springer Science and Business Media LLC
Date: 26-05-2016
A Web-Based Public Health Intervention to Reduce Functional Impairment and Depressive Symptoms in Adults With Type 2 Diabetes (The SpringboarD Trial): Randomized Controlled Trial Protocol
Publisher: JMIR Publications Inc.
Date: 03-08-2017
DOI: 10.2196/RESPROT.7348
General practice in 2008: a time of metamorphosis
Publisher: AMPCo
Date: 07-2008
“You’ve got to breathe, you know” – asthma patients and carers’ perceptions around purchase and use of asthma preventer medicines
Publisher: Elsevier BV
Date: 06-2019
Abstract: To explore influences on patients' purchase and use of asthma preventer medicines and the perceived acceptability of financial incentives via reduced patient co-payments. Semi-structured telephone or face-to-face interviews were conducted with adults and carers of children with asthma. Interviews were recorded, transcribed verbatim and coded. Data were analysed using thematic analysis via grounded theory. Twenty-four adults and 20 carers for children aged 3-17 years with asthma were interviewed. For medicines choice, most participants did not consider themselves the primary decision-maker cost of medicines was an issue for some, but effectiveness was described as more important. For adherence, cost, side-effects, perceived benefit and patient behaviours were important. Patient barriers to adherence with asthma preventer medicines including cost are ongoing. Healthcare professionals need to encourage empathic discussion with patients about cost issues. Implications for public health: Asthma patients and carers could benefit from greater involvement and respect within shared decision-making. Healthcare professionals should be aware that cost may be a barrier for patient adherence, and provided with information about the relative costs of guideline-recommended asthma medicines. Patients and healthcare professionals need education around the efficacy of ICS-alone treatment and the rationale behind co-payments, for initiatives around quality use of medicines to succeed.
Teaching about tobacco in medical schools: A worldwide study
Publisher: Wiley
Date: 09-2009
DOI: 10.1111/J.1465-3362.2009.00105.X
Abstract: As medical practitioners of the future, medical students should be taught about tobacco control strategies and smoking cessation interventions. By including education about tobacco in the medical curricula, they can be informed about the health effects of tobacco use and learn to assist smokers to quit. Our study aimed to estimate the extent of teaching about tobacco and smoking cessation techniques in medical schools worldwide and compare with results we reported 10 years ago, to determine the content of curricula and range of teaching formats and to identify barriers to teaching about tobacco in medical schools and solutions. A cross-sectional survey of all existing medical schools (n = 2090) in 171 countries was conducted. A questionnaire was designed, translated and sent to all medical schools. Main outcome measures included whether and how tobacco is taught comparisons with the survey conducted 10 years ago tobacco content in the curriculum format of teaching and barriers to teaching and solutions. 665 medical schools from 109 countries completed the full questionnaire, with a response rate of 31.8% from medical schools and 64% of countries and consisting of 39% of medical schools in developed and 28% in less developed countries. A further 67 medical schools responded to a single question on whether they taught about tobacco. The total response rate was 35%. Of 561 medical schools responding to questions on teaching options, 27% of medical schools taught a specific module on tobacco compared with only 11% in our survey of medical schools conducted a decade ago 77% integrated teaching on tobacco with other topics compared with 40% 10 years ago 31% taught about tobacco informally as the topic arose (vs. 58%) and 4% did not teach about tobacco (vs. 12%). Most common topics taught were: health effects of smoking (94%), health effects of passive smoking (84.5%), epidemiology of tobacco use (81%), nicotine dependence (78%) and taking a smoking history (75%). Most popular method of teaching was by lectures (78%), case study discussions and problem-based learning exercises (51%), class readings 46%, in the clinical setting with real patients (45%), special projects and assignments (45%) and patient-centred teaching approaches, such as role plays (31%). Significantly, more barriers to teaching were identified by less developed countries (>60%) including: lack of available teaching time in the medical program, limited organisational ability to include new subjects, lack of staff resources to teach, lack of current plans to introduce a tobacco curriculum, lack of a key person to ch ion and organise teaching, lack of financial resources and lack of incentives or advantages to teach. A majority described solutions to these problems. A case study of education on tobacco throughout the medical curriculum is presented. We found an encouraging increase in the extent of teaching on tobacco in medical schools over 10 years. We report that although progress has been made to address the teaching of tobacco in medical schools worldwide, there is a great deal more effort required so that education on tobacco is an ongoing part of medical curricula. The teaching content is generally based on evidence-based smoking cessation guidelines
Uptake and implementation of Advance Care Planning in Australia: findings of key informant interviews
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/AH11019
Abstract: Objective. Advance Care Planning (ACP) has an important role in enhancing patient autonomy and guiding end-of-life care. However, there is low uptake of ACP and evidence that advance care plans are often not implemented. We explored these issues in interviews with expert clinicians and representatives of key stakeholder organisations with interest in end-of-life care. Method. Qualitative descriptive study of semi-structured telephone interviews with 23 participants. Results. Participants thought that the low uptake of ACP in Australia is a result of inadequate awareness, societal reluctance to discuss end-of-life issues, and lack of health professionals’ involvement in ACP. Problems in implementation of advance care plans were thought to be a result of problems in accessing ACP documents interpreting written documents making binding decisions for future unpredictable situations and paternalistic attitudes of health professionals and families. Participants had different perspectives on how advance care plans should be implemented, with some believing in strict implementation, whereas others believed in a more flexible approach. Implications. Low uptake and poor implementation of advance care plans may be addressed by (1) increasing community awareness (2) encouraging health professional involvement and (3) system-wide implementation of multi-faceted interventions. A patient-centred approach to ACP is required to resolve the differences in views on how advance care plans should be implemented. What is known about the topic? Advance Care Planning (ACP) has been gaining prominence in Australia for its role in enhancing a patient’s autonomy and as an important component of good end-of-life care. Evidence from overseas and a limited number of Australian studies have identified several problems with ACP. First, the uptake of ACP seems to be low. Second, even when ACP process takes place, the resultant plans are often not implemented and make little effect on delivery of end-of-life care. What does this paper add? This paper confirms that the uptake of ACP is limited in Australia and is a result of inadequate awareness, societal reluctance to discuss end-of-life issues, and lack of health professionals’ involvement in ACP. Problems in implementation of advance care plans may be because of problems in: accessing ACP documents, interpreting written documents, making binding decisions for future unpredictable situations, and paternalistic attitudes of health professionals and families. This paper also shows that there are different perspectives in how advance care plans should be implemented, with some believing in strict implementation, whereas others believed in a more flexible approach. What are the implications for practitioners? This paper outlines several ways in which problems in the uptake and implementation of advance care plans may be addressed. This involves (1) increasing community awareness (2) encouraging health professional involvement in ACP and (3) system-wide implementation of multi-faceted interventions in ACP. Our findings also suggest that there needs to be a shift from a one-size-fits-all approach to implementing advance care plans to a more flexible patient-centred approach. This approach could ensure that a patient’s autonomy and right to self-determination are adequately protected, while also catering to the needs of those requiring more flexible approaches to end-of-life decision-making.
A Systematic Review of the Efficacy of Interventions that Aim to Increase Self-Compassion on Nutrition Habits, Eating Behaviours, Body Weight and Body Image
Publisher: Springer Science and Business Media LLC
Date: 20-09-2018
Patients’ perspectives on the impact of a new COPD diagnosis in the face of multimorbidity: a qualitative study
Publisher: Springer Science and Business Media LLC
Date: 14-08-2014
Accuracy of the COPD diagnostic questionnaire as a screening tool in primary care
Publisher: Springer Science and Business Media LLC
Date: 14-04-2022
DOI: 10.1186/S12875-022-01685-Z
Abstract: The COPD Diagnostic Questionnaire (CDQ) was developed to identify people who would benefit from spirometry testing to confirm Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to determine the usefulness of a cut-off score of 16.5 on the CDQ in identifying those at increased risk of obstruction, in a mixed population of people ‘at risk’ of COPD and those with an ‘existing’ COPD diagnosis. People ‘at risk’ of COPD (aged 40 years, current/ex-smoker) and those with ‘existing’ COPD were identified from four general practices and invited to participate. Participants completed the CDQ and those with a CDQ score ≥ 16.5 were categorised as having intermediate to increased likelihood of airflow obstruction. Pre and post-bronchodilator spirometry determined the presence of airway obstruction (FEV 1 /FVC ratio 0.7). Sensitivity, specificity and accuracy of the CDQ was determined compared to spirometry as the gold standard. One hundred forty-one participants attended an initial assessment (‘at risk’ = 111 (79%), ‘existing’ COPD = 30 (21%)). A cut-off score of 16.5 corresponded to a sensitivity of 81%, specificity of 36% and accuracy of 50%, in the entire mixed population. The area under the ROC curve was 0.59 ± 0.50 indicating low diagnostic accuracy of the CDQ. Similar results were found in the ‘existing’ COPD group alone. Whilst a cut-off score of 16.5 on the CDQ may result in a large number of false positives, clinicians may still wish to use the CDQ to refine who receives spirometry due to its high sensitivity. ANZCTR, ACTRN12619001127190. Registered 12 August 2019 – Retrospectively registered, www.ANZCTR.org.au/ACTRN12619001127190.aspx
Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial
Publisher: BMJ
Date: 06-2018
Patient and practice characteristics predict the frequency of general practice multidisciplinary referrals of patients with chronic diseases: A multilevel study
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.HEALTHPOL.2010.10.019
Abstract: Chronic diseases require a multidisciplinary approach to provide optimal patient care in general practice. In Australian general practice, this usually involves referral to an allied health provider outside the practice. This study explored the patient and practice factors associated with referral of patients with diabetes, ischaemic heart disease (IHD) or hypertension to external allied health providers (AHPs). A multilevel analysis of data collected as part of a quasi-experimental study was conducted in 26 practices in Sydney. The frequency of patient-reported referral to AHPs 6-months post-intervention was measured against patient and practice characteristics assessed by patients and practice staff questionnaires. Seven per cent of the total variance in the referrals was due to differences between practices and 93% attributed to differences between patients. Previous referral, age over 45 years, multiple conditions, longer illness duration, poor mental and physical health were associated with the likelihood of referral to AHPs but not socio-economic status, patient self-assessment of care and the intervention. Those attending practices with over three GPs were more likely to be referred. Referral to multidisciplinary care for patients with long term conditions was appropriately linked to the complexity, duration and impact of these conditions. The lack of association between the intervention and the frequency of referral suggests that factors other than knowledge and communication such as the accessibility of the allied health services may have been more important in determining referral.
Study protocol for a randomized controlled trial
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.AHJ.2008.11.016
Abstract: Although cardiovascular absolute risk (CVAR) assessment has been recommended for use in Australian general practice for a number of years, there is continuing uncertainty about its implementation and impact. Our previous work has developed a multifaceted implementation model. This study aims to investigate both the feasibility of using this model and the impact of CVAR assessment and management on general practice clinical processes and patient care. This cluster randomized controlled trial will be conducted in general practices in Sydney, involving general practitioners (GPs), other practice staff, and patients aged 45 to 69 years without existing cardiovascular disease. A total of 32 practices (40 GPs) and 1,320 patients will be recruited. Randomization will be conducted at the practice level. The intervention group of GPs will be trained to use a CVAR implementation model, whereas the control group of GPs will continue usual care. Study outcomes include clinical processes, patient risk, use of lifestyle intervention, and prescription of antihypertensive and lipid-lowering medications. Data will be collected and analyzed using mixed methods. Study outcomes before and after the intervention will be compared, and the 2 groups will also be compared after adjusting for baseline difference and clustering factors. This trial will be the first study in Australian general practice and one of few international studies to evaluate the impact of implementing CVAR assessment and management. Results of this study will help improve the primary prevention of cardiovascular disease and inform guidelines for clinical practice and the implementation of other health initiatives.
What drives adoption of a computerised, multifaceted quality improvement intervention for cardiovascular disease management in primary healthcare settings? A mixed methods analysis using normalisation process theory
Publisher: Springer Science and Business Media LLC
Date: 12-11-2018
Experiences and views of a brokerage model for primary care for Aboriginal people
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/AH13205
Abstract: Objective A mixed methods study was conducted to determine the views of Aboriginal people on their experiences of a brokerage model for access to community-based health services in an urban setting. Methods A broad range of approaches, using surveys, semi-structured interviews and community forums with Aboriginal people were used to find out people’s views and experiences of using the brokerage service. Results Of the 1304 people invited to participate, only 127 people provided feedback on the brokerage service model for Aboriginal people. Of these, 120 people identified as being Aboriginal. Participants said that the service helped them to navigate the system and access health care. Participants felt that the health professionals involved with the service were respectful of their needs. The service was not able to improve access to dental care. Conclusions The brokerage model implemented in this area appears to have been well received and is supporting urban Aboriginal people to access some of the health care needed. What is known about the topic? Aboriginal and Torres Strait Islander people often experience difficulty accessing health services. Urban brokerage models of care were funded by the Office for Aboriginal and Torres Strait Islander Health (OATSIH) under the Improving Indigenous Access to Health Care Services initiative and aimed to increase access to mainstream health services. What does this paper add? The brokerage model of care in South West Sydney has been well-received by the Aboriginal people receiving the service and participants are positive about the role of the service in increasing access to mainstream health care. What are the implications for practitioners? Navigating the healthcare system is difficult for some and a brokerage service with supportive Aboriginal health workers increases access.
Validation of the COPD Diagnostic Questionnaire in an Australian general practice cohort: a cross-sectional study
Publisher: Springer Science and Business Media LLC
Date: 25-02-2014
Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: A cluster randomized trial
Publisher: Oxford University Press (OUP)
Date: 17-08-2016
Abstract: Early detection and intervention for chronic obstructive pulmonary disease (COPD) could potentially slow disease progress and minimize harm. To assess the effectiveness of early intervention by a practice nurse-GP team on quality of life (QoL) and process of care in patients with newly diagnosed COPD, compared with usual care. Nurses and GPs in intervention practices were educated to develop and implement disease management plans for COPD. A 12-month, multicentre, pragmatic randomized controlled trial with blinded outcome assessment was conducted. Participants were current and former smokers aged 40 to 85 years newly identified as having COPD on post-bronchodilator spirometry. The primary outcome was health-related QoL, assessed with the St George's Respiratory Questionnaire (SGRQ). Secondary outcome measures were other QoL measures, lung function, disease knowledge, smoking and immunization status, inhaler technique and health service use. Of the 10 234 patients from 36 practices in Sydney invited to a case-finding appointment, 1641 (16%) attended and 287 (18%) were diagnosed with COPD. Nineteen practices (144 patients) were randomized to the intervention group and 17 practices (110 patients) to the control group. Only 15.3% (n = 22) patients in the intervention group saw the nurse for COPD care following case finding. There was no between-group difference in SGRQ score at follow-up (mean difference -0.21 P = 0.86). Influenza vaccination was higher in the intervention group (OR 2.31: P = 0.035), but there were no other significant between-group differences in outcomes. Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.
Smoking cessation
Publisher: The Royal Australian College of General Practitioners
Date: 08-2020
The good, the bad and the ugly of clinical guidelines
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/PYV26N4ABS
National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018
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.
Cardiovascular risk assessment among rural population: findings from a cohort study in a peripheral region of Bangladesh
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.PUHE.2016.02.016
Abstract: The incidences of non-communicable diseases including cardiovascular diseases (CVDs) is increasing in Bangladesh. The reasons for this increasing trend need to be explored. The aim of this study is to assess the risk of CVDs among a peripheral rural Bangladeshi population and to explore the sociodemographic, anthropometric and clinical variables associated with increased risk. Cohort study. From a cohort of 190,471 in iduals of all ages, originally included in a diabetic eye disease program initiated in 2008-2009, a purposive sub-cohort of 66,710 in iduals, aged 31-74 years was recruited. During 2011-2012 these participants were assessed for CVDs using the WHO's risk assessment tool designed for primary care settings in low resource societies. Participant characteristics associated with higher risk were explored using univariable and multivariable regression analysis. Out of all (95.5% participation rate) participants 1170 (1.84%) were found to be at high risk for CVD. The prevalence of hypertension (HTN), pre-HTN, obesity, underweight and self-reported DM were 8.9%, 15.2%, 9.6%, 7.8% and 0.5% respectively, among the study population. In multivariable regression analysis female sex, older age, temporary housing structure (i.e., tin shed), extremes of BMI (both underweight and obese) and central obesity were associated with higher risk for CVDs. The prevalence of CVD risk factors and high CVD risk in iduals in this cohort was found to be lower than previous studies. It may be the effects of urbanization are yet to reach this relatively traditional rural population. This study adds to the literature on use of the WHO risk assessment tool.
Medical practitioners' knowledge and self-reported practices of substitute decision making and implementation of advance care plans
Publisher: Wiley
Date: 03-2014
DOI: 10.1111/IMJ.12354
Abstract: Advance care planning (ACP) provides patients with the ability to make their decisions known about how they would like to be treated if they lose capacity. Medical practitioners have a key role to play in providing information on ACP to their patients. This research explores their knowledge and attitudes to advance care planning and how this affects their practice. The objective of this study is to assess the NSW medical practitioners' knowledge and self-reported practice of ACP. A postal survey of a random s le of 650 general practitioners plus 350 medical specialists from specialties most often involved in end-of-life decisions was conducted. Respondents' work location post codes were subsequently used to assign respondents to one of the eight NSW Area Health Services. The main outcome measures were medical practitioners' knowledge of and practice pertaining to ACP. Thirty-four per cent of specialists (n = 110) and 24% of general practitioners (n = 150) responded the majority of respondents had heard of all ACP options. However, respondents' understanding of the uses and legal requirements of the relevant ACP options vary widely. Respect for patient wishes expressed in advance directives is reassuringly high. The findings suggest significant misunderstanding by medical practitioners of terminologies and systems around substitute decision-making for incompetent persons. Further education and standardisation of terminologies and systems across different jurisdictions would assist in addressing these issues. Low response rate, relating to only one legal jurisdiction, means results may not be generalisable.
National Heart Foundation of Australia consensus statement on catheter ablation as a therapy for atrial fibrillation
Publisher: AMPCo
Date: 2013
DOI: 10.5694/MJA12.10929
Abstract: Atrial fibrillation (AF) is estimated to affect 1%-2% of the population. It is increasing in prevalence and is associated with excess mortality, considerable morbidity and hospitalisations. AF is responsible for a significant and growing societal financial burden. Catheter ablation is an increasingly used therapeutic strategy for the management of AF however, some confusion exists among those caring for patients with this condition about the role and optimal use of ablative treatments for AF. Our aim in this consensus statement is to provide recommendations on the use of primary catheter ablation for AF in Australia, on the basis of current evidence. Our consensus is that the primary indication for catheter ablation of AF is the presence of symptomatic AF that is refractory or intolerant to at least one Class 1 or Class 3 antiarrhythmic medication. In selecting patients for catheter ablation of AF, consideration should be given to the patient's age, duration of AF, left atrial size and the presence of significant structural heart disease. Best results are obtained in younger patients with paroxysmal AF, no structural heart disease and smaller atria. Ablation techniques for patients with persistent AF are still undergoing evaluation. Discontinuation of warfarin or equivalent therapies is not considered a sole indication for this procedure. After AF ablation, anticoagulation therapy is generally recommended for all patients for at least 1-3 months. Discontinuation of warfarin or equivalent therapies after ablation is generally not recommended in patients who have a CHADS 2 score (congestive heart failure, hypertension, age ≥ 75 years, diabetes, 1 point each prior stroke or transient ischaemic attack, 2 points) of ≥ 2.
Barriers to using warfarin in non-valvular atrial fibrillation [5]
Publisher: BMJ
Date: 02-02-2006
Guideline for the diagnosis and management of hypertension in adults — 2016
Publisher: AMPCo
Date: 07-2016
DOI: 10.5694/MJA16.00526
Abstract: The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010). Main recommendations For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) ≥ 160/100 mmHg, start antihypertensive therapy. The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of end-organ damage, together with accurate BP assessment. For patients at moderate absolute cardiovascular disease risk with persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, start antihypertensive therapy. Treat patients with uncomplicated hypertension to a target BP of < 140/90 mmHg or lower if tolerated. Changes in management as a result of the guideline Ambulatory and/or home BP monitoring should be offered if clinic BP is ≥ 140/90 mmHg, as out-of-clinic BP is a stronger predictor of outcome. In selected high cardiovascular risk populations, aiming for a target of < 120 mmHg systolic can improve cardiovascular outcomes. If targeting < 120 mmHg, close follow-up is recommended to identify treatment-related adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury. Why the changes have been made A 2015 meta-analysis of patients with uncomplicated mild hypertension (systolic BP range, 140-169 mmHg) demonstrated that BP-lowering therapy is beneficial (reduced stroke, cardiovascular death and all-cause mortality). A 2015 trial comparing lower with higher blood pressure targets in selected high cardiovascular risk populations found improved cardiovascular outcomes and reduced mortality, with an increase in some treatment-related adverse events.
The influence of personality on trajectories of distress, health and functioning in mild-to-moderately depressed adults with type 2 diabetes
Publisher: Informa UK Limited
Date: 20-09-2020
DOI: 10.1080/13548506.2019.1668567
Abstract: Identification of mental health risk is important for optimising diabetes care in type 2 diabetes mellitus (T2DM). Personality is linked to diabetes health and may assist detection of in iduals with T2DM most at risk of chronic mental health difficulties. This study examined the moderator effect of personality factors on changes in psychological distress and functioning in adults with T2DM and mild-to-moderate depressive symptoms across a 12-month period. Data were obtained from participants in a randomised controlled trial of adults with T2DM. Participants completed measures of depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), general functioning (Work and Social Adjustment Scale), diabetes distress (Diabetes Distress Scale), and diabetes self-management (Self-Management Profile for Type 2 Diabetes) at baseline, 3-, 6- and 12-months. Glycaemic control (HbA1c) was measured at baseline, 6- and 12-months. Two hundred trial completers agreed to complete a personality inventory (Big Five Inventory). Low neuroticism was linked with reduced depression, anxiety, functional impairment and diabetes distress over the year. High extraversion was associated with decreased anxiety and functional impairment. High conscientiousness was linked to increased healthy eating. No personality trait moderated HbA1c levels. Personality screening may help identify mental health risk and guide medical carer approach in T2DM patients.
Access to same day, next day and after-hours appointments
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/AH11080
Abstract: Objective. To evaluate factors associated with the availability of same or next day appointments and after-hours access reported by Australian general practitioners (GPs). Methods. Secondary analysis of a survey of primary care practitioners conducted by the Commonwealth Fund in 2009 in 11 countries. Analysis of factors likely to be associated with reported availability of same or next day appointments and after-hours access. Findings. Of 1016 Australian GPs, 78.8% reported that most patients in their practice had access to an appointment on the same or next day and 50% that their practice had arrangements for after-hours access. Access to same or next day care was better in practices where practitioners reported larger numbers of patients seen per GP per week and reviewed their performance against annual targets, but worse in rural areas and practices routinely reviewing outcomes data. Arrangements for after-hours care were more common among GPs who were planning to retire in the next 5 years worked in practices with high electronic functioning information systems and received and reviewed clinical outcome data and incentives for performance. Conclusions. Improving after-hours access requires a comprehensive approach which includes incentives, improvements to information management and organised systems of care with review of data on clinical outcomes. What is known about the topic? Access to general practice is an important priority for the health system and the subject of several reforms and initiatives over the past decade in Australia. Access to same or next day appointments and after-hours has been an increasing concern related to workforce availability, and limited access to general practice is one factor influencing the demand on hospitals, especially their emergency departments. What does this paper add? This paper reports on secondary analysis of a survey of over 1000 general practitioners in Australia. Responses to questions about access to same or next day appointments or after-hours arrangements were analysed for associations with practitioner and practice characteristics and their processes and systems of care. Access to same day appointments is particularly challenging in rural general practice but is more likely to be reported by GPs working in larger practices. Incentives, quality improvement and better information management may be important strategies to improve after-hours access. What are the implications for practitioners? Strategies to improve access to appointments and to after-hours care need to be considered as part of a comprehensive approach which includes financial incentives, strengthening information systems and quality improvement activities.
Clinical characteristics of patients with asthma COPD overlap (ACO) in australian primary care
Publisher: Informa UK Limited
Date: 12-2019
DOI: 10.2147/COPD.S220346
Does health literacy affect patients' receipt of preventative primary care? A multilevel analysis
Publisher: Springer Science and Business Media LLC
Date: 25-10-2014
An investigation of barriers and enablers to advanced nursing roles in Australian general practice
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.COLEGN.2015.02.003
Abstract: Over the past decade, there has been substantial increase in nurses' roles in primary health care, particularly in general practice settings. Simultaneously, there has been an expansion of advanced roles for nurses across a range of clinical environments. This paper draws upon findings from a study that sought to develop a framework to support development of advanced nursing roles in general practice. It presents findings from one part of that study that explored barriers and facilitators to the development of these roles. Twenty-three key leaders from nursing, general practice and professional organisations participated in semi-structured interviews. Data were analysed using thematic analysis. A range of factors was identified as key to developing advanced roles in general practice. These included increasing awareness and attractiveness of practice nursing, health reform activities, practice limitations, education and professional development. Understanding complex systems and workforce issues is required to promote active intervention that can facilitate development of advanced nursing roles in Australian general practice.
A multifaceted quality improvement intervention for CVD risk management in Australian primary healthcare: a protocol for a process evaluation
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Interdisciplinary model of care (RADICALS) for early detection and management of chronic obstructive pulmonary disease (COPD) in Australian primary care: Study protocol for a cluster randomised controlled trial
Publisher: BMJ
Date: 09-2017
DOI: 10.1136/BMJOPEN-2017-016985
Abstract: Up to half of all smokers develop clinically significant chronic obstructive pulmonary disease (COPD). Gaps exist in the implementation and uptake of evidence-based guidelines for managing COPD in primary care. We describe the methodology of a cluster randomised controlled trial (cRCT) evaluating the efficacy and cost-effectiveness of an interdisciplinary model of care aimed at reducing the burden of smoking and COPD in Australian primary care settings. A cRCT is being undertaken to evaluate an interdisciplinary model of care (RADICALS — Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers). General practice clinics across Melbourne, Australia, are identified and randomised to the intervention group (RADICALS) or usual care. Patients who are current or ex-smokers, of at least 10 pack years, including those with an existing diagnosis of COPD, are being recruited to identify 280 participants with a spirometry-confirmed diagnosis of COPD. Handheld lung function devices are being used to facilitate case-finding. RADICALS includes in idualised smoking cessation support, home-based pulmonary rehabilitation and home medicines review. Patients at control group sites receive usual care and Quitline referral, as appropriate. Follow-ups occur at 6 and 12 months from baseline to assess changes in quality of life, abstinence rates, health resource utilisation, symptom severity and lung function. The primary outcome is change in St George’s Respiratory Questionnaire score of patients with COPD at 6 months from baseline. This project has been approved by the Monash University Human Research Ethics Committee and La Trobe University Human Ethics Committee (CF14/1018 – 2014000433). Results of the study will be disseminated in peer-reviewed journals and research conferences. If the intervention is successful, the RADICALS programme could potentially be integrated into general practices across Australia and sustained over time. ACTRN12614001155684 Pre-results.
Erratum: Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG
Publisher: Springer Science and Business Media LLC
Date: 05-09-2017
DOI: 10.1038/S41533-017-0048-4
Abstract: A correction to this article has been published and is linked from the HTML version of this article.
Sustaining Chronic Disease Management in Primary Care: Lessons from a Demonstration Project
Publisher: CSIRO Publishing
Date: 2007
DOI: 10.1071/PY07030
Abstract: Chronic disease self-management (CDSM) programs have been found effective in improving clinical, behavioural, and self-efficacy outcomes associated with a range of chronic illnesses, and evidence suggests that CDSM is effective in reducing health care costs and health service utilisation. As the setting where most chronic disease is managed, primary health care is an ideal setting for supporting CDSM. This study aimed to explore the uptake and sustainability of CDSM within routine activities of primary health care clinicians involved in the implementation of a demonstration project within an Area Health Service in Sydney NSW. Interviews and focus groups were conducted with managers and clinicians involved in the project. Findings included (1) widespread support from participants for CDSM (2) participating clinicians thought that CDSM was valuable to themselves, their clients and the health system (3) the program required clients to be able to speak and understand English and so presented many barriers for implementation in CALD communities, and (4) the program was not effective in engaging some key members of the primary care team in particular, general practitioners. The study highlights system design issues including communication and continuity of care between service providers, workforce supply and demands of acute care delivery in the community that will need to be addressed for sustainable and effective CDSM to be achieved.
Chronic disease management in primary care: from evidence to policy
Publisher: AMPCo
Date: 04-2008
DOI: 10.5694/J.1326-5377.2008.TB01745.X
Abstract: To review the effectiveness of chronic disease management interventions for physical health problems in the primary care setting, and to identify policy options for implementing successful interventions in Australian primary care. We conducted a systematic review with qualitative data synthesis, using the Chronic Care Model as a framework for analysis between January 1990 and February 2006. Interventions were classified according to which elements were addressed: community resources, health care organisation, self-management support, delivery system design, decision support and/or clinical information systems. Our major findings were discussed with policymakers and key stakeholders in relation to current and emerging health policy in Australia. The interventions most likely to be effective in the context of Australian primary care were engaging primary care in self-management support through education and training for general practitioners and practice nurses, and including self-management support in care plans linked to multidisciplinary team support. The current Practice Incentives Payment and Service Incentives Payment programs could be improved and simplified to encourage guideline-based chronic disease management, integrating incentives so that in idual patients are not managed as if they had a series of separate chronic diseases. The use of chronic disease registers should be extended across a range of chronic illnesses and used to facilitate audit for quality improvement. Training should focus on clear roles and responsibilities of the team members. The Chronic Care Model provides a useful framework for understanding the impact of chronic disease management interventions and highlights the gaps in evidence. Consultation with stakeholders and policymakers is valuable in shaping policy options to support the implementation of the National Chronic Disease Strategy in primary care.
Annual influenza vaccination: Coverage and attitudes of primary care staff in Australia
Publisher: Wiley
Date: 12-10-2011
Better access to psychology services in primary mental health care
Publisher: CSIRO Publishing
Date: 2006
DOI: 10.1071/AH060195
Abstract: Introduction: The Access to Allied Psychological Services program was introduced as part of the Better Outcomes in Mental Health Care initiative in 2001?2002. Divisions of General Practice are funded to establish programs that allow GPs to refer patients for psychological treatments. The University of New South Wales evaluated programs run by the Southern Highlands and Illawarra Divisions of General Practice. This paper presents the findings of these evaluations. Method: Both evaluations analysed process and patient outcomes. This was obtained from a combination of program data and qualitative satisfaction data. Results: The two program models differed in the mechanism of retention of the psychologists and the method of referral of patients. Anxiety and depression were the main reasons for referral, and clinical data showed there was improvement in patient outcomes. Patients, GPs and psychologists expressed satisfaction with the programs. Discussion: The Access to Allied Psychological Services programs in both Divisions have proven popular. Flexibility in the program structure allows Divisions to develop a model which suits their local circumstances. There is support for ongoing Commonwealth funding and the challenge is to find the most effective and financially sustainable model of delivery for psychological services in primary care.
Correction to: Effectiveness of quality incentive payments in general practice (EQuIP-GP): a study protocol for a cluster-randomised trial of an outcomes-based funding model in Australian general prac
Publisher: Springer Science and Business Media LLC
Date: 19-08-2019
Nurse‐led interventions to manage hypertension in general practice: A systematic review and meta‐analysis
Publisher: Wiley
Date: 04-03-2022
DOI: 10.1111/JAN.15159
Abstract: To evaluate the impact of general practice nurse‐led interventions for blood pressure control and cardiovascular disease risk factor reduction in patients with hypertension. Systematic review and meta‐analysis of randomized control trials. CINAHL, Medline and Scopus databases were searched to identify peer‐reviewed studies published between 2000 and 2021. A systematic review of randomized control trials was conducted using a structured search strategy. The Meta‐Analysis of Statistics Assessment and Review Instrument (JBI‐MAStARI) was used to appraise study quality. Meta‐analysis and narrative synthesis were performed to determine the effectiveness of the included interventions. Eleven trials comprising of 4454 participants were included in the review. Meta‐analysis showed significant reductions in both systolic and diastolic blood pressure in trials with 6 months or less follow‐up. Improvements were also demonstrated in reducing blood lipids, physical activity, general lifestyle measures and medication adherence. Evidence for dietary improvements and reduction in alcohol and smoking rates was inconclusive. Nurse‐led interventions for patients with hypertension are heterogeneous in terms of the nature of the intervention and outcomes measured. However, nurse‐led interventions in general practice demonstrate significant potential to improve blood pressure and support cardiovascular disease risk factor reduction. Future research should be directed towards elucidating the successful elements of these interventions, evaluating cost‐effectiveness and exploring translation into usual care. This review provides evidence that nurses in general practice could enhance current hypertension management through nurse‐led interventions.
Erratum: Effectiveness of a new model of primary care management on knee pain and function in patients with knee osteoarthritis: Protocol for the PARTNER STUDY (BMC Musculoskeletal Disorders DOI: 10.1186/s12891-018-2048-0)
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Social and occupational outcomes for young people who attend early intervention mental health services: a longitudinal study
Publisher: Wiley
Date: 17-07-2022
DOI: 10.5694/MJA2.51655
Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general practice
Publisher: Springer Science and Business Media LLC
Date: 23-04-2013
Analysis of health related quality of life and primary care management of OSA and insomnia
Publisher: Wiley
Date: 10-2019
Investigation of diarrhoea in a traveller just returned from India
Publisher: BMJ
Date: 26-05-2011
DOI: 10.1136/BMJ.D2978
Process evaluation of a practice nurse-led smoking cessation trial in Australian general practice: Views of general practitioners and practice nurses
Publisher: Oxford University Press (OUP)
Date: 29-05-2015
Abstract: Support in primary care can assist smokers to quit successfully, but there are barriers to general practitioners (GPs) providing this support routinely. Practice nurses (PNs) may be able to effectively take on this role. The aim of this study was to perform a process evaluation of a PN-led smoking cessation intervention being tested in a randomized controlled trial in Australian general practice. Process evaluation was conducted by means of semi-structured telephone interviews with GPs and PNs allocated in the intervention arm (Quit with PN) of the Quit in General Practice trial. Interviews focussed on nurse training, content and implementation of the intervention. Twenty-two PNs and 15 GPs participated in the interviews. The Quit with PN intervention was viewed positively. Most PNs were satisfied with the training and the materials provided. Some challenges in managing patient data and follow-up were identified. The Quit with PN intervention was acceptable to participating PNs and GPs. Issues to be addressed in the planning and wider implementation of future trials of nurse-led intervention in general practice include providing ongoing mentoring support, integration into practice management systems and strategies to promote greater collaboration in GPs and PN teams in general practice. The ongoing feasibility of the intervention was impacted by the funding model supporting PN employment and the competing demands on the PNs time.
Seroprevalence of hepatitis B antibodies among international and domestic university students
Publisher: Wiley
Date: 08-08-2021
DOI: 10.1111/JVH.13580
Abstract: Chronic hepatitis B prevalence is low in most Australian populations, with universal infant HBV vaccination introduced in 2000. Migrants from high prevalence countries are at risk of acquisition before arrival and non‐immune adults are potentially at risk through skin penetrating procedures and sexual contact, particularly during international travel. The risk profile of young adult students, many from high prevalence countries, is inadequately understood. A cross‐sectional online survey conducted among university students collected data on demographic, vaccination and travel characteristics and blood s les were tested for hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb). Analyses identified factors associated with HBsAb seroprevalence and self‐reported vaccination. The serosurvey was completed by 804 students born between 1988 and 1993, with 613/804 (76.2%, 95% CI 73.2–79.1) self‐reporting prior HBV vaccination. Overall, 526/804 (65.4%, 95% CI 62.0%–68.6%) students were seropositive to HBsAb, including 438/613 (71.5%, 95% CI 67.8–74.9) students self‐reporting a prior HBV vaccine and 88/191 (46.1%, 95% CI 39.2–53.2) students self‐reporting no prior HBV vaccine. Overall, 8/804 (1.0%, 95% CI 0.5%–2.0%) students were HBcAb positive, of whom 1/804 (0.1%, 95% CI 0.02%–0.7%) was currently infectious. The prevalence of chronic HBV infection was low. However, more than one in four students were susceptible to HBV and over‐estimated their immunity. Future vaccination efforts should focus on domestic students born before the introduction of the infant program and all international students. Screening and vaccination of students, including through c us‐based health services, are an opportunity to catch‐up young adults prior to undertaking at‐risk activities, including international travel.
Activating primary care COPD patients with multi-morbidity through tailored self-management support
Publisher: Springer Science and Business Media LLC
Date: 03-04-2020
DOI: 10.1038/S41533-020-0171-5
Abstract: Given the dearth of COPD self-management interventions that specifically acknowledge multi-morbidity in primary care, we aimed to activate COPD patients through personalised self-management support that recognised the implications of co-morbidities. This single-group experimental study included patients aged 40−84 with a spirometry diagnosis of COPD and at least one co-morbidity. A self-management education programme for COPD in the context of multi-morbidity, based on the Health Belief Model, was tailored and delivered to participants by general practice nurses in face-to-face sessions. At 6 months’ follow-up, there was significant improvement in patient activation ( p 0.001), COPD-related quality of life ( p = 0.012), COPD knowledge ( p 0.001) and inhaler device technique ( p = 0.001), with no significant change in perception of multi-morbidity ( p = 0.822) or COPD-related multi-morbidity (0.084). The programme improved patients’ self-efficacy for their COPD as well as overall health behaviour. The findings form an empirical basis for further testing the programme in a large-scale randomised controlled trial.
Self-management support has potential but is difficult to deliver in routine primary care
Publisher: BMJ
Date: 14-08-2013
No difference demonstrated between faxed or mailed prenotification in promoting questionnaire response among family physicians: a randomized controlled trial
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.JCLINEPI.2011.08.014
Abstract: Achieving high survey participation rates among physicians is challenging. We aimed to assess the effectiveness of response-aiding strategies in a postal survey of 1,000 randomly selected Australian family physicians (FPs). A two × two randomized controlled trial was undertaken to assess the effectiveness of a mailed vs. faxed prenotification letter and a mailed questionnaire sealed with a label marked attention to doctor vs. a control label. At the time of our final reminder, we randomized remaining nonresponders to receive a more or less personalized mail-out. Response did not significantly differ among eligible FPs receiving a prenotification letter via mail or fax. However, 25.6% of eligible FPs whose questionnaires were sealed with a label marked attention to the doctor responded before reminders were administered and compared with 18.6% of FPs whose questionnaires were sealed with a control label (P=0.008). Differences were not statistically significant thereafter. There was no significant difference in response between FPs who received a more vs. less personalized approach at the time of the final reminder (P=0.16). Mail marked attention to doctor may usefully increase early response. Prenotification letters delivered via fax are equally effective to those administered by mail and may be cheaper.
Barriers and facilitators to influenza vaccination among high‐risk groups aged less than 65 years – views from general practitioners and practice nurses
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1111/J.1753-6405.2007.00143.X
Abstract: To explore the views of general practitioners and practice nurses about barriers to influenza vaccination among under 65 high-risk patients and strategies to overcome those barriers. Focus group discussions with general practitioners and practice nurses. Barriers identified included: lack of awareness among patients about influenza vaccination GP workload poor GP motivation lack of practice nurses lack of patient recall systems cost of vaccine and lack of media c aign. Strategies proposed included: public education c aigns free supply of vaccine dissemination of evidence to motivate GPs incentives to establish recall systems and greater involvement of practice nurses in the process. Influenza vaccination has not been well accepted by people aged less than 65 years. Implementation of proposed strategies has the potential to improve the vaccination coverage. An improvement in influenza vaccination coverage among people less than 65 years who are in high-risk groups has the potential to reduce hospitalisation and health care costs.
Care of patients with a diagnosis of chronic obstructive pulmonary disease
Publisher: AMPCo
Date: 10-2012
DOI: 10.5694/MJA12.10813
Abstract: To evaluate a partnership model of care for patients with a diagnosis of chronic obstructive pulmonary disease (COPD). Cluster randomised controlled trial with blinded outcome assessment of 44 general practices in south-western Sydney comprising 451 people with a diagnosis of COPD, conducted between 2006 and 2009. Participants from intervention group practices were visited at their home by a registered nurse with specific training in COPD care who worked with the general practitioner, the patient and other health professionals to develop and implement an in idualised care plan based on best-practice guidelines. Participants from control group practices received usual care. The primary outcome was disease-related quality of life measured using the St George's Respiratory Questionnaire (SGRQ) at 12-month follow-up. Other outcomes were overall quality of life, lung function, smoking status, immunisation status, patient knowledge of COPD, and health service use. Of the 451 participants, 257 (57.8%) were confirmed as having COPD on post-bronchodilator spirometry. Follow-up was completed for 330 patients (73.2%). At 12 months, there was no statistically significant difference in the mean SGRQ scores between intervention and control groups (38.7 v 37.6 difference, 1.1 95% CI, - 1.53-3.74 P = 0.41) or in measures of quality of life, lung function and smoking status. Compared with the control group, in the intervention group, attendance at pulmonary rehabilitation was more frequent (31.1% v 9.6% OR, 5.16 95% CI, 2.40-11.10 P = 0.002) and the mean COPD knowledge score was higher (10.5 v 9.8 difference, 0.70 CI, 0.10-1.21 P = 0.02). The nurse-GP partnership intervention did not have an impact on disease-related quality of life at 12-month follow-up. However, there was evidence of improved quality of care, in particular, in attendance at pulmonary rehabilitation and patient knowledge of COPD. Australian Clinical Trials Registry ACTRN012606000304538.
Preventive Evidence into Practice: What factors matter in a facilitation intervention to prevent vascular disease in family practice?
Publisher: Springer Science and Business Media LLC
Date: 08-08-2019
Evaluating the use of the Australian and New Zealand COPD guidelines (The COPD-X Plan) in clinical practice: a user survey
Publisher: European Respiratory Society
Date: 07-09-2020
Healthcare workers and immunity to infectious diseases
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1111/J.1753-6405.2008.00257.X
Abstract: In 2002, New South Wales (NSW) Health introduced an updated policy for occupational screening and vaccination against infectious diseases. This study describes healthcare worker (HCW) immunity to hepatitis B, measles, mumps, rubella (MMR) and varicella based on serological screening, following introduction of this policy. HCW screening serology performed at two healthcare facilities in south western Sydney (Bankstown and Fairfield) was extracted for the period September 2003 to September 2005. Immunity to hepatitis B, MMR and varicella was quantitated and cross-tabulated against age, sex and staff risk category. A total of 1,320 HCWs were screened. Almost two thirds were immune to hepatitis B while immunity to MMR and varicella ranged from 88% to 94%. Age stratification showed lower levels of measles immunity in those born after 1965. Despite availability of vaccination for over two decades, a significant proportion of HCWs at these two facilities were non-immune to hepatitis B. This is of concern for those non-immune staff involved in direct clinical care, who are at risk of blood and body fluid exposures. The small group of HCWs non-immune to MMR and varicella pose a risk to themselves and others in the event of an outbreak. There is a need for improved implementation of the occupational screening and vaccination policy, including better education of HCWs about the risks of non-immunity to vaccine preventable diseases. The revised 2007 NSW Health policy may assist this process and will need evaluation to determine whether HCW immunity improves in the coming years.
Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study
Publisher: Oxford University Press (OUP)
Date: 10-2016
Abstract: People with unknown atrial fibrillation (AF), who are often asymptomatic, have a substantially increased risk of stroke. Although recommended in European guidelines, AF screening is not routinely performed. Screening at the time of influenza vaccination presents an ideal opportunity to detect AF in large numbers in a primary care medical setting, with an existing annual recall system for patients aged ≥65 years. Cross-sectional pilot study of handheld smartphone electrocardiogram (iECG) screening to identify unknown AF. General practices in Sydney, Australia, were recruited during the influenza-vaccination period of April-June 2015. Practice nurses screened patients aged ≥65 years with a 30-second iECG, which has a validated algorithm for detecting AF in real time. In order to confirm the accuracy of the algorithm, two research cardiologists reviewed de-identified iECGs. In order to explore barriers and enablers, semi-structured interviews were conducted with selected nurses, practice managers and general practitioners. Five general practices were recruited, and 973/2476 (39%) patients attending influenza vaccination were screened. Screening took an average of 5 minutes (range 1.5-10 minutes) however, abnormal iECGs required additional time. Newly identified AF was found in 8/973 patients (0.8%). The sensitivity of the iECG automated algorithm was 95% (95% confidence interval: 83-99%) and the specificity was 99% (95% confidence interval: 98-100%). Screening by practice nurses was well accepted by practice staff. Key enablers were the confidence and competence of nurses and a 'designated ch ion' to lead screening at the practice. Barriers were practice specific, and mainly related to staff time and funding. Screening with iECG during influenza vaccination by primary care nurses is feasible and well accepted by practice staff. Addressing barriers is likely to increase uptake.
Implementing guidelines to routinely prevent chronic vascular disease in primary care: The Preventive Evidence into Practice cluster randomised controlled trial
Publisher: BMJ
Date: 12-2015
Online training in evidence-based medicine and research methods for GP registrars: a mixed-methods evaluation of engagement and impact
Publisher: Springer Science and Business Media LLC
Date: 14-09-2021
DOI: 10.1186/S12909-021-02916-0
Abstract: Evidence-based medicine (EBM) is a core skillset for enhancing the quality and safety of patients’ care. Online EBM education could improve clinicians’ skills in EBM, particularly when it is conducted during vocational training. There are limited studies on the impact of online EBM training on clinical practice among general practitioner (GP) registrars (trainees in specialist general practice). We aimed to describe and evaluate the acceptability, utility, satisfaction and applicability of the GP registrars experience with the online course. The course was developed by content-matter experts with educational designers to encompass effective teaching methods (e.g. it was interactive and used multiple teaching methods). Mixed-method data collection was conducted after in idual registrars’ completion of the course. The course comprised six modules that aimed to increase knowledge of research methods and application of EBM skills to everyday practice. GP registrars who completed the online course during 2016–2020 were invited to complete an online survey about their experience and satisfaction with the course. Those who completed the course within the six months prior to data collection were invited to participate in semi-structured phone interviews about their experience with the course and the impact of the course on clinical practice. A thematic analysis approach was used to analyse the data from qualitative interviews. The data showed the registrars were generally positive towards the course and the concept of EBM. They stated that the course improved their confidence, knowledge, and skills and consequently impacted their practice. The students perceived the course increased their understanding of EBM with a Cohen’s d of 1.6. Registrars identified factors that influenced the impact of the course. Of those, some were GP-related including their perception of EBM, and being comfortable with what they already learnt some were work-place related such as time, the influence of supervisors, access to resources and one was related to patient preferences. This study showed that GP registrars who attended the online course reported that it improved their knowledge, confidence, skill and practice of EBM over the period of three months. The study highlights the supervisor’s role on GP registrars’ ability in translating the EBM skills learnt in to practice and suggests exploring the effect of EBM training for supervisors.
Data-driven quality improvement program to prevent hospitalisation and improve care of people living with coronary heart disease: Protocol for a process evaluation
Publisher: Elsevier BV
Date: 07-2022
How is advance care planning conceptualised in Australia? Findings from key informant interviews
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH10883
Abstract: Objective. Advance Care Planning (ACP) has been gaining prominence as an important component of good end-of-life care. This study explored how ACP is conceptualised by stakeholder organisations and clinicians involved in aged care and end-of-life care in Australia, in particular their views on the aim, appropriate context and settings for ACP, and how ACP should be facilitated. Participants. Twenty-three participants including expert clinicians and representatives of government organisations, professional societies, consumer groups and other organisations involved in aged care and end-of-life care. Design. Qualitative descriptive analysis of semi-structured telephone interviews. Results. Most participants viewed ACP as an ongoing process aimed at enhancing an in idual’s autonomy and ensuring good end-of-life care. However, there were significant differences in how this process was conceptualised. Some viewed ACP as a process undertaken by patients to define and communicate their treatment preferences. Others viewed ACP as discussions undertaken by health professionals to gain a better understanding of the patient’s values and goals in order to provide good care. Implications. Our findings highlight significant differences in how ACP is conceptualised in Australia. A shared conceptualisation and agreement on purpose is needed to ensure a successful implementation of ACP in Australia. What is known about the topic? Advance care planning (ACP) has been gaining increasing prominence both internationally and in Australia and is seen as an important component of good end-of-life care. Originally conceptualised as a document outlining a patient’s specific treatment preferences about life-sustaining treatments, ACP has been increasingly recognised in the literature as an ongoing process of discussion, communication and documentation of the patient’s wishes and values regarding end-of-life care. What does this paper add? This paper shows that most expert clinicians and representatives of key stakeholder organisations view ACP as a process that aims to enhance in idual autonomy and ensure good end-of-life care. However, our findings show that they often hold contrasting views on ACP – ranging from a consumer-orientated view that sees ACP as undertaken to define and communicate their care preferences to a care-orientated view that sees ACP as discussions led by health professionals in order to gain an understanding of patients’ values and wishes in order to provide better care. What are the implications for practitioners? Our findings highlight significant differences in how ACP is conceptualised in Australia. This can cause confusion and conflict, leading to reduced effectiveness of ACP. A shared conceptualisation and agreement on purpose is needed to ensure a successful implementation of ACP in Australia.
The effectiveness, safety and cost-effectiveness of cytisine versus varenicline for smoking cessation in an Australian population: a study protocol for a randomized controlled non-inferiority trial.
Publisher: Wiley
Date: 03-02-2019
DOI: 10.1111/ADD.14541
Abstract: Smoking cessation medications are effective, but often underutilized because of costs and side effects. Cytisine is a plant-based smoking cessation medication with more than 50 years of use in central and eastern Europe. While cytisine has been found to be well-tolerated and more effective than nicotine replacement therapy, direct comparisons with varenicline have not been conducted. This study evaluates the effectiveness, safety and cost-effectiveness of cytisine compared with varenicline. Two-arm, parallel group, randomized, non-inferiority trial, with allocation concealment and blinded outcome assessment. Australian population-based study. Adult daily smokers (n = 1266) interested in quitting will be recruited through advertisements and Quitline telephone-based cessation support services. Eligible participants will be randomized (1 : 1 ratio) to receive either cytisine capsules (25-day supply) or varenicline tablets (12-week supply), prescribed in accordance with the manufacturer's recommended dosing regimen. The medication will be mailed to each participant's nominated residential address. All participants will also be offered standard Quitline behavioural support (up to six 10-12-minute sessions). Assessments will be undertaken by telephone at baseline, 4 and 7 months post-randomization. Participants will also be contacted twice (2 and 4 weeks post-randomization) to ascertain adverse events, treatment adherence and smoking status. The primary outcome will be self-reported 6-month continuous abstinence from smoking, verified by carbon monoxide at 7-month follow-up. We will also evaluate the relative safety and cost-effectiveness of cytisine compared with varenicline. Secondary outcomes will include self-reported continuous and 7-day point prevalence abstinence and cigarette consumption at each follow-up interview. If cytisine is as effective as varenicline, its lower cost and natural plant-based composition may make it an acceptable and affordable smoking cessation medication that could save millions of lives world-wide.
Prerequisites for implementing cardiovascular absolute risk assessment in general practice: A qualitative study of Australian general practitioners' and patients' views
Publisher: Wiley
Date: 25-05-2010
DOI: 10.1111/J.1365-2753.2009.01170.X
Abstract: Although recommended in clinical practice guidelines, cardiovascular absolute risk (CVAR) assessment is still used infrequently in Australian general practice. One reason is the lack of an implementation strategy. Given the lack of published reports on the implementation of CVAR worldwide, the aim of this study was to explore the views of general practitioners (GPs) and patients on prerequisites for successfully implementing CVAR assessment in general practice. Multiple data involving GPs and patients were collected using focus groups (FGs) in three isions of General Practice in Sydney between 2005 and 2006. Both GPs' and patients' opinions were analysed using thematic analysis. Twenty-two GPs participated in three GP FGs and 26 patients in three patient FGs. Many GPs thought that an initial cardiovascular risk screening could start from 40 years old while some patients thought it should start even younger. Targeting patients with known risk factors was supported by most GPs although some also stressed the importance of reaching those of unknown risk. For new patients or patients presenting for other problems, another visit for CVAR risk assessment and discussion was preferred by most GPs. A strong GP-patient relationship, common ground on priorities between GPs and their patients, patient awareness of cardiovascular risk and motivation were seen as important by both GPs and patients to the implementation of CVAR assessment. Addressing the appropriate selection of patients and time for implementing CVAR assessment requires a consideration of multiple factors. GPs see it as a process that may need to be staged over more than one consultation and requiring appropriate strategies.
International travel in the pandemic era: Implications for health advice
Publisher: The Royal Australian College of General Practitioners
Date: 11-2022
A scoping review of approaches used to educate primary care providers to manage sleep disorders
Publisher: Wiley
Date: 10-2019
Postgraduate education for doctors in smoking cessation
Publisher: Wiley
Date: 09-2009
DOI: 10.1111/J.1465-3362.2009.00103.X
Abstract: Smoking cessation advice from doctors helps improve quit rates but the opportunity to provide this advice is often missed. Postgraduate education is one strategy to improve the amount and quality of cessation support provided. This paper describes a s le of postgraduate education programs for doctors in smoking cessation and suggests future directions to improve reach and quality. Survey of key informants identified through tobacco control listserves supplemented by a review of the published literature on education programs since 2000. Programs and publications from Europe were not included as these are covered in another paper in this Special Issue. Responses were received from only 21 key informants from eight countries. Two further training programs were identified from the literature review. The following components were present in the majority of programs: 5 As (Ask, Advise, Assess, Assist and Arrange) approach (72%), stage of change (64%), motivational interviewing (72%), pharmacotherapies (84%). Reference to clinical practice guidelines was very common (84%). The most common model of delivery of training was face to face. Lack of interest from doctors and lack of funding were identified as the main barriers to uptake and sustainability of training programs. Identifying programs proved difficult and only a limited number were identified by the methods used. There was a high level of consistency in program content and a strong link to clinical practice guidelines. Key informants identified limited reach into the medical profession as an important issue. New approaches are needed to expand the availability and uptake of postgraduate education in smoking cessation
Diagnosing asthma in adults in primary care: A qualitative study of Australian GPs' experiences
Publisher: Springer Science and Business Media LLC
Date: 21-07-2010
QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with coronary heart disease (QUEL): Protocol for a 24-month cluster randomised controlled trial in primary care
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).
Attitudes and Experiences of Australian General Practitioners Towards the Identification and Management of Obstructive Sleep Apnea Within Primary Care
Publisher: American Thoracic Society
Date: 05-2020
DOI: 10.1164/AJRCCM-CONFERENCE.2020.201.1_MEETINGABSTRACTS.A4152
The role of travel in measles outbreaks in Australia – An enhanced surveillance study
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.VACCINE.2016.07.023
Abstract: Many developed countries, like Australia, maintain a high population level immunity against measles, however, there remains a risk of acquisition of measles in non-immune travellers and subsequent importation into Australia leading to localised outbreaks. In this study, we estimate the incidence of measles and describe characteristics including immunisation and pre-travel health seeking behaviour of notified cases of measles in New South Wales and Victoria, Australia between February 2013 and January 2014. Cases were followed up by telephone interview using a questionnaire to collect information of demographic and travel characteristics. In NSW, the incidence was highest in age group 0-9years (20/million population) whereas in Victoria the highest incidence was observed in 10-19 (23/million population) years group. Out of 44 cases interviewed, 25 (56.8%) had history of travel outside of Australia during or immediately prior to the onset of measles. Holiday (60%) was the main reason for travel with 44% (11/25) reporting visiting friends and relatives (VFR) during the trip. The major reason described for not seeking prior medical advice before travel were "no perceived risk of diseases" (41%) and "previous overseas travel without any problem" (41%). Of the 25 measles cases with recent overseas travel during the incubation period, one reported a measles vaccine prior to their recent trip. Four cases were children of parents who refused vaccination. Twenty out of 25 (80.0%) had attended mass gathering events. Young adults and VFR travellers should be a high priority for preventive strategies in order to maintain measles elimination status.
Identifying leadership for clinical governance in rural and remote primary health care services
Publisher: Wiley
Date: 26-07-2020
DOI: 10.1111/AJR.12653
Effectiveness of a New Service Delivery Model for Management of Knee Osteoarthritis in Primary Care: A Cluster Randomized Controlled Trial
Publisher: Wiley
Date: 29-12-2023
DOI: 10.1002/ACR.25037
Abstract: To evaluate the effectiveness and health costs of a new primary care service delivery model (the Optimising Primary Care Management of Knee Osteoarthritis [PARTNER] model) to improve health outcomes for patients with knee osteoarthritis (OA) compared to usual care. This study was a 2‐arm, cluster, superiority, randomized controlled trial with randomization at the general practice level, undertaken in Victoria and New South Wales, Australia. We aimed to recruit 44 practices and 572 patients age ≥45 years with knee pain for months. Professional development opportunities on best practice OA care were provided to intervention group general practitioners (GPs). All recruited patients had an initial GP visit to confirm knee OA diagnosis. Control patients continued usual GP care, and intervention patients were referred to a centralized care support team (CST) for 12‐months. Via telehealth, the CST provided OA education and an agreed OA action plan focused on muscle strengthening, physical activity, and weight management. Primary outcomes were patient self‐reported change in knee pain (Numerical Rating Scale [range 0–10 higher score = worse]) and physical function (Knee Injury and Osteoarthritis Outcome Score activities of daily living subscale [range 0–100 higher score = better] at 12 months. Health care cost outcomes included costs of medical visits and prescription medications over the 12‐month period. Recruitment targets were not reached. A total of 38 practices and 217 patients were recruited. The intervention improved pain by 0.8 of 10 points (95% confidence interval [95% CI] 0.2, 1.4) and function by 6.5 of 100 points (95% CI 2.3, 10.7), more than usual care at 12 months. Total costs of medical visits and prescriptions were $3,940 (Australian) for the intervention group versus $4,161 for usual care. This difference was not statistically significant. The PARTNER model improved knee pain and function more than usual GP care. The magnitude of improvement is unlikely to be clinically meaningful for pain but is uncertain for function.
A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams
Publisher: Springer Science and Business Media LLC
Date: 07-09-2012
Abstract: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of disability, hospitalization, and premature mortality. General practice is well placed to diagnose and manage COPD, but there is a significant gap between evidence and current practice, with a low level of awareness and implementation of clinical practice guidelines. Under-diagnosis of COPD is a world-wide problem, limiting the benefit that could potentially be achieved through early intervention strategies such as smoking cessation, dietary advice, and exercise. General practice is moving towards more structured chronic disease management, and the increasing involvement of practice nurses in delivering chronic care. A pragmatic cluster randomised trial will test the hypothesis that intervention by a practice nurse-general practitioner (GP) team leads to improved health-related quality of life and greater adherence with clinical practice guidelines for patients with newly-diagnosed COPD, compared with usual care. Forty general practices in greater metropolitan Sydney Australia will be recruited to identify patients at risk of COPD and invite them to attend a case finding appointment. Practices will be randomised to deliver either practice nurse-GP partnership care, or usual care, to patients newly-diagnosed with COPD. The active intervention will involve the practice nurse and GP working in partnership with the patient in developing and implementing a care plan involving (as appropriate), smoking cessation, immunisation, pulmonary rehabilitation, medication review, assessment and correction of inhaler technique, nutritional advice, management of psycho-social issues, patient education, and management of co-morbidities. The primary outcome measure is health-related quality of life, assessed with the St George’s Respiratory Questionnaire 12 months after diagnosis. Secondary outcome measures include validated disease-specific and general health related quality of life measures, smoking and immunisation status, medications, inhaler technique, and lung function. Outcomes will be assessed by project officers blinded to patients’ randomization groups. This study will use proven case-finding methods to identify patients with undiagnosed COPD in general practice, where improved care has the potential for substantial benefit in health and healthcare utilization. The study provides the capacity to trial a new model of team-based assessment and management of newly diagnosed COPD in Australian primary care. ACTRN12610000592044\\
Population-based analysis of sociodemographic predictors, health-related quality of life and health service use associated with obstructive sleep apnoea and insomnia in Australia
Publisher: CSIRO Publishing
Date: 03-03-2021
DOI: 10.1071/PY20216
Abstract: Although there is growing recognition of the effects of living with sleep disorders and the important role of primary care in their identification and management, studies indicate that the detection of sleep apnoea (OSA) and insomnia may still be low. This large representative community-based study (n = 2977 adults) used logistic regression models to examine predictors of self-reported OSA and current insomnia and linear regression models to examine the association of these sleep conditions with both mental and physical components of health-related quality of life (HRQoL) and health service use. Overall, 5.6% (95% confidence interval (CI) 4.6–6.7) and 6.8% (95% CI 5.7–7.9) of subjects self-reported OSA (using a single-item question) and current insomnia (using two single-item questions) respectively. Many sociodemographic and lifestyle predictors for OSA and insomnia acted in different directions or showed different magnitudes of association. Both disorders had a similar adverse relationship with physical HRQoL, whereas mental HRQoL was more impaired among those with insomnia. Frequent consultations with a doctor were associated with a lower physical HRQoL across these sleep conditions however, lower mental HRQoL among those frequently visiting a doctor was observed only among in iduals with insomnia. The adverse relationship between sleep disorders and physical and mental HRQoL was substantial and should not be underestimated.
A Web-Based Mental Health Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The Springboard Trial): 12-Month Outcomes of a Randomized Controlled Trial
Publisher: JMIR Publications Inc.
Date: 12-2020
DOI: 10.2196/16729
Abstract: People with type 2 diabetes mellitus (T2DM) often experience mental health symptoms that exacerbate illness and increase mortality risk. Access to psychological support is low in people with T2DM. Detection of depression is variable in primary care and can be further h ered by mental health stigma. Electronic mental health (eMH) programs may provide an accessible, private, nonstigmatizing mental health solution for this group. This study aims to evaluate the efficacy over 12 months of follow-up of an eMH program (myCompass) for improving social and occupational functioning in a community s le of people with T2DM and self-reported mild-to-moderate depressive symptoms. myCompass is a fully automated and self-guided web-based public health program for people with depression or anxiety. The effects of myCompass on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior were also examined. Adults with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited via online advertisements, community organizations, and general practices. Screening, consent, and self-report questionnaires were administered online. Eligible participants were randomized to receive either myCompass (n=391) or an attention control generic health literacy program (Healthy Lifestyles n=379) for 8 weeks. At baseline and at 3, 6, and 12 months postintervention, participants completed the Work and Social Adjustment Scale, the Patient Health Questionnaire-9 item, the Diabetes Distress Scale, the Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Glycosylated hemoglobin measurements were obtained at baseline and 6 and 12 months postintervention. A total of 38.9% (304/780) of the trial participants completed all postintervention assessments. myCompass users logged in on an average of 6 times and completed an average of 0.29 modules. Healthy Lifestyles users logged in on an average of 4 times and completed an average of 1.37 modules. At baseline, the mean scores on several outcome measures, including the primary outcome of work and social functioning, were close to the normal range, despite a varied and extensive recruitment process. Intention-to-treat analyses revealed slightly greater improvement at 12 months in work and social functioning for the Healthy Lifestyles group relative to the myCompass group. All participants reported equivalent improvements in depression anxiety, diabetes distress, diabetes self-management, and glycemic control across the trial. The Healthy Lifestyles group reported higher ratings of social and occupational functioning than the myCompass group, but no differences were observed for any secondary outcome. Although these findings should be interpreted in light of the near-floor symptom scores at baseline, the trial yields important insights into how people with T2DM might be engaged in eMH programs and the challenges of focusing specifically on mental health. Several avenues emerge for continued investigation into how best to deal with the growing mental health burden in adults with T2DM. Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000931572 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109& isReview=true
Quit in general practice
Publisher: Oxford University Press (OUP)
Date: 09-02-2015
Abstract: To evaluate the uptake and effectiveness of tailored smoking cessation support, provided primarily by the practice nurse (PN), and compare this to other forms of cessation support. Three arm cluster randomized controlled trial conducted in 101 general practices in Sydney and Melbourne involving 2390 smokers. The Quit with PN intervention was compared to Quitline referral and a usual care control group. Smoking cessation pharmacotherapy was recommended to all groups. Outcomes were assessed by self-report at 3- and 12-month follow-up. Uptake of the interventions is also reported. The three groups were similar at baseline. Follow-up at 12 months was 82%. The sustained and point prevalence abstinence rates, respectively, at 3 months by group were: PN intervention 13.1% and 16.3% Quitline referral 10.8% and 14.2% Usual GP care 11.4% and 15.0%. At 12 months, the rates were: PN intervention 5.4% and 17.1% Quitline referral 4.4% and 18.8% Usual GP care 2.9% and 16.4%. Only 43% of patients in the PN intervention group attended to see the nurse. Multilevel regression analysis showed no effect of the intervention overall, but patients who received partial or complete PN support were more likely to report sustained abstinence [partial support odds ratio (OR) 2.27 complete support OR 5.34]. The results show no difference by group on intention to treat analysis. Those patients who received more intensive PN intervention were more likely to quit. This may have been related to patient motivation or an effect of PN led cessation support.
Factors influencing general practice follow-up attendances of patients with complex medical problems after hospitalization
Publisher: Oxford University Press (OUP)
Date: 04-11-2009
Abstract: Supported discharge care of patients with complex medical problems is associated with improved health outcomes. GPs are ideally placed to provide post-discharge care in the community. Knowledge of factors that influence patients' decisions to attend such follow-up is thus important to improve health care outcomes of these patients. To explore factors that influence complex medical patients' decision to attend GP follow-up after discharge and factors affecting their level of satisfaction with such follow-up. Qualitative investigation using semi-structured telephone interviews of 26 patients with complex medical issues conducted 2 weeks after hospital discharge. Complex medical patients experienced varying degrees of concern and information needs after discharge from hospital. Patients' understanding of the role of the GP and experiences of continuity of care also influence patients' decisions to attend follow-up with their GP. In addition, practical factors such as GP availability, presence of discharge instructions, access to transport and level of social support also affect patients' ability to attend early GP follow-up after hospital discharge. Patients' satisfaction with GP follow-up was influenced by perceived competence and personal continuity with the GP. Patients' decisions to attend GP follow-up after hospitalization are influenced by a number of factors. Interventions to support post-hospital care that address these issues need to be developed and tested. Key issues are patients' understanding of their condition, understanding of the role of the GP in follow-up and continuity of care.
Impact of sustained use of a multifaceted computerized quality improvement intervention for cardiovascular disease management in Australian primary health care
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-10-2017
Abstract: We evaluated a multifaceted, computerized quality improvement intervention for management of cardiovascular disease ( CVD ) risk in Australian primary health care. After completion of a cluster randomized controlled trial, the intervention was made available to both trial arms. Our objective was to assess intervention outcomes in the post‐trial period and any heterogeneity based on original intervention allocation. Data from 41 health services were analyzed. Outcomes were (1) proportion of eligible population with guideline‐recommended CVD risk factor measurements and (2) the proportion at high CVD risk with current prescriptions for guideline‐recommended medications. Patient‐level analyses were conducted using generalized estimating equations to account for clustering and time effects and tests for heterogeneity were conducted to assess impact of original treatment allocation. Median follow‐up for 22 809 patients (mean age, 64.2 years 42.5% men, 26.5% high CVD risk) was 17.9 months post‐trial and 35 months since trial inception. At the end of the post‐trial period there was no change in CVD risk factor screening overall when compared with the end of the trial period (64.7% versus 63.5%, P =0.17). For patients at high CVD risk, there were significant improvements in recommended prescriptions at end of the post‐trial period when compared with the end of the trial period (65.2% versus 56.0%, P .001). There was no heterogeneity of treatment effects on the outcomes based on original randomization allocation. CVD risk screening improvements were not observed in the post‐trial period. Conversely, improvements in prescribing continued, suggesting that changes in provider and patient actions may take time when initiating medications. URL : www.anzctr.org.au . Unique identifier: 12611000478910.
Preventing chronic disease in overweight and obese patients with low health literacy using eHealth and teamwork in primary healthcare (HeLP-GP): a cluster randomised controlled trial.
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2021-060393
Abstract: To evaluate a multifaceted intervention on diet, physical activity and health literacy of overweight and obese patients attending primary care. A pragmatic two-arm cluster randomised controlled trial. Urban general practices in lower socioeconomic areas in Sydney and Adelaide. We aimed to recruit 800 patients in each arm. Baseline assessment was completed by 215 patients (120 intervention and 95 control). A practice nurse-led preventive health check, a mobile application and telephone coaching. Primary outcomes were measured at baseline, 6 and 12 months, and included patient health and eHealth literacy, weight, waist circumference and blood pressure. Secondary outcomes included changes in diet and physical activity, preventive advice and referral, blood lipids, quality of life and costs. Univariate and multivariate analyses of difference-in-differences (DiD) estimates for each outcome were conducted. At 6 months, the intervention group, compared with the control group, demonstrated a greater increase in Health Literacy Questionnaire domain 8 score (ability to find good health information mean DiD 0.22 95% CI 0.01 to 0.44). There were similar differences for domain 9 score (understanding health information well enough to know what to do) among patients below the median at baseline. Differences were reduced and non-statistically significant at 12 months. There was a small improvement in diet scores at 6 months (DiD 0.78 (0.10 to 1.47) p=0.026) but not at 12 months. There were no differences in eHealth literacy, physical activity scores, body mass index, weight, waist circumference or blood pressure. Targeted recruitment and engagement were challenging in this population. While the intervention was associated with some improvements in health literacy and diet, substantial differences in other outcomes were not observed. More intensive interventions and using codesign strategies to engage the practices earlier may produce a different result. Codesign may also be valuable when targeting lower socioeconomic populations. Australian New Zealand Clinical Trials Registry (ACTRN 12617001508369) (www.ANZCTR.org.au/ACTRN12617001508369.aspx). The protocol for this trial has been published (open access ontent/8/6/e023239).
A Web-Based Cognitive Behavior Therapy Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The SpringboarD Trial): Randomized Controlled Trial
Publisher: JMIR Publications Inc.
Date: 21-05-2019
DOI: 10.2196/12246
Do people with existing chronic conditions benefit from telephone coaching? A rapid review
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH13005
Abstract: Objective. To examine the effectiveness of telephone-based coaching services for the management of patients with chronic diseases. Methods. A rapid scoping review of the published peer reviewed literature, using Medline, Embase, CINAHL, PsychNet and Scopus. We included studies involving people aged 18 years or over with one or more of the following chronic conditions: type 2 diabetes, congestive cardiac failure, coronary artery disease, chronic obstructive pulmonary disease and hypertension. Patients were identified as having multi-morbidity if they had an index chronic condition plus one or more other chronic condition. To be included in this review, the telephone coaching had to involve two-way conversations by telephone or video phone between a patient and a provider. Behaviour change, goal setting and empowerment are essential features of coaching. Results. The review found 1756 papers, which was reduced to 30 after screening and relevance checks. Most coaching services were planned, as opposed to reactive, and targeted patients with complex needs who had one or more chronic disease. Several studies reported improvements in health behaviour, self-efficacy, health status and satisfaction with the service. More than one-third of the papers targeted vulnerable people and telephone coaching was found to be effective for these people. Conclusions. Telephone coaching for people with chronic conditions can improve health behaviour, self-efficacy and health status. This is especially true for vulnerable populations who had difficulty accessing health services. There is less evidence for improvements in quality of life and patient satisfaction with the service. The evidence for improvements in health service use was limited. This rapid scoping review found that telephone-based coaching can enhance the management of chronic disease, especially for vulnerable groups. Further work is needed to identify what models of telephone coaching are most effective according to patients’ level of risk and co-morbidity. What is known about the topic? With the increasing prevalence of chronic diseases more demands are being made of limited health services and resources. Telephone health coaching for people with or at risk of chronic diseases is seen as a means of supporting people to manage their health and reducing the burden on the healthcare system. What does this paper add? Telephone coaching interventions were effective for vulnerable people with chronic disease(s). Often the vulnerable populations had worse control of their chronic condition at baseline and demonstrated the greatest improvement compared with those with better control at baseline. Planned (i.e. weekly or monthly telephone calls to support the patients with chronic disease) and unscripted telephone coaching interventions appear to be most effective for improving self-management skills in people from vulnerable groups: the planned telephone coaching services had the advantage of regular contact and helping people develop their skills over time, whereas the unscripted aspect allowed the coach to tailor support to the patient’s in idual needs What are the implications for practitioners? Telephone coaching is an effective means of supporting people with chronic diseases to manage their own health. Further work is needed to embed telephone coaching within existing services. Good linkages with the patient’s general practitioner are important. This might be a regular report, updates via the patient e-health record, or provision for contact if a problem is identified or linking to the patient e-health record.
Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence†
Publisher: Oxford University Press (OUP)
Date: 2018
DOI: 10.1093/JTM/TAY010
Abstract: Travellers visiting friends and relatives (VFR travellers) in their country of origin are at increased risk of a range of preventable infections. Risks are broadly related to circumstances of travel, risk misconceptions and access to health services. Despite nearly two decades of literature highlighting these increased risks little impact has been made on their risk disparity. This review draws on evidence from travel medicine literature, supplemented by evidence from the broader field of immigrant health, and is structured to include strategies that aim to reduce barriers at the patient, provider and health system level. For the travel medicine provider, tailored risk communication that is cognisant of the unique health beliefs and barriers to travel health for VFR travellers is needed, including enhanced communication through the use of interpreters and supplementary written communication. Primary care providers are uniquely placed to identify future travel plans among immigrant patients, however, greater awareness of VFR traveller risks and training in travel medicine are required. Community health promotion interventions that are culturally appropriate, translated into multiple languages and takes into account the cumulative risk of multiple return visits are key to normalizing travel healthcare seeking behaviours and improving awareness of VFR travel risks. Currently, there are few ex les of novel strategies to engage migrant communities in travel health with no formal evaluations of their effectiveness. Best practice includes the use of community-consulted approaches in collaboration with government, primary care and travel medicine. Multifactorial barriers related to health beliefs and access to health services require a range of strategies and interventions in both reaching and providing advice to VFR travellers. To improve the evidence base, future research should focus on the evaluation of novel strategies that address these barriers and improve access and provision of pre-travel healthcare to VFR travellers.
Reviewing the Evidence on the Effectiveness of Smoking Cessation Interventions
Publisher: PUBLISHED BY IMPERIAL COLLEGE PRESS AND DISTRIBUTED BY WORLD SCIENTIFIC PUBLISHING CO.
Date: 11-2009
Risk activities and pre-travel health seeking practices of notified cases of imported infectious diseases in Australia
Publisher: Oxford University Press (OUP)
Date: 12-07-2017
DOI: 10.1093/JTM/TAX044
Abstract: Travellers are at risk of acquiring infectious diseases during travel, with risks differing by destination, travel and traveller characteristics. A pre-travel health consultation may minimize this risk. However, uptake of pre-travel health advice remains low. We investigated pre-travel health preparations and disease-specific risk behaviours among notified cases of selected travel-associated infectious diseases imported into Australia. Prospective enhanced surveillance of notified cases of typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya was conducted in two Australian states between February 2013 and January 2014. Details of pre-travel health preparation and disease-specific risk behaviours were collected. Among 180 cases associated with international travel, 28% were <18 years, 65% were VFR travellers and 22% were frequent travellers, having travelled ≥5 times in the past 5 years. 25% had sought pre-travel advice from a healthcare provider, and 16% reported a pre-travel vaccine. Seeking pre-travel health advice did not differ by immigrant status ( P = 0.22) or by reason for travel ( P = 0.13) but was more commonly sought by first time travellers ( P = 0.03). Travellers visiting friends and relatives were more likely to report at-risk activities of brushing teeth with tap water ( P < 0.001) and eating uncooked food ( P = 0.03) during travel compared to other travellers. Pre-travel health advice seeking practices and vaccine uptake was suboptimal among cases of notified disease. The results of this study highlight the need for a better understanding of barriers to pre-travel health seeking, particularly among high risk travellers, to reduce the importation of infectious diseases into Australia.
Age-Related Variation in the Provision of Primary Care Services and Medication Prescriptions for Patients with Cardiovascular Disease
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.
Australian general practitioner perceptions of the detection and screening of at-risk drinking, and the role of the AUDIT-C: A qualitative study
Publisher: Springer Science and Business Media LLC
Date: 20-08-2013
The cost of asthma medicines
Publisher: Therapeutic Guidelines Limited
Date: 04-2018
Barriers to the use of anticoagulation for nonvalvular atrial fibrillation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2008
DOI: 10.1161/STROKEAHA.107.495036
Abstract: Background and Purpose— Anticoagulation reduces the risk of stroke in nonvalvular atrial fibrillation yet remains underused. We explored barriers to the use of anticoagulants among Australian family physicians. Methods— The authors conducted a representative, national survey. Results— Of the 596 (64.4%) eligible family physicians who participated, 15.8% reported having a patient with nonvalvular atrial fibrillation experience an intracranial hemorrhage with anticoagulation and 45.8% had a patient with known nonvalvular atrial fibrillation experience a stroke without anticoagulation. When presented with a patient at “very high risk” of stroke, only 45.6% of family physicians selected warfarin in the presence of a minor falls risk and 17.1% would anticoagulate if the patient had a treated peptic ulcer. Family physicians with less decisional conflict and longer-standing practices were more likely to endorse anticoagulation. Conclusion— Strategies to optimize the management of nonvalvular atrial fibrillation should address psychological barriers to using anticoagulation.
Feasibility and acceptability of a nurse-led hypertension management intervention in general practice
Publisher: Elsevier BV
Date: 02-2018
The Summary of an Urdu Version of Diabetes Self-Care Activities Measure: Psychometric Evaluation and Validation
Publisher: SAGE Publications
Date: 2020
Abstract: Objective: The English version of the Summary of Diabetes Self-Care Activities (SDSCA) measure is the most frequently used self-reporting instrument assessing diabetes self-management. This study is aimed at translating English SDSCA into the Urdu version and validating and evaluating its psychometric properties. Methods: The Urdu version of SDSCA was developed based on the guidelines provided by the World Health Organization for translation and adaptation of instruments. The panel of experts examined the content validity, reliability, and internal consistency of the instrument. The translation process from the English version to the Urdu version revealed excellent results at all the stages. Results: The instrument showed promising and acceptable results. Of particular mention are the results related to split-half reliability coefficient 0.90, test-retest reliability ( r = 0.918, P .001), intraclass coefficient (0.912), and Cronbach’s alpha (.79). The factor analysis (exploratory and confirmatory) was not performed in this study due to the small s le size (n = 30) as the objective was to validate the Urdu version of the SDSCA instrument. Conclusions: This study provided evidence for the reliability and validity of the Urdu Summary of Diabetes Self-Care Activities (U-SDSCA) instrument, which may be used in the future for the patients of diabetes in order to assess type 2 diabetes self-management activities in the rural area of Pakistan and other Urdu-speaking countries.
Bupropion as an aid to smoking cessation: a review of real-life effectiveness
Publisher: Hindawi Limited
Date: 02-04-2004
DOI: 10.1111/J.1368-5031.2004.00153.X
Abstract: Clinical trials rigorously demonstrate the efficacy of new products and justify their marketing. However, it is only after use in real-life settings that the clinical value (effectiveness) of a new treatment is fully known. The purpose of this review was to summarise the effectiveness data for bupropion SR as an aid to smoking cessation. Available reports of effectiveness data for bupropion SR were obtained from the literature, presentations at smoking cessation meetings and from the manufacturer. Twelve sources of effectiveness data were found and included clinical practice trials, observational studies/surveys, motivational support programme results and employer-based cessation programme results. The 6-month point prevalence smoking cessation rates ranged from 25 to 49%. There is a growing body of evidence supporting the effectiveness of bupropion SR as an aid to smoking cessation. Real-life quit rates for bupropion SR are similar to those seen in the original clinical trial programme.
Self-management experiences among middle-aged population of rural area of Pakistan with type 2 diabetes: A qualitative analysis
Publisher: Elsevier BV
Date: 06-2019
An inquiry into patient and general practice attitudes to financial quality-care incentives in primary care: pre-intervention data from the EQuIP-GP trial
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/PYV25N3ABS
Prevalence of FOB testing in eastern‐Australian general practice patients: what has a national bowel cancer screening program delivered?
Publisher: Wiley
Date: 30-03-2015
DOI: 10.1071/HE14058
Advancing general practice nursing in Australia: Roles and responsibilities of primary healthcare organisations
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH15239
Abstract: Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce. Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territories Results Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs (2) facilitating leadership opportunities (3) providing education and educational access (4) facilitating integration of general practice with other primary care services to support interdisciplinary care and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies. Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices. What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses’ skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally. What does this paper add? This study delineates organisational support roles for PHCOs in strengthening nurses’ roles and career development in Australian general practice. What are the implications for practitioners? Effective implementation of appropriate responsibilities by PHCOs can assist development of the primary care nursing workforce.
Role of pharmacists in collaborative care of travellers with chronic conditions
Publisher: Elsevier BV
Date: 05-0012
Telehealth's future in Australian Primary Health Care: Lessons from the COVID-19 Pandemic
Publisher: Royal College of General Practitioners
Date: 07-02-2202
Abstract: During the COVID-19 pandemic, telehealth emerged as a means of safely providing primary healthcare (PHC) consultations. In Australia, changes to telehealth funding led to the reconsideration of the role of telehealth in the ongoing provision of PHC services. To investigate GPs’, registered nurses‘ (RNs), nurse practitioners‘ (NPs), and allied health (AH) clinicians perceptions of the sustainability of telehealth in PHC post-pandemic. Semi-structured interviews were undertaken with 33 purposively selected clinicians, including GPs ( n = 13), RNs ( n = 5), NPs ( n = 9), and AH clinicians ( n = 6) working in PHC settings across Australia. Participants were drawn from responders to a national survey of PHC providers ( n = 217). The thematic analysis approach reported by Braun and Clarke was used to analyse the interview data. Data analysis revealed that the perception of providers was represented by the following two themes: lessons learnt and the sustainability of telehealth. Lessons learnt included the need for rapid adaptation to telehealth, use of technology, and the pandemic being a catalyst for long-term change. The sustainability of telehealth in PHC comprised four subthemes around challenges: the funding model, maintaining patient and provider safety, hybrid service models, and access to support. Providers required resilience and flexibility to adapt to telehealth. Funding models must reward providers from an outcome focus, rather than placing limits on telehealth’s use. Hybrid approaches to service delivery will best meet the needs of the community but must be accompanied by support and education for PHC professionals.
Asthma COPD overlap versus COPD alone in Australian primary care
Publisher: Wiley
Date: 03-2019
DOI: 10.1111/RESP.13491
Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG
Publisher: Springer Science and Business Media LLC
Date: 09-06-2017
DOI: 10.1038/S41533-017-0039-5
Abstract: Tobacco smoking is the world’s leading cause of premature death and disability. Global targets to reduce premature deaths by 25% by 2025 will require a substantial increase in the number of smokers making a quit attempt, and a significant improvement in the success rates of those attempts in low, middle and high income countries. In many countries the only place where the majority of smokers can access support to quit is primary care. There is strong evidence of cost-effective interventions in primary care yet many opportunities to put these into practice are missed. This paper revises the approach proposed by the International Primary Care Respiratory Group published in 2008 in this journal to reflect important new evidence and the global variation in primary-care experience and knowledge of smoking cessation. Specific for primary care, that advocates for a holistic, bio-psycho-social approach to most problems, the starting point is to approach tobacco dependence as an eminently treatable condition. We offer a hierarchy of interventions depending on time and available resources. We present an equitable approach to behavioural and drug interventions. This includes an update to the evidence on behaviour change, gender difference, comparative information on numbers needed to treat, drug safety and availability of drugs, including the relatively cheap drug cytisine, and a summary of new approaches such as harm reduction. This paper also extends the guidance on special populations such as people with long-term conditions including tuberculosis, human immunodeficiency virus, cardiovascular disease and respiratory disease, pregnant women, children and adolescents, and people with serious mental illness. We use expert clinical opinion where the research evidence is insufficient or inconclusive. The paper describes trends in the use of waterpipes and cannabis smoking and offers guidance to primary-care clinicians on what to do faced with uncertain evidence. Throughout, it recognises that clinical decisions should be tailored to the in idual’s circumstances and attitudes and be influenced by the availability and affordability of drugs and specialist services. Finally it argues that the role of the International Primary Care Respiratory Group is to improve the confidence as well as the competence of primary care and, therefore, makes recommendations about clinical education and evaluation. We also advocate for an update to the WHO Model List of Essential Medicines to optimise each primary-care intervention. This International Primary Care Respiratory Group statement has been endorsed by the Member Organisations of World Organization of Family Doctors Europe.
A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors
Publisher: Springer Science and Business Media LLC
Date: 06-2012
The effects of a brief physiotherapist-led intervention in primary care on physical activity levels in people with COPD
Publisher: Wiley
Date: 03-2022
DOI: 10.1111/RESP.14216
Why Are Advance Care Planning Decisions Not Implemented? Insights from Interviews with Australian General Practitioners
Publisher: Mary Ann Liebert Inc
Date: 10-2013
Abstract: Advance care planning (ACP) is thought to enhance patient autonomy and improve end-of-life care. However, there is evidence that when patients engage in ACP, the resultant plans are often not implemented. This has been attributed to either nonadherence by health professionals or inadequacies in ACP such as inaccessibility of the plans, plans providing ambiguous or conflicting instructions, and inappropriate focus on the completion of documents rather than communication. However, it is not known whether these postulated reasons are consistent with the experiences and views of health care professionals providing end-of-life care in the community. Our aim was to explore the perspectives of general practitioners (GPs) on factors influencing the implementation of ACPs. We conducted semi-structured, open-ended interviews of a purposive s le of 17 Australian GPs. Interview transcripts were analysed using constructionist grounded theory utilizing NVivo 9 software. Factors that were considered to have an important influence on the implementation of ACPs include: ACP factors such as form, legal standing, accessibility, clarity, currency, and specificity illness factors such as quality of life, function, diagnosis, prognosis, and prognostic certainty family factors such as family attitudes to ACP and different conceptualizations on whether care is provided to in iduals or to a family unit and organizational and care setting factors such as health care facility's attitudes and policies in relation to end-of-life care. Problems in implementation of ACPs are multifactorial and not necessarily due to deliberate nonadherence by health professionals. Potential solutions to improve the clinical impact of ACP are discussed.
Applications of a Chronic Care Model for Self-Management of Type 2 Diabetes: A Qualitative Analysis
Publisher: MDPI AG
Date: 15-10-2021
Abstract: The main aim of this study was to explore the suitability, practicality, and acceptability of the self-management support and delivery system design components of the Chronic Care Model (CCM) in type 2 diabetes self-management in primary care settings in rural Pakistan. Thirty patients living with type 2 diabetes and 20 healthcare professionals (10 general practitioners and 10 nurses) were recruited from Al-Rehman Hospital at Abbottabad, Pakistan. The study data were collected using semi-structured interviews and analyzed using thematic analysis. The self-management element of the CCM played an important role in managing type 2 diabetes, and self-efficacy in relation to diet and diabetes management were the most effective strategies. Surprisingly, considering the local culture around diabetes, patient care reflecting their cultural background was identified as an important factor by patients not healthcare professionals. The delivery system design element of the CCM promoted multidisciplinary teamwork. Our findings suggest that the self-management support and delivery system design components of the CCM provided an effective framework for supporting diabetes self-management education and support in rural areas.
Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation: a cluster randomised trial
Publisher: Springer Science and Business Media LLC
Date: 08-06-2020
DOI: 10.1186/S12875-020-01175-0
Abstract: Anticoagulation for preventing stroke in atrial fibrillation is under-utilised despite evidence supporting its use, resulting in avoidable death and disability. We aimed to evaluate an intervention to improve the uptake of anticoagulation. We carried out a national, cluster randomised controlled trial in the Australian primary health care setting. General practitioners received an educational session, delivered via telephone by a medical peer and provided information about their patients selected either because they were not receiving anticoagulation or for whom anticoagulation was considered challenging. General practitioners were randomised to receive feedback from a medical specialist about the cases (expert decisional support) either before or after completing a post-test audit. The primary outcome was the proportion of patients reported as receiving oral anticoagulation. A secondary outcome assessed antithrombotic treatment as appropriate against guideline recommendations. One hundred and seventy-nine general practitioners participated in the trial, contributing information about 590 cases. At post-test, 152 general practitioners (84.9%) completed data collection on 497 cases (84.2%). A 4.6% ( Adjusted Relative Risk = 1.11, 95% CI = 0.86–1.43) difference in the post-test utilization of anticoagulation between groups was not statistically significant ( p = 0.42). Sixty-one percent of patients in both groups received appropriate antithrombotic management according to evidence-based guidelines at post-test (Adjusted Relative Risk = 1.0 95% CI = 0.85 to 1.19) ( p = 0.97). Specialist feed-back in addition to an educational session did not increase the uptake of anticoagulation in patients with AF. ANZCTRN12611000076976 Retrospectively registered.
General Practitioners' Perception of Risk for Travelers Visiting Friends and Relatives
Publisher: Oxford University Press (OUP)
Date: 11-2015
DOI: 10.1111/JTM.12229
Abstract: General practitioners (GPs) are an important source of pre-travel health advice for travelers however, only a few studies have investigated primary healthcare provider-related barriers to the provision of pre-travel health advice, particularly to travelers visiting friends and relatives (VFR). We aimed to investigate Australian GPs' knowledge, attitudes, and practices with regard to VFR travelers. A postal survey was sent to randomly s led GPs in Sydney, Australia, in 2012. The questionnaire investigated GPs' perception of risk and barriers to the provision of advice to VFR travelers. Of 563 GPs, 431 (76.6%) spoke a language other than English (LOTE) with 361 (64.1%) consulting in a LOTE. Overall, 222 (39.4%) GPs considered VFR travelers to be at higher risk than holiday travelers, with GPs consulting in English only [adjusted odds ratio (aOR) 1.65, 95% confidence interval (CI) 1.11-2.44, p = 0.01] and GPs considering long-term migrants as VFR travelers (aOR 1.86 95% CI 1.07-3.23, p = 0.03) remaining significant on multivariate analysis. Multilingual GPs are a valuable resource to reducing language and cultural barriers to healthcare. Targeted education of this subgroup of GPs may assist in promoting pre-travel health assessments for VFR travelers. Awareness of the need for opportunistic targeting of migrants for pre-travel consultation through routine identification of future travel is needed.
Which providers can bridge the health literacy gap in lifestyle risk factor modification education: a systematic review and narrative synthesis
Publisher: Springer Science and Business Media LLC
Date: 28-05-2012
The management of non-valvular atrial fibrillation (NVAF) in Australian general practice: Bridging the evidence-practice gap. A national, representative postal survey
Publisher: Springer Science and Business Media LLC
Date: 13-11-2008
Pretravel Advice and Hepatitis A Immunization Among Australian Travelers
Publisher: Oxford University Press (OUP)
Date: 2007
DOI: 10.1111/J.1708-8305.2006.00088.X
Abstract: More Australians are traveling to overseas destinations where preventable infectious diseases, such as hepatitis A, are endemic. Yet, there is only limited data concerning the extent to which Australians seek travel advice and vaccination before their departures. Annual telephone surveys were conducted among adult Australians travelers. Information was collected on the travel advice and vaccinations received before departure. Perceptions about, and their potential exposure to, travel-related infections while overseas were also assessed. This paper presents data from the 2003 survey related to travel advice and hepatitis A, while hepatitis B is discussed in the companion article. Only a third of interviewees had sought health advice before travel. Infrequent travelers, those departing for endemic countries or for longer journeys, were more likely to seek medical advice. Overall, 32% of interviewees had been vaccinated against hepatitis A, with travelers to high/medium-hepatitis A endemicity destinations being more likely to be vaccinated than those visiting low-endemicity countries (44% vs 20%). Among the 263 visitors to endemic countries, those who stayed with friends and relatives were least likely to be vaccinated against hepatitis A compared to other styles of accommodation. Despite government recommendations and industry group c aigns about the need for pretravel advice, the majority of Australians travel overseas without adequate health advice and protection against hepatitis A and other travel-related infectious diseases.
Management of cardiovascular disease risk in people with comorbid mental illness: A cross sectional study in Australian general practice
Publisher: SAGE Publications
Date: 31-10-2022
Self‐management support for patients with chronic disease: potential and questions
Publisher: AMPCo
Date: 02-2018
DOI: 10.5694/MJA17.01002
Telehealth use in Australian primary healthcare during COVID-19: a cross-sectional descriptive survey
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJOPEN-2022-065478
Abstract: This study aimed to investigate Australian primary healthcare professionals’ experiences of the rapid upscaling of telehealth during COVID-19. A cross-sectional survey. Two hundred and seventeen general practitioners, nurses and allied health professionals employed in primary healthcare settings across Australia were recruited via social media and professional organisations. An online survey was disseminated between December 2020 and March 2021. The survey comprised items about in idual demographics, experiences of delivering telehealth consultations, perceived quality of telehealth consultations and future perceptions of telehealth. Telephone was the most widely used method of providing telehealth, with less than 50% of participants using a combination of telephone and video. Key barriers to telehealth use related to the inability to undertake physical examination or physical intervention. Telehealth was perceived to improve access to healthcare for some vulnerable groups and those living in rural settings, but reduced access for people from non-English-speaking backgrounds. Quality of telehealth care was considered mostly or somewhat the same as care provided face-to-face, with actual or perceived negative outcomes related to missed or delayed diagnosis. Overwhelmingly, participants wanted telehealth to continue with guaranteed ongoing funding. Some 43.7% of participants identified the need to further improve telehealth models of care. The rapid shift to telehealth has facilitated ongoing care during the COVID-19 pandemic. However, further work is required to better understand how telehealth can be best harnessed to add value to service delivery in usual care.
Utilisation of government-subsidised chronic disease management plans and cardiovascular care in Australian general practices
Publisher: Springer Science and Business Media LLC
Date: 21-06-2022
DOI: 10.1186/S12875-022-01763-2
Abstract: Government-subsidised general practice management plans (GPMPs) facilitate chronic disease management however, impact on cardiovascular disease (CVD) is unknown. We aimed to determine utilisation and impact of GPMPs for people with or at elevated risk of CVD. Secondary analysis of baseline data from the CONNECT randomised controlled trial linked to Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) claims. Multivariate regression examining the association of GPMP receipt and review with: (1) ≥ 1 MBS-subsidised allied health visit in the previous 24 months (2) adherence to dual cardioprotective medication (≥ 80% of days covered with a dispensed PBS prescription) and (3) meeting recommended LDL-cholesterol and blood pressure (BP) targets concurrently. Overall, 905 trial participants from 24 primary health care services consented to data linkage. Participants with a GPMP (46.6%, 422/905) were older (69.4 vs 66.0 years), had lower education (32.3% vs 24.7% high school or lower), lower household income (27.5% vs 17.0% in lowest bracket), and more comorbidities, particularly diabetes (42.2% vs 17.6%) compared to those without a GPMP. After adjustment, a GPMP was strongly associated with allied health visits (odds ratio (OR) 14.80, 95% CI: 9.08–24.11) but not higher medication adherence rates (OR 0.82, 95% CI: 0.52–1.29) nor meeting combined LDL and BP targets (OR 1.31, 95% CI: 0.72–2.38). Minor differences in significant covariates were noted in models using GPMP review versus GPMP initiation. In people with or at elevated risk of CVD, GPMPs are under-utilised overall. They are targeting high-needs populations and facilitate allied health access, but are not associated with improved CVD risk management, which represents an opportunity for enhancing their value in supporting guideline-recommended care.
Sleep health management within primary care: an interpretive description of the knowledge, experiences and attitudes of australian general practice nurses
Publisher: Elsevier BV
Date: 12-2019
Implementation of a consumer-focused eHealth intervention for people with moderate-to-high cardiovascular disease risk
Publisher: BMJ
Date: 2017
A Web-Based Cognitive Behavior Therapy Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The SpringboarD Trial): Randomized Controlled Trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 19-09-2018
Abstract: epressive symptoms are common in people with type 2 diabetes mellitus (T2DM). Effective depression treatments exist however, access to psychological support is characteristically low. Web-based cognitive behavioral therapy (CBT) is accessible, nonstigmatizing, and may help address substantial personal and public health impact of comorbid T2DM and depression. he aim of this study was to evaluate the Web-based CBT program, myCompass, for improving social and occupational functioning in adults with T2DM and mild-to-moderate depressive symptoms. myCompass is a fully automated, self-guided public health treatment program for common mental health problems. The impact of treatment on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior was also examined. articipants with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited online via Google and Facebook advertisements targeting adults with T2DM and via community and general practice settings. Screening, consent, and self-report scales were all self-administered online. Participants were randomized using double-blind computerized block randomization to either myCompass (n=391) for 8 weeks plus a 4-week tailing-off period or an active placebo intervention (n=379). At baseline and postintervention (3 months), participants completed the Work and Social Adjustment Scale, the primary outcome measure. Secondary outcome measures included the Patient Health Questionnaire-9 item, Diabetes Distress Scale, Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. yCompass users logged in an average of 6 times and completed an average of .29 modules. Healthy Lifestyles users logged in an average of 4 times and completed an average of 1.37 modules. At baseline, mean scores on several outcome measures, including the primary outcome of work and social functioning, were near to the normal range, despite an extensive recruitment process. Approximately 61.6% (473/780) of participants completed the postintervention assessment. Intention-to-treat analyses revealed improvement in functioning, depression, anxiety, diabetes distress, and healthy eating over time in both groups. Except for blood glucose monitoring and medication adherence, there were no specific between-group effects. Follow-up analyses suggested the outcomes did not depend on age, morbidity, or treatment engagement. mprovement in social and occupational functioning and the secondary outcomes was generally no greater for myCompass users than for users of the control program at 3 months postintervention. These findings should be interpreted in light of near-normal mean baseline scores on several variables, the self-selected study s le, and s le attrition. Further attention to factors influencing uptake and engagement with mental health treatments by people with T2DM, and the impact of illness comorbidity on patient conceptualization and experience of mental health symptoms, is essential to reduce the burden of T2DM. ustralian New Zealand Clinical Trials Registry ACTRN12615000931572 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109& isReview=true (Archived by WebCite at 850eg8pi)
Improving the uptake of pre-travel health advice amongst migrant Australians
Publisher: Springer Science and Business Media LLC
Date: 18-05-2016
Development and validation of a model for diagnosis of obstructive sleep apnoea in primary care
Publisher: Wiley
Date: 02-08-2021
DOI: 10.1111/RESP.14122
Abstract: Use of in‐laboratory polysomnography (PSG) to diagnose obstructive sleep apnoea (OSA) is cost and resource intensive. Questionnaires, physical measurements and home monitors have been studied as potential simpler alternatives. This study aimed to develop a diagnostic model for OSA for use in primary care. Primary care practitioners were trained to recognize symptoms of sleep apnoea and recruited patients based on the clinical need to investigate OSA. Assessment was by symptom questionnaires, anthropomorphic measurements, digital facial photography, and a single‐channel nasal flow monitor (Flow Wizard©, DiagnoseIT, Sydney, Australia) worn at home for 3 nights. The in‐laboratory PSG was the reference test, with OSA defined as apnoea–hypopnoea index (AHI) ≥10 events/h. In the model development phase, 25 primary care practitioners studied 315 patients in whom they suspected OSA, of which 57% had AHI≥10 and 22% had AHI≥30. Published OSA questionnaires provided low to moderate prediction of OSA (area under the curve [AUC] 0.53–0.73). The nasal flow monitor alone yielded high accuracy for predicting OSA with AUC of 0.87. Sensitivity was 0.87 and specificity 0.77 at a threshold respiratory event index (REI) of 18 events/h. A model adding age, gender, symptoms and BMI to the nasal flow monitor REI only modestly improved OSA prediction (AUC 0.89), with similar AUC (0.88) confirmed in the validation population of 114 patients. Sleep apnoea can be diagnosed in the primary care setting with a combination of clinical judgement and portable monitor test outcomes.
Perspectives of rural and remote primary healthcare services on the meaning and goals of clinical governance
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/PY16168
Abstract: Definitions of clinical governance are varied and there is no one agreed model. This paper explored the perspectives of rural and remote primary healthcare services, located in North Queensland, Australia, on the meaning and goals of clinical governance. The study followed an embedded multiple case study design with semi-structured interviews, document analysis and non-participant observation. Participants included clinicians, non-clinical support staff, managers and executives. Similarities and differences in the understanding of clinical governance between health centre and committee case studies were evident. Almost one-third of participants were unfamiliar with the term or were unsure of its meaning alongside limited documentation of a definition. Although most cases linked the concept of clinical governance to key terms, many lacked a comprehensive understanding. Similarities between cases included viewing clinical governance as a management and administrative function. Differences included committee members’ alignment of clinical governance with corporate governance and frontline staff associating clinical governance with staff safety. Document analysis offered further insight into these perspectives. Clinical governance is well-documented as an expected organisational requirement, including in rural and remote areas where geographic, workforce and demographic factors pose additional challenges to quality and safety. However, in reality, it is not clearly, similarly or comprehensively understood by all participants.
Utilisation of Medicare-funded schemes for people with cardiovascular disease
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/PY16166
Abstract: The aim of this study is to investigate the utilisation of Medicare Benefit Scheme items for chronic disease in the management of cardiovascular disease (CVD) in general practice and to compare characteristics of CVD patients with and without a General Practice Management Plan (GPMP). Subgroup analysis of Treatment of Cardiovascular Risk using Electronic Decision Support (TORPEDO) baseline data was collected in a cohort comprising 6123 patients with CVD. The mean age (s.d.) was 71 (±13) years, 55% were male, 64% had a recorded diagnosis of coronary heart disease, 31% also had a diagnosis of diabetes and the mean number of general practice (GP) visits (s.d.) was 11 (±9) in 12 months. A total of 1955/6123 (32%) received a GPMP in the 12 months before data extraction 1% received a Mental Health Plan. Factors associated with greater likelihood of receiving a GPMP were: younger age, had a diagnosis of diabetes, BMI 30kgm–2, prescription of blood pressure-lowering therapy and more than ten general practice visits. Enhancing utilisation of existing schemes could augment systematic follow up and support of patients with CVD.
Evaluating the Guideline Enhancement Tool (GET): an innovative clinical training tool to enhance the use of hypertension guidelines in general practice
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Gender Comparison of Receipt of Government-Funded Health Services and Medication Prescriptions for the Management of Patients With Cardiovascular Disease in Primary Care
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.
An Interpretive Description of the Knowledge, Attitudes and Experiences of Family Practice Nurses Towards Sleep Health Care Within Australia
Publisher: American Thoracic Society
Date: 05-2020
DOI: 10.1164/AJRCCM-CONFERENCE.2020.201.1_MEETINGABSTRACTS.A4631
Recruiting to a Randomized Controlled Trial of a Web-Based Program for People With Type 2 Diabetes and Depression: Lessons Learned at the Intersection of e-Mental Health and Primary Care
Publisher: JMIR Publications Inc.
Date: 24-05-2019
DOI: 10.2196/12793
Vaccine‐Preventable Disease
Publisher: Wiley
Date: 11-02-2013
Patient experiences of nurse-facilitated advance care planning in a general practice setting: a qualitative study
Publisher: Springer Science and Business Media LLC
Date: 06-03-2019
When colocation is not enough: A case study of General Practitioner Super Clinics in Australia
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/PY16039
Abstract: Developed nations are implementing initiatives to transform the delivery of primary care. New models have been built around multidisciplinary teams, information technology and systematic approaches for chronic disease management (CDM). In Australia, the General Practice Super Clinic (GPSC) model was introduced in 2010. A case study approach was used to illustrate the development of inter-disciplinary CDM over 12 months in two new, outer urban GPSCs. A social scientist visited each practice for two 3–4-day periods. Data, including practice documents, observations and in-depth interviews (n=31) with patients, clinicians and staff, were analysed using the concept of organisational routines. Findings revealed slow, incremental evolution of inter-disciplinary care in both sites. Clinic managers found the facilitation of inter-disciplinary routines for CDM difficult in light of competing priorities within program objectives and the demands of clinic construction. Constraints inherent within the GPSC program, a lack of meaningful support for transformation of the model of care and the lack of effective incentives for collaborative care in fee-for-service billing arrangements, meant that program objectives for integrated multidisciplinary care were largely unattainable. Findings suggest that the GPSC initiative should be considered a program for infrastructure support rather than one of primary care transformation.
Interdisciplinary COPD intervention in primary care: a cluster randomised controlled trial
Publisher: European Respiratory Society (ERS)
Date: 20-02-2019
DOI: 10.1183/13993003.01530-2018
Abstract: We evaluated the effectiveness of an interdisciplinary, primary care-based model of care for chronic obstructive pulmonary disease (COPD). A cluster randomised controlled trial was conducted in 43 general practices in Australia. Adults with a history of smoking and/or COPD, aged ≥40 years with two or more clinic visits in the previous year were enrolled following spirometric confirmation of COPD. The model of care comprised smoking cessation support, home medicines review (HMR) and home-based pulmonary rehabilitation (HomeBase). Main outcomes included changes in St George's Respiratory Questionnaire (SGRQ) score, COPD Assessment Test (CAT), dyspnoea, smoking abstinence and lung function at 6 and 12 months. We identified 272 participants with COPD (157 intervention, 115 usual care) 49 (31%) out of 157 completed both HMR and HomeBase. Intention-to-treat analysis showed no statistically significant difference in change in SGRQ at 6 months (adjusted between-group difference 2.45 favouring intervention, 95% CI –0.89–5.79). Per protocol analyses showed clinically and statistically significant improvements in SGRQ in those receiving the full intervention compared to usual care (difference 5.22, 95% CI 0.19–10.25). No statistically significant differences were observed in change in CAT, dyspnoea, smoking abstinence or lung function. No significant evidence was found for the effectiveness of this interdisciplinary model of care for COPD in primary care over usual care. Low uptake was a limitation.
Travelling with medicines
Publisher: Therapeutic Guidelines Limited
Date: 08-2018
Application of structural equation modeling in assessing the self-management activities of patients with type 2 diabetes
Publisher: SAGE Publications
Date: 2020
Abstract: This study aimed at assessing the self-management activities of type 2 diabetes patients using Structural Equation Modeling (SEM) which measures and analyzes the correlations between observed and latent variables. This statistical modeling technique explored the linear causal relationships among the variables and accounted for the measurement errors. A s le of 200 patients was recruited from the middle-aged population of rural areas of Pakistan to explore the self-management activities of type 2 diabetes patients using the validated version of the Urdu Summary of Diabetes Self-care Activities (U-SDSCA) instrument. The structural modeling equations of self-management of diabetes were developed and used to analyze the variation in glycemic control (HbA1c). The validated version of U-SDSCA instrument showed acceptable psychometric properties throughout a consecutive reliability and validity evaluation including: split-half reliability coefficient 0.90, test-retest reliability (r = 0.918, P ≤ .001), intra-class coefficient (0.912) and Cronbach’s alpha (0.79). The results of the analysis were statistically significant (α = 0.05, P-value .001), and showed that the model was very well fitted with the data, satisfying all the parameters of the model related to confirmatory factor analysis with chi-squared = 48.9, CFI = 0.94, TLI = 0.95, RMSEA = 0.065, SPMR = 0.068. The model was further improved once the items related to special diet were removed from the analysis, chi-squared value (30.895), model fit indices (CFI = 0.98, TLI = 0.989, RMSEA = 0.045, SPMR = 0.048). A negative correlation was observed between diabetes self-management and the variable HbA1c (r = –0.47 P .001). The Urdu Summary of Diabetes Self-Care Activities (U-SDSCA) instrument was used for the patients of type 2 diabetes to assess their diabetes self-management activities. The structural equation models of self-management showed a very good fit to the data and provided excellent results which may be used in future for clinical assessments of patients with suboptimal diabetes outcomes or research on factors affecting the associations between self-management activities and glycemic control
A Web-Based Mental Health Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The Springboard Trial): 12-Month Outcomes of a Randomized Controlled Trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 17-10-2019
Abstract: eople with type 2 diabetes mellitus (T2DM) often experience mental health symptoms that exacerbate illness and increase mortality risk. Access to psychological support is low in people with T2DM. Detection of depression is variable in primary care and can be further h ered by mental health stigma. Electronic mental health (eMH) programs may provide an accessible, private, nonstigmatizing mental health solution for this group. his study aims to evaluate the efficacy over 12 months of follow-up of an eMH program (myCompass) for improving social and occupational functioning in a community s le of people with T2DM and self-reported mild-to-moderate depressive symptoms. myCompass is a fully automated and self-guided web-based public health program for people with depression or anxiety. The effects of myCompass on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior were also examined. dults with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited via online advertisements, community organizations, and general practices. Screening, consent, and self-report questionnaires were administered online. Eligible participants were randomized to receive either myCompass (n=391) or an attention control generic health literacy program (Healthy Lifestyles n=379) for 8 weeks. At baseline and at 3, 6, and 12 months postintervention, participants completed the Work and Social Adjustment Scale, the Patient Health Questionnaire-9 item, the Diabetes Distress Scale, the Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Glycosylated hemoglobin measurements were obtained at baseline and 6 and 12 months postintervention. total of 38.9% (304/780) of the trial participants completed all postintervention assessments. myCompass users logged in on an average of 6 times and completed an average of 0.29 modules. Healthy Lifestyles users logged in on an average of 4 times and completed an average of 1.37 modules. At baseline, the mean scores on several outcome measures, including the primary outcome of work and social functioning, were close to the normal range, despite a varied and extensive recruitment process. Intention-to-treat analyses revealed slightly greater improvement at 12 months in work and social functioning for the Healthy Lifestyles group relative to the myCompass group. All participants reported equivalent improvements in depression anxiety, diabetes distress, diabetes self-management, and glycemic control across the trial. he Healthy Lifestyles group reported higher ratings of social and occupational functioning than the myCompass group, but no differences were observed for any secondary outcome. Although these findings should be interpreted in light of the near-floor symptom scores at baseline, the trial yields important insights into how people with T2DM might be engaged in eMH programs and the challenges of focusing specifically on mental health. Several avenues emerge for continued investigation into how best to deal with the growing mental health burden in adults with T2DM. ustralian New Zealand Clinical Trials Registry Number (ACTRN) 12615000931572 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109& isReview=true
Clinical and biochemical characterization of high risk and not high risk for cardiovascular disease adults in a population from peripheral region of Bangladesh Chronic Disease epidemiology
Publisher: Springer Science and Business Media LLC
Date: 18-06-2015
Managing sleep disorders: A qualitative study exploring current practices, knowledge and attitudes of general practitioners
Publisher: Wiley
Date: 10-2019
DOI: 10.1111/JSR.57_12913
Ham for the holidays: The challenge of choosing wisely
Publisher: BMJ
Date: 17-12-2018
DOI: 10.1136/BMJ.K5288
Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: A qualitative study
Publisher: Oxford University Press (OUP)
Date: 30-09-2017
Abstract: Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD. Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically. PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs' active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied. PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP.
COPD-X Australian guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2022 update
Publisher: Wiley
Date: 18-09-2022
DOI: 10.5694/MJA2.51708
Abstract: Chronic obstructive pulmonary disease (COPD) is a treatable and preventable disease characterised by persistent respiratory symptoms and chronic airflow limitation on spirometry. COPD is highly prevalent and is associated with exacerbations and comorbid conditions. "COPD-X" provides quarterly updates in COPD care and is published by the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand. The COPD-X guidelines (version 2.65) encompass 26 recommendations addressing: case finding and confirming diagnosis optimising function preventing deterioration developing a plan of care and managing an exacerbation. Both non-pharmacological and pharmacological strategies are included within these recommendations, reflecting the importance of a holistic approach to clinical care for people living with COPD to delay disease progression, optimise quality of life and ensure best practice care in the community and hospital settings when managing exacerbations. Several of the new recommendations, if put into practice in the appropriate circumstances, and notwithstanding known variations in the social determinants of health, could improve quality of life and reduce exacerbations, hospitalisations and mortality for people living with COPD.
Feasibility, acceptability and impact of a telephone support service initiated in primary medical care to help Arabic smokers quit
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/PY10066
Abstract: Evidence-based tobacco control in ethnic minorities is compromised by the near absence of rigorous testing of interventions in either prevention or cessation. This randomised controlled trial was designed to evaluate the feasibility, acceptability and impact of a culturally specific cessation intervention delivered in the context of primary medical care in the most culturally erse region of New South Wales. Adult Arabic smokers were recruited from practices of 29 general practitioners (GPs) in south-west Sydney and randomly allocated to usual care (n = 194) or referred to six sessions of smoking cessation telephone support delivered by bilingual psychologists (n = 213). Although 62.2% of participants indicated that telephone support would benefit Arabic smokers, there were no significant differences at 6 or 12 months between intervention and control groups in point prevalence abstinence rates (11.7% vs 12.9%, P = 0.83 8.4% vs 11.3%, P = 0.68, respectively) or the mean shift in stage-of-change towards intention to quit. As participants and GPs found telephone support acceptable, we also discuss redesign and the unfulfilled obligation to expand the evidence base in tobacco control from which the ethnic majority already benefits.
New South Wales and Australian Capital Territory Researcher Development Program 2005-07: Modest investment, considerable outcomes
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/PY11155
Abstract: This evaluation of the Researcher Development Program (RDP) in NSW and ACT aimed to determine whether the RDP was effective in assisting novice researchers to undertake primary health care research. In mid-2008, 47 participants of the NSW and ACT RDP during 2005–07 were invited to participate in a postal survey. The survey included questions regarding previous research training and experience, outcomes during and after participation in the program, and organisational aspects of the program. Follow-up interviews were conducted with selected participants. Interview questions covered time in the program, supervision, organisational support and placement outcomes. Thirty-seven participants responded to the survey and 23 (62%) participants took part in the semi-structured interviews. Seventy-eight per cent of survey respondents felt that the RDP helped them move from novice to a more experienced researcher with effective supervision identified by participants as a key element in determining the success of the program. Many felt that time allocation was inadequate and 20% thought their capacity to maintain their workload was adversely affected by participating. Outcomes were considerable given the modest nature of the program. Notable outcomes were that most participants published their research and presented their research at a conference. Furthermore, one-fifth of survey respondents had enrolled in higher degrees. Several interviewees reported that their research led to changes in practice. Most respondents found the RDP valuable and considered that undertaking the program increased their research knowledge.
Effectiveness of quality incentive payments in general practice (EQuIP-GP): a study protocol for a cluster-randomised trial of an outcomes-based funding model in Australian general practice to improve
Publisher: Springer Science and Business Media LLC
Date: 29-07-2019
Healthcare Professionals' Perspectives of Patients' Experiences of the Self-Management of Type 2 Diabetes in the Rural Areas of Pakistan: A Qualitative Analysis
Publisher: MDPI AG
Date: 19-09-2021
Abstract: The main objective of this research work was to explore the healthcare professionals’ perspectives of type 2 diabetes patients’ experiences of self-management of diabetes in the rural area of Pakistan. In this study, we have carried out a methodological approach to use a self-management framework to direct the interview guide for healthcare professionals to examine their perceptions and expectations of their diabetes patients’ adherence to the medications prescribed. Twenty healthcare professionals were recruited in this study consisting of ten general practitioners and ten nurses from various clinics (medical centres) of Al-Rehman Hospital at Abbottabad, Pakistan. This qualitative study explored the feelings and opinions of general practitioners on patients’ compliance and adherence by using the semi-structured interview guide using a methodological framework. All interviews of participants were audiotaped and transcribed for content analysis. Six major themes were identified: patient–doctor relationship patient’s non-adherence to diet and exercise conflicts with the patients low self-efficacy and feeling of “resignation with poor care” the influence of culture on patients’ self-management activities and lack of support for patients by health care providers, patients, and their families. We have derived relevant solutions from qualitative studies and considered that communication, tailored, and shared care is the best approach for patient adherence to treatment. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase adherence. The results of this qualitative health research highlighted the challenges healthcare professionals are facing in rural Pakistan in managing patients with type 2 diabetes and supporting their management activities. Healthcare professionals and patients may benefit by adopting a methodological framework approach to ensure meaningful participation and adjusting the patient–doctor relationship, and setting up achievable management and self-management goals.
Multimorbidity in Australia: Comparing estimates derived using administrative data sources and survey data
Publisher: Public Library of Science (PLoS)
Date: 29-08-2017
Quit in General Practice: A cluster randomised trial of enhanced in-practice support for smoking cessation
Publisher: Springer Science and Business Media LLC
Date: 12-08-2010
Experience in implementation of cardiovascular absolute risk assessment and management in Australian general practice
Publisher: Hindawi Limited
Date: 16-06-2010
Qualitative evaluation of a diabetes electronic decision support tool
Publisher: Springer Science and Business Media LLC
Date: 03-07-2012
Abstract: Quality care of type 2 diabetes is complex and requires systematic use of clinical data to monitor care processes and outcomes. An electronic decision support (EDS) tool for the management of type 2 diabetes in primary care was developed by the Australian Pharmaceutical Alliance. The aim of this qualitative study was to evaluate the uptake and use of the EDS tool as well as to describe the impact of the EDS tool on the primary care consultation for diabetes from the perspectives of general practitioners and practice nurses. This was a qualitative study of telephone interviews. General Practitioners and Practice Nurses from four Divisions of General Practice who had used the EDS tool for a minimum of six weeks were invited to participate. Semi-structured interviews were conducted and the interview transcripts were coded and thematically analysed using NVivo 8 software. In total 15 General Practitioners and 2 Practice Nurses completed the interviews. The most commonly used feature of the EDS tool was the summary side bar its major function was to provide an overview of clinical information and a prompt or reminder to diabetes care. It also assisted communication and served an educational role as a visual aide in the consultation. Some participants thought the tool resulted in longer consultations. There were a range of barriers to use related to the design and functionality of the tool and to the primary care context. The EDS tool shows promise as a way of summarising information about patients’ diabetes state, reminder of required diabetes care and an aide to patient education.
Effect of Cytisine vs Varenicline on Smoking Cessation
Publisher: American Medical Association (AMA)
Date: 06-07-2021
Study protocol: The DESPATCH study: Delivering stroke prevention for patients with atrial fibrillation - a cluster randomised controlled trial in primary healthcare
Publisher: Springer Science and Business Media LLC
Date: 20-05-2011
Advance care planning and interpersonal relationships: a two-way street
Publisher: Oxford University Press (OUP)
Date: 10-2012
Abstract: Advance care planning (ACP) has been gaining prominence for its perceived benefits for patients in enhancing patient autonomy and ensuring high-quality end-of-life-care. Moreover, it has been postulated that ACP has positive effects on families and health professionals and their relationship with the patient. However, there is a paucity of studies examining the views of GPs on this issue. To explore GP views on the impact that ACP has on interpersonal relationships among those involved in the patient's care. Semi-structured, open-ended interviews of a purposive s le of 17 GPs. Interview transcripts were analysed using constructionist grounded theory methodology with QSR NVivo 9 software. ACP was seen as having both positive and negative impacts on interpersonal relationships. It was thought to enhance family relationships, help resolve conflicts between families and health professionals and improve trust and understanding between patients and health professionals. Negatively, it could take the family's attention away from patient care. The link between ACP and interpersonal relationships was perceived to be bidirectional-the nature of interpersonal relationship that patients have with their families and health professionals has a profound impact on what form of ACP is likely to be useful. Our study highlights the importance that GPs place on the link between ACP and the patient's interpersonal context. This has implications on how ACP is conducted in primary care settings that are considerably different from other care settings in their emphasis on continuity of care and long-term nature of relationships.
Efficacy and acceptability of a pilot dietary intervention focusing on self-compassion, goal-setting and self-monitoring
Publisher: Cambridge University Press (CUP)
Date: 10-06-2020
DOI: 10.1017/S1368980020000658
Abstract: Overweight and obesity are universal health challenges. Recent evidence emphasises the potential benefits of addressing psychological factors associated with obesity in dietary programmes. This pilot study investigated the efficacy and acceptability of a combined online and face-to-face dietary intervention that used self-compassion, goal-setting and self-monitoring to improve dietary behaviour, as well as psychological factors associated with dietary behaviour. Embedded mixed methods including a 4-week before-after trial and a one-on-one interview. Quantitative outcomes of the study were the levels of self-compassion eating pathology depression, anxiety and stress and dietary intake. Qualitative outcomes were participants’ perceptions about the acceptability of the intervention. UNSW Kensington c us. Fourteen participants with overweight and obesity aged between 18 and 55 years old. Results showed that the intervention significantly improved self-compassion and some aspects of dietary intake (e.g. decrease in energy intake) at Week Four compared with Week Zero. Some aspects of eating pathology also significantly decreased (e.g. Eating Concern). However, changes in self-compassion over the 4 weeks did not significantly predict Week Four study outcomes, except for level of stress. Most participants found self-compassion, goal-setting and self-monitoring to be essential for dietary behaviour change. However, participants also indicated that an online programme needed to be efficient, simple and interactive. In conclusion, the current study provides preliminary but promising findings of an effective and acceptable combined online and face-to-face intervention that used self-compassion, goal-setting and self-monitoring to improve dietary habits. However, the results need to be examined in future long-term randomised controlled trials.
Influencing antibiotic prescribing in general practice: a trial of prescriber feedback and management guidelines
Publisher: Oxford University Press (OUP)
Date: 10-1999
Abstract: The extent of use of antibiotics to treat upper respiratory infections in general practice is an area for concern due to the increasing problem of bacterial resistance. Effective educational strategies to promote rational prescribing are needed. We aimed to examine the effectiveness of prescriber feedback and management guidelines in reducing antibiotics prescribing by GP trainees for undifferentiated upper respiratory tract infection, and in improving the choice of antibiotic for tonsillitis/streptococcal pharyngitis. The research tested a stepwise approach to targeting educational input to high prescribers. General Practice trainees in New South Wales (n = 157) were randomly allocated to a treatment group (n = 78) which received an education intervention on antibiotic use, or to a control group (n = 79) which received an intervention on an unrelated topic. Trainees completed three practice activity surveys, each of 110 consecutive patient encounters, with 6-month intervals between surveys. Prescriber feedback and management guidelines on use of antibiotics for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis were delivered in a written form between surveys 1 and 2. An educational outreach visit to high prescribers occurred between surveys 2 and 3. Outcome measures were the rate of antibiotic prescribing for all indications, for URTI and prescribing of select antibiotics for tonsillitis/streptococcal pharyngitis. Antibiotic prescribing by the intervention group declined over three occasions from 25.0 to 23.3 to 19.7 per 100 URTI problems, while the control group increased from 22.0 to 25.0 to 31.7 per 100 URTI problems (P = 0.002). Prescribing in agreement with accepted guidelines for tonsillitis/streptococcal pharyngitis increased over time in the intervention group from 55.6 to 69.8 to 73.0 per 100 problems, but decreased in the control group from 59.6 to 57.5 to 58.5 (P = 0.05). Prescriber feedback and management guidelines were shown to influence antibiotic prescribing for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis. This study provides a model for targeting educational input to those prescribers who most need to change their behaviour.
The impact of health literacy and life style risk factors on health-related quality of life of Australian patients
Publisher: Springer Science and Business Media LLC
Date: 04-05-2016
Primary care management of chronic insomnia
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.
An explorative qualitative study on acceptability of physical activity assessment instruments among primary care professionals in southern Sydney
Publisher: Springer Science and Business Media LLC
Date: 22-09-2016
Treatment of tobacco dependence
Publisher: Oxford University Press
Date: 02-06-2010
Effectiveness, safety and cost-effectiveness of vaporised nicotine products versus nicotine replacement therapy for tobacco smoking cessation in a low-socioeconomic status Australian population: A study protocol for a randomised controlled trial
Publisher: Wiley
Date: 29-09-2022
DOI: 10.1111/DAR.13537
The treatment of cardiovascular risk in primary care using electronic decision support (TORPEDO) study
Publisher: BMJ
Date: 2012
Prevalence of risk factors for cardiovascular diseases in Bangladesh: A systematic review and meta-analysis
Publisher: Public Library of Science (PLoS)
Date: 05-08-2016
Travelling with medicines
Publisher: Therapeutic Guidelines Limited
Date: 06-2006
Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis
Publisher: Informa UK Limited
Date: 08-2016
DOI: 10.2147/COPD.S107884
Role of the general practitioner in smoking cessation
Publisher: Wiley
Date: 2006
DOI: 10.1080/09595230500459487
Abstract: This paper reflects on the role of general practitioners in smoking cessation and suggests initiatives to enhance general practice as a setting for effective smoking cessation services. This paper is one of a series of reflections on key issues in smoking cessation. In this article we highlight the extent that general practitioners (GPs) have contact with the population, evidence for effectiveness of GP advice, barriers to greater involvement and suggested future directions. General practice has an extensive population reach, with the majority of smokers seeing a GP at least once per year. Although there is level 1 evidence of the effectiveness of smoking cessation advice from general practitioners, there are substantial barriers to this advice being incorporated routinely into primary care consultations. Initiatives to overcome these barriers are education in smoking cessation for GPs and other key practice staff teaching of medical students about tobacco and cessation techniques, clinical practice guidelines support for guideline implementation access to pharmacotherapies and development of referral models. We believe the way forward for the role of the GPs is to develop the practice as a primary care service for providing smoking cessation advice. This will require education relevant to the needs of a range of health professionals, provision of and support for the implementation of clinical practice guidelines, access for patients to smoking cessation pharmacotherapies and integration with other cessation services such as quitlines.
The Macarthur GP After-hours Service: a model of after-hours care for Australia
Publisher: CSIRO Publishing
Date: 2007
DOI: 10.1071/AH070223
Abstract: Introduction: The Macarthur GP After-hours Service (MGPAS) was established to streamline the provision of after-hours medical care in an outer-urban community. This paper reports on a process evaluation of the MGPAS. Methods: A mixed methods approach involving surveys, stakeholder interviews and analysis of administrative data was used. Results and discussion: This model of care was well accepted and regarded by general practitioners, Macarthur Health Service staff and the community. The MGPAS was found to be an acceptable and efficient model of after-hours medical care. Areas that required further review included the need for telephone triage, home visiting and improved communication and referral to the health service. The financial viability of the MGPAS depends on supplementary funding due to the constraints of the Medicare rebate, and limited opportunities to reduce costs or increase revenue. Further research, including an economic evaluation to identify opportunity costs of the service, is needed.
Inhaler technique mastery and maintenance in healthcare professionals trained on different devices
Publisher: Informa UK Limited
Date: 28-04-2018
DOI: 10.1080/02770903.2017.1310227
Abstract: Healthcare professionals (HCPs) are required to assess and train patients in the correct use of inhalers but are often unable to demonstrate correct technique themselves. We sought to assess the level of training required for HCPs to master and maintain device mastery when using two different dry powder inhalers (DPIs). We conducted a randomized, un-blinded, crossover study in undergraduate HCPs who undertook a six-step training procedure (intuitive use, patient information leaflet, instructional video, in idual tuition from expert, then two repeats of in idual tuition) for the use of Turbuhaler® (an established device) and Spiromax® (a newer device, reportedly easier to use). Device mastery (absence of errors) was evaluated by expert assessors at each training step. Maintenance of mastery was assessed 4 ± 1 week (visit 2) and 8 ± 2 weeks (visit 3) after initial training (visit 1). Of 516 eligible participants, 113 (22%) demonstrated device mastery prior to training on Spiromax® compared with 20 (4%) on Turbuhaler® (p < 0.001). The median number of training steps required to achieve mastery was 2 (interquartile range [IQR] 2-4) for Spiromax® and 3 (IQR 2-4) for Turbuhaler® (p < 0.001). A higher number of participants maintained mastery with Spiromax® compared with Turbuhaler®, at visits 2 and 3 (64% vs 41% and 79% vs 65%, respectively p < 0.001). There are significant differences in the nature and extent of training required to achieve and maintain mastery for Spiromax® and Turbuhaler® devices. The implications on clinical practice, device education delivery, and patient outcomes require further evaluation.
Travel Health Advisory Group: A joint travel industry and travel health Special Interest Group promoting healthy travel in Australia
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.TMAID.2012.08.004
Abstract: The Travel Health Advisory Group (THAG), established in 1997, is a joint initiative between the travel industry and travel health professionals in Australia that aims to promote healthy travel. THAG seeks to promote cooperation in improving the health of travellers between the travel industry and travel medicine professionals and to raise public awareness of the importance of travel health. From 2011, THAG has been a Special Interest Group of The Australasian College of Tropical Medicine and its membership has been active in several areas, including web-based travel health information, travel health promotion, media releases, research and education in Australia. Information is given on the objectives, membership and an overview of the various activities of the group.
Cost-Related Underuse of Medicines for Asthma—Opportunities for Improving Adherence
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JAIP.2019.03.024
Abstract: In asthma, underuse of cost-effective preventive treatments increases morbidity and mortality. The cost of medicines contributes to underuse ("nonadherence"), but the extent to which people with asthma skip or reduce doses or let prescriptions go unfilled when faced with cost pressures is unknown. To estimate the extent of cost-related underuse behaviors and associated factors. Using previously validated summary indicators, we conducted an online cross-sectional survey of adults and parents of children 5 to 17 years with asthma in Australia (a high-income country) and developed logistic regression models for adults and children with asthma, controlling for key clinical and demographic factors. The survey was completed by n = 792 adults (mean age, 47 [standard deviation, 17] years, male 47%, concession 60%) and n = 609 parents of children (5-10 years 51%, male 60%, concession 59%) with asthma. Cost-related underuse was reported by 52.9% adults and 34.3% parents, predominantly decreasing or skipping doses to make medicines last longer. Higher odds of cost-related underuse were observed with younger adults (adults: odds ratio [OR]: 1.19 95% confidence interval [CI]: 1.12, 1.27), males (adults: OR: 1.49 95% CI: 1.06, 2.08), having concerns about medicines (adults: OR: 3.12 95% CI: 2.17, 4.35 parents: OR: 2.63 95% CI: 1.56, 4.55), less comfortable talking to prescribers about cost (parents: OR: 1.22 95% CI: 1.12, 1.33) or changing medicines (adults: OR: 1.12 95% CI: 1.03, 1.22), feeling less engaged with prescribers about medicine decisions (parents: OR: 1.11 95% CI: 1.01, 1.23), and with poorer asthma control (adults, poor control: OR: 1.87 95% CI: 1.13, 3.09 parents, poor control: OR: 3.87 95% CI: 1.99, 7.54), and requiring specialist (parents: OR: 1.83 95% CI: 1.16, 2.87) or urgent health care visits (adults: OR: 1.54 95% CI: 1.06, 2.23). Income and concession card status were not associated with cost-related underuse. Adults and parents of children with asthma indicate high rates of cost-related underuse of asthma medicines, even in the context of national medicines subsidies. Urgent targeting of interventions to promote discussion of medicines and costs between doctor and patients, particularly young adult males, is needed.
Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare
Publisher: CSIRO Publishing
Date: 06-08-2021
DOI: 10.1071/PYV27N4ABS
Assessment, referral and management of obstructive sleep apnea by Australian general practitioners: a qualitative analysis
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.
Challenges to establishing successful partnerships in community health promotion programs: local experiences from the national implementation of healthy eating activity and lifestyle (HEAL™) program
Publisher: Wiley
Date: 04-2015
DOI: 10.1071/HE14035
Characteristics of effective self-management interventions in patients with COPD: individual patient data meta-analysis
Publisher: European Respiratory Society (ERS)
Date: 28-04-2016
DOI: 10.1183/13993003.01860-2015
Abstract: It is unknown whether heterogeneity in effects of self-management interventions in patients with chronic obstructive pulmonary disease (COPD) can be explained by differences in programme characteristics. This study aimed to identify which characteristics of COPD self-management interventions are most effective. Systematic search in electronic databases identified randomised trials on self-management interventions conducted between 1985 and 2013. In idual patient data were requested for meta-analysis by generalised mixed effects models. 14 randomised trials were included (67% of eligible), representing 3282 patients (75% of eligible). Univariable analyses showed favourable effects on some outcomes for more planned contacts and longer duration of interventions, interventions with peer contact, without log keeping, without problem solving, and without support allocation. After adjusting for other programme characteristics in multivariable analyses, only the effects of duration on all-cause hospitalisation remained. Each month increase in intervention duration reduced risk of all-cause hospitalisation (time to event hazard ratios 0.98, 95% CI 0.97–0.99 risk ratio (RR) after 6 months follow-up 0.96, 95% CI 0.92–0.99 RR after 12 months follow-up 0.98, 95% CI 0.96–1.00). Our results showed that longer duration of self-management interventions conferred a reduction in all-cause hospitalisations in COPD patients. Other characteristics are not consistently associated with differential effects of self-management interventions across clinically relevant outcomes.
COPD-X australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update
Publisher: AMPCo
Date: 11-2017
DOI: 10.5694/MJA17.00686
Abstract: Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and chronic airflow limitation, and is associated with exacerbations and comorbidities. Advances in the management of COPD are updated quarterly in the national COPD guidelines, the COPD-X plan, published by Lung Foundation Australia in conjunction with the Thoracic Society of Australia and New Zealand and available at copdx.org.au. Main recommendations: Spirometry detects persistent airflow limitation (post-bronchodilator FEV1/FVC < 0.7) and must be used to confirm the diagnosis.Non-pharmacological and pharmacological therapies should be considered as they optimise function (ie, improve symptoms and quality of life) and prevent deterioration (ie, prevent exacerbations and reduce decline).Pulmonary rehabilitation and regular exercise are highly beneficial and should be provided to all symptomatic COPD patients.Short- and long-acting inhaled bronchodilators and, in more severe disease, anti-inflammatory agents (inhaled corticosteroids) should be considered in a stepwise approach.Given the wide range of inhaler devices available, inhaler technique and adherence should be checked regularly.Smoking cessation is essential, and influenza and pneumococcal vaccinations reduce the risk of exacerbations.A plan of care should be developed with the multidisciplinary team. COPD action plans reduce hospitalisations and are recommended as part of COPD self-management.Exacerbations should be managed promptly with bronchodilators, corticosteroids and antibiotics as appropriate to prevent hospital admission and delay COPD progression.Comorbidities of COPD require identification and appropriate management.Supportive, palliative and end-of-life care are beneficial for patients with advanced disease.Education of patients, carers and clinicians, and a strong partnership between primary and tertiary care, facilitate evidence-based management of COPD. Changes in management as result of the guideline: Spirometry remains the gold standard for diagnosing airflow obstruction and COPD. Non-pharmacological and pharmacological treatment should be used in a stepwise fashion to control symptoms and reduce exacerbation risk.
Improving depression outcomes among Australian primary care patients: protocol for a cluster randomised controlled trial
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-032057
Abstract: Depression is a common and debilitating condition. In Australia, general practitioners (GPs) are the key providers of depression care. However, available evidence suggests that case finding for depression in primary care is poor. This study will examine whether a systematic approach to screening for depression and assessing patient preferences for depression care improves depression outcomes among primary care patients. A cluster randomised controlled design will be used with general practice clinics randomly assigned to either the intervention (n=12) or usual care group (n=12). Patients who are aged 18 and older, presenting for general practice care, will be eligible to participate. Eighty-three participants will be recruited at each clinic. Participants will be asked to complete a baseline survey administered on a touch screen computer at their GP clinic, and then a follow-up survey at 3, 6 and 12 months. Those attending usual care practices will receive standard care. GPs at intervention practices will complete an online Clinical e-Audit, and will be provided with provider and patient-directed resources for depression care. Patients recruited at intervention practices who score 10 or above on the Patient Health Questionnaire-9 will have feedback regarding their depression screening results and preferences for care provided to their GP. The primary analysis will compare the number of cases of depression between the intervention and control groups. The study has been approved by the University of Newcastle Human Research Ethics Committee, and registered with Human Research Ethics Committees of the University of Wollongong, Monash University and University of New South Wales. Results will be disseminated through peer-reviewed journal publications and conference presentations. ACTRN12618001139268 Pre-results.
Resourcing an evolution of roles in general-practice: a study to determine the validity and reliability of tools to assist nurses and patients to assess physical activity
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY15027
Abstract: Traditionally, GPs have been responsible for physical activity (PA) assessment within the general practice setting. Multiple questionnaires are available to support uptake of PA assessment but less than 30% of patients are assessed. A range of barriers h er uptake. Evidence indicates that practice nurses (PNs) and patients are resourceful members of the general practice team but have been underutilised. This study assessed the validity and reliability of two instruments for assessing PA, administered by PNs and patients. The study aimed to identify robust tool(s) to support the evolving role of PNs and patients in prevention and management strategies in general practice. A purposive s le of PNs and patients from general practices in Sydney was invited to participate. The results of the PN- or patient-administered general practice physical activity questionnaire (GPPAQ) and the three-question physical activity questionnaire (3Q) were compared against accelerometer activity. The study examined agreement in classification of PA levels according to Australian PA recommendations. Validity showed low–moderate correlations between accelerometer and GPPAQ (rho=0.26), 3Q (rho=0.45). Seven-day test-retest reliability intraclass correlation coefficients (ICCs) were 0.82–0.95 for GGPAQ and 0.94–0.98 for 3Q. Agreement with PA recommendations was moderate for GPPAQ (kappa 0.73, 95% CI, 0.56–0.85) and fair for 3Q (kappa 0.62, 95% CI, 0.47–0.78). Although 3Q demonstrated higher correlation with accelerometry, GPPAQ demonstrated higher agreement with PA guidelines. Given GPPAQ showed reasonable rigour, it may prove useful for PN and patient use.
Sharing risk management: An implementation model for cardiovascular absolute risk assessment and management in Australian general practice
Publisher: Hindawi Limited
Date: 28-06-2008
Preventive evidence into practice (PEP) study: Implementation of guidelines to prevent primary vascular disease in general practice protocol for a cluster randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 18-01-2013
Feasibility and effectiveness of nurse-delivered smoking cessation counselling combined with nicotine replacement in Australian general practice
Publisher: Wiley
Date: 06-09-2010
DOI: 10.1111/J.1465-3362.2010.00243.X
Abstract: Practice nurses (PN) are an alternative workforce for cessation support in primary care, but their role and effectiveness is underdeveloped and underresearched. This study evaluated a model of smoking cessation intervention in Australian general practice based on PNs. Smokers were identified by their general practitioner (GP) and referred to the PN for cessation support over four counselling visits and offered free nicotine patches. Pre- and post-study using mixed quantitative and qualitative methods. Cessation outcomes were collected by patient self-report at 6 months. Semistructured interviews were conducted with PNs and GPs to provide qualitative data on the acceptability of the model. The project involved 31 PNs, 35 GPs and 498 patients from 19 general practices in Sydney. Mean age of participating patients was 46 years and 61% were female. Mean number of PN counselling visits was 3.1. At 6 month follow up the point prevalence abstinence rate was 22% and continuous abstinence rate was 16%. Participants who had attended for four or more counselling visits with the PN were significantly more likely to quit. PNs and GPs expressed enthusiasm for the PN role in smoking cessation and belief in its value and feasibility. Substantial rates of cessation were found in this uncontrolled study and the role was well accepted by PNs and GPs. The model shows promise as a means of providing cessation support in Australian primary care and further research in a randomised trial is warranted.
Travelling with medications and medical equipment across international borders
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.TMAID.2014.07.007
Abstract: The international traveller needs to plan ahead to ensure medicines are available and used as directed for optimal therapeutic outcome. The planning needs to take account of legal and customs requirements for travelling with medicines for personal use. The standard advice by travel health providers is that travellers should check with the country of destination for requirements when travelling into the country with medicines for personal use. This is akin to introducing a barrier to care for this category of travellers. Innovative method of care for this group of traveller is needed.
Hepatitis B risks and immunisation coverage amongst Australians travelling to Southeast Asia and East Asia
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.TMAID.2009.03.008
Abstract: Southeast Asia and East Asia are regarded as highly endemic regions for hepatitis B virus (HBV) and include many popular destinations for Australian travellers. The objectives of this survey were to evaluate the extent of pre-travel health advice, the prevalence of behaviours with HBV infection risks and the prevalence of HBV vaccination amongst Australian travellers to Southeast Asia and East Asia. In 2004, a telephone survey was conducted amongst Australians, who had travelled overseas to Southeast Asia and East Asia in the past three years for three nights or more. Three hundred and nine travellers aged 14 years and over completed the interview, including 138 males (45%) and 171 females (55%). Respondents travelled for leisure (64%), business (20%), and visiting friends and relatives (VFR) (16%). The most common destinations were Indonesia (34%), Thailand (32%), and China (27%). About half of the travellers (54%) sought vaccination specific health advice before travel of which about half (56%) had sought this advice more than six weeks before travel. Just over one quarter of travellers reported receiving HBV vaccination (28%) of whom most (70%) were vaccinated at least three weeks before travel. About half of the travellers (49%) had participated in at least one activity with HBV risk during their last overseas trip. Of those travellers aged 18 years and over who either had no HBV vaccination or who were unsure, about half (49%) had participated in at least one activity with HBV risk during their last overseas trip. Australian travellers to Southeast Asia and East Asia commonly undertake activities with a risk of exposure to HBV. Hepatitis B vaccination coverage amongst this group remains low. It is important that travellers to this region seek travel health advice from a qualified source, which will include a risk assessment for hepatitis B vaccination.
Activating primary care COPD patients with multi-morbidity (APCOM) pilot project: study protocol
Publisher: Springer Science and Business Media LLC
Date: 16-02-2017
Effectiveness, safety and cost-effectiveness of vaporized nicotine products versus nicotine replacement therapy for tobacco smoking cessation in a low-socioeconomic status Australian population: a study protocol for a randomized controlled trial
Publisher: Springer Science and Business Media LLC
Date: 14-09-2022
DOI: 10.1186/S13063-022-06644-8
Abstract: In Australia, tobacco smoking rates have declined but inequalities remain with significantly higher smoking prevalence among low-socioeconomic populations. Clinical trial data suggest vaporized nicotine products (VNPs) aid smoking cessation. Most VNP trials have used refillable tank systems, but newer generation (pod) devices now comprise the largest market share yet have limited clinical trial evidence on safety and effectiveness. This study evaluates the effectiveness, safety and cost-effectiveness of VNPs (pod and tank device) compared with nicotine replacement therapy ([NRT]—gum or lozenge) for smoking cessation. This is a two-arm, open-label, superiority, parallel group, randomized controlled trial (RCT) with allocation concealment and blinded outcome assessment. The RCT is conducted at the National Drug and Alcohol Research Centre at the University of New South Wales, Sydney, Australia. Participants are people who smoke daily, are interested in quitting and receive a government pension or allowance ( N = 1058). Participants will be randomized (1:1 ratio) to receive 8 weeks of free: VNPs, with pod (40 mg/mL nicotine salt) and tank device (18 mg/mL freebase nicotine) in mixed flavours or NRT (gum or lozenge 4 mg). All participants will receive daily text message behavioural support for 5 weeks. Assessments will be undertaken by telephone at baseline, with three follow-up calls (two check-in calls within the first month and final follow-up at 7 months post randomization) to ascertain smoking status, treatment adherence and adverse events. The primary outcome is 6-month continuous abstinence verified by carbon monoxide breath test of ≤5ppm at 7-month follow-up. Safety and cost-effectiveness of VNPs versus NRT will also be evaluated. Further data are required to strengthen certainty of evidence for VNPs aiding smoking cessation, particularly for newer generation pod devices. To our knowledge, this trial is the first to offer choice of VNPs and no comparative effectiveness trial data exists for new pod devices. If effective, the findings can inform wider implementation of VNPs to aid smoking cessation in a priority group. Australian New Zealand Clinical Trials Registry ACTRN12621000076875. Registered on 29 January 2021. www.anzctr.org.au
Barriers to care in gout: From prescriber to patient
Publisher: The Journal of Rheumatology
Date: 15-11-2016
Abstract: To explore the understanding of gout and its management by patients and general practitioners (GP), and to identify barriers to optimal gout care. Semistructured interviews were conducted with 15 GP and 22 patients in Sydney, Australia. Discussions were focused on medication adherence, experiences with gout, and education and perceptions around interventions for gout. Interviews were audio recorded, transcribed verbatim, and analyzed for themes using an analytical framework. Adherence to urate-lowering medications was identified as problematic by GP, but less so by patients with gout. However, patients had little appreciation of the risk of acute attacks related to variable adherence. Patients felt stigmatized that their gout diagnosis was predominantly related to perceptions that alcohol and dietary excess were causal. Patients felt they did not have enough education about gout and how to manage it. A manifestation of this was that uric acid concentrations were infrequently measured. GP were concerned that they did not know enough about managing gout and most were not familiar with current guidelines for management. For ex le and importantly, the strategies for reducing the risk of acute attacks when commencing urate-lowering therapy (ULT) were not well appreciated by GP or patients. Patients and GP wished to know more about gout and its management. Greater success in establishing and maintaining ULT will require further and better education to substantially benefit patients. Also, given the prevalence, and personal and societal significance of gout, innovative approaches to transforming the management of this eminently treatable disease are needed.
Development and early experience from an intervention to facilitate teamwork between general practices and allied health providers: the Team-link study
Publisher: Springer Science and Business Media LLC
Date: 27-04-2010
Travel and immunosuppressant medication
Publisher: The Royal Australian College of General Practitioners
Date: 03-2020
National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018
Publisher: Elsevier BV
Date: 10-2018
Depression, smoking and smoking cessation: a qualitative study
Publisher: Oxford University Press (OUP)
Date: 08-07-2013
Abstract: A high proportion of smokers suffer from mental health problems including depression. Despite many of them wanting to stop smoking, low mood adversely affects their ability to quit. To explore the experiences of smokers with self-reported depression, the relationship of smoking with mental health problems and the experiences of smokers while trying to quit. The study also explored what help within the primary care setting could assist in quitting. Participants were recruited from a large general-practice-based smoking cessation trial. Participants who had indicated they were suffering from depression on a self-reported baseline survey were invited to participate. Semi-structured interviews were conducted over the telephone and digitally recorded. The interviews were transcribed and analysed using a phenomenological qualitative approach. Sixteen interviews were conducted (11 females, 5 males). Mood disturbances were frequently reported as triggers for smoking and low mood was seen as a barrier to quitting. Perceived benefits of smoking when depressed were limited and for many, it was a learned response. A sense of hopelessness, lack of control over one's life and a lack of meaningful activities all emerged as important factors contributing to continued smoking. Participants felt that their quit attempts would be aided by better mood management, increased self-confidence and motivation and additional professional support. Smoking and depression were found to be strongly interconnected. Depressed smokers interested in quitting may benefit from increased psychological help to enhance self-confidence, motivation and mood management, as well as a supportive general practice environment.
Warfarin
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2009
Recruiting to a Randomized Controlled Trial of a Web-Based Program for People With Type 2 Diabetes and Depression: Lessons Learned at the Intersection of e-Mental Health and Primary Care (Preprint)
Publisher: JMIR Publications Inc.
Date: 09-12-2018
Abstract: -mental health (eMH) interventions are now widely available and they have the potential to revolutionize the way that health care is delivered. As most health care is currently delivered by primary care, there is enormous potential for eMH interventions to support, or in some cases substitute, services currently delivered face to face in the community setting. However, randomized trials of eMH interventions have tended to recruit participants using online recruitment methods. Consequently, it is difficult to know whether participants who are recruited online differ from those who attend primary care. his paper aimed to document the experience of recruiting to an eMH trial through primary care and compare the characteristics of participants recruited through this and other recruitment methods. ecruitment to the SpringboarD randomized controlled trial was initially focused on general practices in 2 states of Australia. Over 15 months, we employed a comprehensive approach to engaging practice staff and supporting them to recruit patients, including face-to-face site visits, regular contact via telephone and trial newsletters, and development of a Web-based patient registration portal. Nevertheless, it became apparent that these efforts would not yield the required s le size, and we therefore supplemented recruitment through national online advertising and promoted the study through existing networks. Baseline characteristics of participants recruited to the trial through general practice, online, or other sources were compared using the analysis of variance and chi square tests. etween November 2015 and October 2017, 780 people enrolled in SpringboarD, of whom 740 provided information on the recruitment source. Of these, only 24 were recruited through general practice, whereas 520 were recruited online and 196 through existing networks. Key barriers to general practice recruitment included perceived mismatch between trial design and diabetes population, prioritization of acute health issues, and disruptions posed by events at the practice and community level. Participants recruited through the 3 different approaches differed in age, gender, employment status, depressive symptoms, and diabetes distress, with online participants being distinguished from those recruited through general practice or other sources. However, most differences reached only a small effect size and are unlikely to be of clinical importance. ime, labor, and cost-intensive efforts did not translate into successful recruitment through general practice in this instance, with barriers identified at several different levels. Online recruitment yielded more participants, who were broadly similar to those recruited via general practice.
Formation of non-uniform fibre distributions in winding-pultrusion process and its effect on axial compressive properties of hollow GFRP profiles
Publisher: Elsevier BV
Date: 10-2023
Satisfaction with referral relationships between general practice and allied health professionals in Australian primary health care
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/PY10026
Abstract: Chronic diseases require a multidisciplinary approach to provide patients with optimal care in general practice. This often involves general practitioners (GPs) referring their patients to allied health professionals (AHPs). The Team-link study explored the impact of an intervention to enhance working relationships between GPs and AHPs in general practice regarding the management of two chronic diseases: diabetes and ischaemic heart disease (IHD) or hypertension. The Measure of Multidisciplinary Linkages (MoML) questionnaire was developed to assess professional interactions and satisfaction with various aspects of the multidisciplinary relationship. Questionnaires were completed at baseline and 6 months by GPs (n = 29) participating in the Team-link project and by AHPs (n = 39) who had a current working relationship with these GPs. The Chronic Care Team Profile (CCTP) and Clinical Linkages Questionnaire (CLQ) were also completed by GPs. There were significant changes from baseline to 6 months after the intervention measures for in idual items and overall MoML scores for GPs, especially items assessing ‘contact’, ‘shared care’ and ‘satisfaction with communication’. The comparable item in the CLQ, ‘Shared Care’, also showed significant improvement. However, there were no statistically significant correlations between the change in overall ‘Referral Satisfaction’ scores in the GP MoML and the CLQ. The CCTP also improved and was a weak negative correlation between the GP MoML and two of the subscores of this instrument. There were no changes in AHP measure. This study demonstrates that the instrument is sensitive to differences between providers and conditions and is sensitive to change over time following an intervention. There were few associations with the other measures suggesting that the MoML might assess other aspects of teamwork involving practitioners who are not collocated or in the same organisation.
The feasibility of an innovative GP-physiotherapist partnership to identify and manage chronic obstructive pulmonary disease (INTEGRATED): Study protocol
Publisher: Springer Science and Business Media LLC
Date: 23-09-2020
DOI: 10.1186/S40814-020-00680-4
Abstract: Chronic obstructive pulmonary disease (COPD) contributes significantly to mortality, hospitalisations and health care costs worldwide. There is evidence that the detection, accurate diagnosis and management of COPD are currently suboptimal in primary care. Physiotherapists are well-trained in cardiorespiratory management and chronic care but are currently underutilised in primary care. A cardiorespiratory physiotherapist working in partnership with general practitioners (GPs) has the potential to improve quality of care for people with COPD. A prospective pilot study will test the feasibility of an integrated model of care between GPs and physiotherapists to improve the diagnosis and management of people with COPD in primary care. Four general practices will be selected to work in partnership with four physiotherapists from their local health district. Patients at risk of developing COPD or those with a current diagnosis of COPD will be invited to attend a baseline assessment with the physiotherapist, including pre- and post-bronchodilator spirometry to identify new cases of COPD or confirm a current diagnosis and stage of COPD. The intervention for those with COPD will involve the physiotherapist and GP working in partnership to develop and implement a care plan involving the following tailored to patient need: referral to pulmonary rehabilitation (PR), physical activity counselling, medication review, smoking cessation, review of inhaler technique and education. Process outcomes will include the number of people invited and reviewed at the practice, the proportion with a new diagnosis of COPD, the number of patients eligible and referred to PR and the number who attended PR. Patient outcomes will include changes in symptoms, physical activity levels, smoking status and self-reported exacerbations. If feasible, we will test the integration of physiotherapists within the primary care setting in a cluster randomised controlled trial. If the model improves health outcomes for the growing numbers of people with COPD, then it may provide a GP-physiotherapist model of care that could be tested for other chronic conditions. ANZCTR, ACTRN12619001127190 . Registered on 12 August 2019—retrospectively registered.
Identifying airway obstruction in primary care: is there a role for physiotherapists?
Publisher: Springer Science and Business Media LLC
Date: 14-12-2022
DOI: 10.1186/S12875-022-01944-Z
Abstract: To examine the implementation of a physiotherapist-driven spirometry case finding service in primary care to identify new cases of COPD and confirm diagnosis of existing cases of COPD. Four general practices were recruited. ‘At risk’ participants (aged ≥ 40 years, current/ex-smoker) and people with ‘existing’ COPD were identified from practice databases and invited to attend an assessment with a cardiorespiratory physiotherapist in each general practice. The physiotherapist performed pre ost-bronchodilator spirometry to identify or confirm a diagnosis of COPD (FEV 1 /FVC 0.7). Outcome measures included number (%) of new cases of COPD, number (%) confirmed diagnosis of COPD and number (%) of high quality spirometry assessments with accurate interpretation. One hundred forty eight participants (mean age 70 years (SD 11.1), 57% female) attended a baseline assessment (117 ‘at risk’, 31’existing’ COPD) from 748 people invited. Physiotherapists performed 145 pre ost bronchodilator spirometry assessments. Obstruction on post-bronchodilator spirometry was confirmed in 17% (19/114) of ‘at risk’ and 77% (24/31) of ‘existing’ COPD. Majority of cases were classified as GOLD Stage II (63%, n = 27). Quality of pre ost bronchodilator spirometries for FEV 1 were classified as A (68%), B (19%) and C (5%). Physiotherapists integrated into primary care performed high quality spirometry testing, successfully case finding ‘at risk’ patients and identifying potential misdiagnosis of obstruction in some ‘existing’ COPD cases. ANZCTR, ACTRN12619001127190. Registered 12 August 2019 – Retrospectively registered, www.ANZCTR.org.au/ACTRN12619001127190.aspx
The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010
Publisher: Springer Science and Business Media LLC
Date: 31-05-2010
Review of bupropion for smoking cessation
Publisher: Wiley
Date: 06-2003
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