ORCID Profile
0000-0002-9018-0361
Current Organisation
University of Adelaide
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Climate change impacts and adaptation | Climate change impacts and adaptation not elsewhere classified | Environmental epidemiology | Primary health care |
Publisher: Cambridge University Press (CUP)
Date: 04-07-2012
DOI: 10.1017/S1041610212001111
Abstract: Background: Identification of factors associated with quality of life (QoL) in people having dementia will help develop strategies for maintenance and improvement of patient QoL. This study examined the predictors of QoL in a community-dwelling population aged 75 years and over, with or without dementia. Methods: This was a cross-sectional study involving 169 GPs and 2,028 patients. Patients were interviewed to collect information on personal circumstances. Several instruments were administered including the WHOQOL-BREF (quality of life outcome measure), Geriatric Depression Scale, GPAQ (satisfaction with GP care), and the CAMCOG-R (cognitive function). Patients with a CAMCOG-R score 80 were allocated to the dementia group. GPs provided an independent clinical judgment of cognitive function for each of their participating patients. Results: The dementia group had significantly lower QoL scores in all four domains of the WHOQOL-BREF (all p ≤ 0.002). The GDS score was negatively correlated with all four domains in the non-dementia group and with physical, psychological, and environmental QoL in the dementia group (all p 0.001). Satisfaction with GP communication was positively associated with psychological QoL in the dementia group and all domains in the non-dementia group. Participants in the dementia group who had been given a diagnosis of a memory problem had significantly higher physical (2.05, 95% CI 0.36 to 3.74) and environmental (2.18, 95% CI 0.72 to 3.64) QoL. Conclusions: Satisfaction with GP communication is associated with a higher QoL in their older patients. Diagnosis and disclosure of memory problems is associated with better QoL in people with dementia. Clinicians should not be deterred from discussing a memory diagnosis and plans for the future with patients.
Publisher: Springer Science and Business Media LLC
Date: 26-09-2014
DOI: 10.1007/S10995-013-1369-8
Abstract: To examine whether items comprising a preschool well-child check for use by family doctors in Australia with 4-5-year old children predicts health and academic outcomes at 6-7 years. The well-child check includes mandatory (anthropometry, eye/vision, ear/hearing, dental, toileting, allergy problems) and non-mandatory (processed food consumption, low physical activity, motor, behaviour/mood problems) items. The predictive validity of mandatory and non-mandatory items measured at 4-5 years was examined using data from the Longitudinal Study of Australian Children. Outcomes at 6-7 years included overweight/obesity, asthma, health care/medication needs, general health, mental health problems, quality of life, teacher-reported mathematics and literacy ability (n = 2,280-2,787). Weight or height >90th centile at 4-5 years predicted overweight/obesity at 6-7 years with 60% sensitivity, 79% specificity and 40% positive predictive value (PPV). Mood/behaviour problems at 4-5 predicted mental health problems at 6-7 years with 86% sensitivity, 40% specificity and 8% PPV. Non-mandatory items improved the discrimination between children with and without mental health problems at 6-7 years (area under the receiver operating characteristic curve 0.75 compared with 0.69 for mandatory items only), but was weak for most outcomes. Items used in a well-child health check were moderate predictors of overweight/obesity and mental health problems at 6-7 years, but poor predictors of other health and academic outcomes.
Publisher: Elsevier BV
Date: 11-2013
Publisher: Oxford University Press (OUP)
Date: 09-07-2016
Abstract: Blood pressure targets in in iduals treated for hypertension in primary care remain difficult to attain. To assess the role of practice nurses in facilitating intensive and structured management to achieve ideal BP levels. We analysed outcome data from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Patients were randomly allocated (2:1) to the study intervention or usual care. Within both groups, a practice nurse mediated the management of blood pressure for 439 patients with endpoint blood pressure data (n=1492). Patient management was categorised as: standard usual care (n=348, 23.3%) practice nurse-mediated usual care (n=156, 10.5%) standard intervention (n=705, 47.3%) and practice nurse-mediated intervention (n=283, 19.0%). Blood pressure goal attainment at 26-week follow-up was then compared. Mean age was 59.3±12.0 years and 62% were men. Baseline blood pressure was similar in practice nurse-mediated (usual care or intervention) and standard care management patients (150 ± 16/88 ± 11 vs. 150 ± 17/89 ± 11 mmHg, respectively). Practice nurse-mediated patients had a stricter blood pressure goal of ⩽125/75 mmHg (33.7% vs. 27.3%, p=0.026). Practice nurse-mediated intervention patients achieved the greatest blood pressure falls and the highest level of blood pressure goal attainment (39.2%) compared with standard intervention (35.0%), practice nurse-mediated usual care (32.1%) and standard usual care (25.3% p<0.001). Practice nurse-mediated intervention patients were almost two-fold more likely to achieve their blood pressure goal compared with standard usual care patients (adjusted odds ratio 1.92, 95% confidence interval 1.32 to 2.78 p=0.001). There is greater potential to achieve blood pressure targets in primary care with practice nurse-mediated hypertension management.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Wiley
Date: 24-06-2020
DOI: 10.1111/IRV.12774
Publisher: SAGE Publications
Date: 02-12-2019
Abstract: The success of integrated prevention initiatives for eating disorders and obesity is h ered by a lack of shared risk factor research. Bullying and sexual abuse are potentially potent shared risk factors for the spectrum of eating and weight disorders. A representative s le of N = 3005 South Australian males and females ≥15 years was interviewed about their height, weight, eating disorder symptoms, lifetime experiences of bullying and sexual abuse and mental and physical health-related quality of life. Participants who were currently obese (25.2%) or underweight (2.7%) or who reported current eating disorder symptoms (32.7%) were between 10% and 27% more likely to have experienced bullying, and obese and eating disordered participants were also 47% and 56% more likely to have experienced sexual abuse, respectively. In regard to specific symptoms, a lifetime history of bullying was associated with increased risk of obesity, extreme dieting, purging and overvaluation of body weight and/or shape, whereas a lifetime history of sexual abuse was associated with increased risk of obesity, binge eating and extreme dieting and decreased risk of underweight. Lifetime histories of bullying and sexual abuse were associated with health-related quality of life impairment however, lifetime bullying was associated with a greater adverse impact among participants with current eating disorder symptoms. Self-reported bullying and sexual abuse victimisation have shared associations with eating and weight spectrum problems. Differences in the symptoms associated with bullying versus sexual abuse are discussed, as well as the clinical and public health implications.
Publisher: Cambridge University Press (CUP)
Date: 29-04-2016
DOI: 10.1017/S0950268816000819
Abstract: Data were pooled from three Australian sentinel general practice influenza surveillance networks to estimate Australia-wide influenza vaccine coverage and effectiveness against community presentations for laboratory-confirmed influenza for the 2012, 2013 and 2014 seasons. Patients presenting with influenza-like illness at participating GP practices were swabbed and tested for influenza. The vaccination odds of patients testing positive were compared with patients testing negative to estimate influenza vaccine effectiveness (VE) by logistic regression, adjusting for age group, week of presentation and network. Pooling of data across Australia increased the s le size for estimation from a minimum of 684 to 3,683 in 2012, from 314 to 2,042 in 2013 and from 497 to 3,074 in 2014. Overall VE was 38% [95% confidence interval (CI) 24–49] in 2012, 60% (95% CI 45–70) in 2013 and 44% (95% CI 31–55) in 2014. For A(H1N1)pdm09 VE was 54% (95% CI–28 to 83) in 2012, 59% (95% CI 33–74) in 2013 and 55% (95% CI 39–67) in 2014. For A(H3N2), VE was 30% (95% CI 14–44) in 2012, 67% (95% CI 39–82) in 2013 and 26% (95% CI 1–45) in 2014. For influenza B, VE was stable across years at 56% (95% CI 37–70) in 2012, 57% (95% CI 30–73) in 2013 and 54% (95% CI 21–73) in 2014. Overall VE against influenza was low in 2012 and 2014 when A(H3N2) was the dominant strain and the vaccine was poorly matched. In contrast, overall VE was higher in 2013 when A(H1N1)pdm09 dominated and the vaccine was a better match. Pooling data can increase the s le available and enable more precise subtype- and age group-specific estimates, but limitations remain.
Publisher: European Centre for Disease Control and Prevention (ECDC)
Date: 26-10-2017
DOI: 10.2807/1560-7917.ES.2017.22.43.17-00707
Abstract: In 2017, influenza seasonal activity was high in the southern hemisphere. We present interim influenza vaccine effectiveness (VE) estimates from Australia. Adjusted VE was low overall at 33% (95% confidence interval (CI): 17 to 46), 50% (95% CI: 8 to 74) for A(H1)pdm09, 10% (95% CI: -16 to 31) for A(H3) and 57% (95% CI: 41 to 69) for influenza B. For A(H3), VE was poorer for those vaccinated in the current and prior seasons.
Publisher: Massachusetts Medical Society
Date: 18-10-2018
Publisher: Springer Science and Business Media LLC
Date: 18-01-2018
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2020-046425
Abstract: This study aimed to explore the relationship (presence and severity) between chronic breathlessness and sleep problems, independently of diagnoses and health service contact by surveying a large, representative s le of the general population. Analysis of the 2017 South Australian Health Omnibus Survey, an annual, cross-sectional, face-to-face, multistage, clustered area systematic s ling survey carried out in Spring 2017. Chronic breathlessness was self-reported using the ordinal modified Medical Research Council (mMRC scores 0 (none) to 4 (housebound)) where breathlessness has been present for more than 3 of the previous 6 months. ‘Sleep problems—ever’ and ‘sleep problem—current’ were assessed dichotomously. Regression models were adjusted for age sex and body mass index (BMI). 2900 responses were available (mean age 48.2 years (SD=18.6) 51% were female mean BMI 27. 1 (SD=5.9)). Prevalence was: 2.7% (n=78) sleep problems—past 6.8% (n=198) sleep problems—current and breathlessness (mMRC 1–4) was 8.8% (n=254). Respondents with sleep problemspast were more likely to be breathless, older with a higher BMI and sleep problems—present also included a higher likelihood of being female. After adjusting for age, sex and BMI, respondents with chronic breathlessness had 1.9 (95% CI=1.0 to 3.5) times the odds of sleep problems—past and sleep problems—current (adjusted OR=2.3 95% CI=1.6 to 3.3). There is a strong association between the two prevalent conditions. Future work will seek to understand if there is a causal relationship using validated sleep assessment tools and whether better managing one condition improves the other.
Publisher: SAGE Publications
Date: 2003
Publisher: BMJ
Date: 25-05-2002
DOI: 10.1136/BMJ.324.7348.1254
Abstract: To evaluate the impact of an intervention based in general practice on the incidence of repeat episodes of deliberate self harm. Cluster randomised controlled trial in which 98 general practices were assigned in equal numbers to an intervention or a control group. The intervention comprised a letter from the general practitioner inviting the patient to consult, and guidelines on assessment and management of deliberate self harm for the general practitioner to use in consultations. Control patients received usual general practitioner care. General practices within Avon, Wiltshire, and Somerset Health Authorities, whose patients lived within the catchment area of four general hospitals in Bristol and Bath. 1932 patients registered with the study practices who had attended accident and emergency departments at one of the four hospitals after an episode of deliberate self harm. Primary outcome was occurrence of a repeat episode of deliberate self harm in the 12 months after the index episode. Secondary outcomes were number of repeat episodes and time to first repeat. The incidence of repeat episodes of deliberate self harm was not significantly different for patients in the intervention group compared with the control group (odds ratio 1.2, 95% confidence interval 0.9 to 1.5). Similar findings were obtained for the number of repeat episodes and time to first repeat. Subgroup analyses indicated that there was no differential effect of the intervention according to patient's sex (P=0.51) or method used to cause deliberate self harm (P=0.64). The treatment seemed to be beneficial for people with a history of deliberate self harm, but it was associated with an adverse effect in people for whom the index episode was their first episode (interaction P=0.017). An invitation to consult, sent by the general practitioner of patients who have deliberately harmed themselves, and the use of management guidelines during any subsequent consultation did not reduce the incidence of repeat self harm. A subgroup analysis that indicated that patients who had previously harmed themselves benefited from the intervention was inconsistent with previous evidence and should be treated with caution. More research is needed on how to manage patients who deliberately harm themselves, to reduce the incidence of repeat episodes.
Publisher: Cambridge University Press (CUP)
Date: 04-03-2014
DOI: 10.1017/S1368980013000220
Abstract: To evaluate a primary prevention care model using telephone support delivered through an existing health call centre to general practitioner-referred patients at risk of developing CVD, using objective measures of CVD risk reduction and weight loss. Participants were randomised into two groups: (i) those receiving a telephone-supported comprehensive lifestyle intervention programme (CLIP: written structured diet and exercise advice, plus seven telephone sessions with the Heart Foundation Health Information Service) and (ii) those receiving usual care from their general practitioner (control: written general lifestyle advice). Fasting plasma lipids, blood pressure, weight, waist circumference and height were assessed on general practice premises by a practice nurse at Weeks 0 and 12. Two general practices in Adelaide, South Australia. Forty-nine men and women aged 48·0 ( sd 5·88) years identified by their general practitioner as being at future risk of CVD (BMI = 33·13 ( sd 5·39) kg/m 2 LDL cholesterol (LDL-C) = 2·66 ( sd 0·92) mmol/l). CLIP participants demonstrated significantly greater reductions in LDL-C (estimated mean ( EM) = 1·98 ( se 0·17) mmol/l) and total cholesterol (EM = 3·61 ( se 0·21) mmol/l) at Week 12 when compared with the control group (EM = 3·23 ( se 0·18) mmol/l and EM = 4·77 ( se 0·22) mmol/l, respectively). There were no significant treatment effects for systolic blood pressure ( F (1,45) = 0·28, P = 0·60), diastolic blood pressure ( F (1,43) = 0·52, P = 0·47), weight ( F (1,42) = 3·63, P = 0·063) or waist circumference ( F (1,43) = 0·32, P = 0·577). In general practice patients, delivering CLIP through an existing telephone health service is effective in achieving reductions in LDL-C and total cholesterol. While CLIP may have potential for wider implementation to support primary prevention of CVD, longer-term cost-effectiveness data are warranted.
Publisher: JMIR Publications Inc.
Date: 22-01-2023
Abstract: he Health eLiteracy for Prevention in General Practice (HeLP-GP) trial is a primary healthcare-based behavior change intervention for weight loss in overweight and obese Australians from lower socioeconomic areas. In iduals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp) and referral to telephone coaching his study aimed to assess the mysnapp app use within the HeLP-GP trial and its effects on study outcomes. n 2018, we recruited 22 general practices from 2 Australian states and randomized them by cluster to the intervention or usual care. Patients who met the main eligibility criteria (i.e. BMI 28 in previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about the study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants' choice. We collected data directly through the app and combined it with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants' questionnaires at baseline, and 6-month follow-up. The analyses comprised descriptive and inferential statistics. f the 120 participants who received the intervention, 62 (52%) participants chose to use the app. The two groups did not differ significantly in demographics or recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (χ21=6.4, P=.010) and participate in the telephone coaching (χ22=25.0, P .001) than non-app users. here seemed to be no differences in demographics or recent hospital admissions between those who chose to use the app and those who did not. App users were more likely to attend the 6-week health check and participate in telephone coaching. These finding suggest that participants who opted for several intervention components felt more committed to the study. NZCTR.org.au ACTRN12617001508369 R2-10.1136/bmjopen-2018-023239
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-10-2023
Publisher: Oxford University Press (OUP)
Date: 12-2008
Publisher: Oxford University Press (OUP)
Date: 06-07-2011
Abstract: Clinical asthma guidelines recommend spirometry for asthma diagnosis, but there is inconsistent evidence about benefits to patients in using it for ongoing management. Our aim was to determine whether training in the use of spirometry for management of asthma provided better health outcomes and improved the quality of care in the primary care setting. Pragmatic, cluster randomized controlled trial. General practices in two states of Australia. Forty practices and 397 adults with asthma. The staff of 26 intervention practices received comprehensive spirometry training. Fourteen control practices provided usual care. Primary outcome measures were quality of life, self-reported asthma symptoms and lung function. Secondary measures related to the process of care (e.g. performance of spirometry, preparation of a written asthma action plan) and patient and general practitioner rating of the acceptability and usefulness of spirometry. There were no statistically significant differences between the groups at 12 months for quality of life (mean difference = -0.23 95% CI: -0.44, -0.01), days off work (rate ratio = 1.52 95% CI: 0.91, 2.54), exacerbations (rate ratio = 1.09 95% CI: 0.85, 1.41), asthma on waking (rate ratio = 1.21 95% CI: 0.79, 1.85), nocturnal asthma (rate ratio = 0.98 95% CI: 0.63, 1.51) and post-bronchodilator FEV(1)/FVC ratio (mean difference = -0.01, 95% CI: -0.03, 0.02). There was no improvement in the quality of care provided. Training in spirometry did not result in any measurable improvement in the use of spirometry, quality of management of asthma or patient outcomes in primary care.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2012
Abstract: Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1) hypertension (HT) and 2) chronic heart failure (CHF). The objectives of this study were to improve general practitioner’s drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention. A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI) intervention on prescribing practice among Australian general practitioners (GP) in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion) with each group undertaking the clinical topics (CHF and HT) in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a “control” for the other two groups. De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs. This paper describes the study protocol for a project that will contribute to the development of acceptable and sustainable methods to promote QI activities within routine general practice, enhance prescribing practices and improve patient outcomes in the context of CHF and HT. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), Trial # 320870.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.YPMED.2017.02.007
Abstract: This study investigated the achievement of lifestyle recommendations and use of preventive medication in people who 1) are obese, 2) or have metabolic risk factors (hypertension, dyslipidaemia, and/or diabetes), 3) or have cardiovascular disease (CVD), 4) or are healthy, and the impact this preventive health care had on their 'Health-Related Quality of Life' (HRQoL). Cross-sectional survey conducted in 2015 with 2379 South Australian adults (57.1±14years 51.7% females). Physical (PCS) and mental components scores (MCS) of HRQoL were assessed using the SF-12 questionnaire. Although adequate fruit/vegetable intake was lower among in iduals with CVD (29.8% p=0.049), this behaviour was associated with a better MCS. Adequate physical activity level was lower among those with metabolic risk factors (29.5%) or CVD (31.0% p=0.008), but independent of their clinical condition, this behaviour was associated with a higher PCS. In iduals with CVD were less likely to have adequate alcohol consumption (63.4% p=0.026), but those achieving this recommendation had poorer PCS. Non-smoking was similar in all groups (85% p=0.768) and was associated with a better MCS only among healthy in iduals and those with CVD. In all the groups, in iduals achieving all the lifestyle recommendations had a better PCS. Only 48.2% of in iduals with CVD reported combined use of antithrombotic, antihypertensive, and antilipidemic drugs, but the use of these medications was not associated with HRQoL. In conclusion, the vast majority of in iduals at risk of or with CVD did not achieve preventive recommendations, and only the adequacy of uptake of all recommended lifestyle behaviours showed consistent benefits for PCS and MCS.
Publisher: Frontiers Media SA
Date: 08-01-2019
Publisher: AMPCo
Date: 04-2009
DOI: 10.5694/J.1326-5377.2009.TB02475.X
Abstract: To estimate the prevalence of depression among older Australians with common medical morbidities, and to determine the association between poor physical health and depression in this age group. Cross-sectional, postal questionnaire survey. 20 183 community-dwelling adults aged 60 years and over, under the care of 383 general practitioners participating in the Depression and Early Prevention of Suicide in General Practice (DEPS-GP) project (conducted between 2005 and 2008 the data in this article were collected during the baseline phase of the study in 2005). Depressive symptoms (measured by the nine-item depression scale of the Patient Health Questionnaire), health status (measured by the 12-item Short Form Health Survey and a medical morbidity inventory), social support (measured by the subjective support subscale from the Duke Social Support Index), and demographic and lifestyle information. 18 190 participants (90.1%) reported having at least one chronic physical health condition, while 1493 (7.1%) experienced clinically significant depression (3.1% major depressive syndrome 4.0% other depressive syndrome). Most chronic physical illnesses were associated with increased odds of depression, and participants with numerous medical morbidities and a high level of functional impairment were three to four times more likely to have a depressive illness. Depression is more the exception than the rule in later life, and among those who are medically unwell, the level of associated impairment may determine their risk of depression more than their acquired physical illness. Many of the factors associated with depression in medically ill patients are amenable to treatment, and GPs are in a unique position to address this important public health issue.
Publisher: Informa UK Limited
Date: 02-11-2017
DOI: 10.1080/19390211.2017.1375060
Abstract: Vitamin D deficiency is a public health issue, with reports of six- to twenty-five-fold rise in vitamin D testing. Vitamin D deficiency has been linked to many chronic diseases such as diabetes mellitus, cardiovascular disease, depression, and chronic pain. Identifying factors associated with risk of deficiency in in iduals with chronic pain will help minimize time and cost. This study aims to examine the factors associated with vitamin D testing, intake, and physician-advised supplementation in in iduals with chronic pain. Using a cross-sectional design, data were collected from 465 in iduals with chronic pain. These data were analyzed using penalized logistic regression with the LASSO technique. Fifty-seven percent reported being tested for vitamin D, about 40% reported being diagnosed with vitamin D deficiency, and of those who had been tested, 60% reported taking vitamin D supplementation. The findings suggest older age (OR 3.12, CI [1.02, 9.50]) and higher mean pain intensity score (OR 2.02, CI [1.13, 3.59]) increased an in idual's chance of being vitamin D deficient. Unemployment or on leave due to pain (OR 1.79, [CI 1.03, 3.11]), part-time employment (OR 1.86, CI [1.02, 3.39]), and being a resident of Australia (OR 2.32, CI [1.13, 4.72]) increased chances of being tested for vitamin D. Being diagnosed with vitamin D deficiency (OR 6.67, CI [2.75, 16.19]), unemployed or on leave due to pain (OR 3.71, CI [1.25, 11.00]), and in part-time employment (OR 2.69, CI [0.86, 8.38]) were associated with physician-advised vitamin D supplementation. Our results may have practical implications, as identifying pretest risk factors may assist in identifying who is at risk of vitamin D deficiency, whom to test, and when to treat.
Publisher: Elsevier BV
Date: 2018
Publisher: Cambridge University Press (CUP)
Date: 26-06-2013
DOI: 10.1017/S1041610213000884
Abstract: Dementia is a complex and variable condition which makes recognition of it particularly difficult in a low prevalence primary care setting. This study examined the factors associated with agreement between an objective measure of cognitive function (the revised Cambridge Cognitive Assessment, CAMCOG-R) and general practitioner (GP) clinical judgment of dementia. This was a cross-sectional study involving 165 GPs and 2,024 community-dwelling patients aged 75 years or older. GPs provided their clinical judgment in relation to each of their patient's dementia status. Each patient's cognitive function and depression status was measured by a research nurse using the CAMCOG-R and the 15-item Geriatric Depression Scale (GDS), respectively. GPs correctly identified 44.5% of patients with CAMCOG-R dementia and 90% of patients without CAMCOG-R dementia. In those patients with CAMCOG-R dementia, two patient-dependent factors were most important for predicting agreement between the CAMCOG-R and GP judgment: the CAMCOG-R score (p = 0.006) and patient's mention of subjective memory complaints (SMC) to the GP (p = 0.040). A higher CAMCOG-R (p 0.001) score, female gender (p = 0.005), and larger practice size (p 0.001) were positively associated with GP agreement that the patient did not have dementia. Subjective memory complaints (p 0.001) were more likely to result in a false-positive diagnosis of dementia. Timely recognition of dementia is advocated for optimal dementia management, but early recognition of a possible dementia syndrome needs to be balanced with awareness of the likelihood of false positives in detection. Although GPs correctly agree with dimensions measured by the CAMCOG-R, improvements in sensitivity are required for earlier detection of dementia.
Publisher: Springer Science and Business Media LLC
Date: 17-02-2015
Publisher: Royal College of General Practitioners
Date: 30-12-2013
Publisher: Springer Science and Business Media LLC
Date: 03-07-2017
Publisher: Oxford University Press (OUP)
Date: 05-07-2021
DOI: 10.1111/BJD.20494
Publisher: Royal College of General Practitioners
Date: 08-2012
Publisher: Public Library of Science (PLoS)
Date: 07-06-2018
Publisher: Springer Science and Business Media LLC
Date: 25-03-2011
DOI: 10.1038/EYE.2011.56
Publisher: Oxford University Press (OUP)
Date: 08-2002
Abstract: It is unclear which symptoms and signs GPs use when attributing diagnostic labels to patients with acute respiratory illness (ARI). We sought to ascertain GPs' self-reported definitions of ARI. A postal questionnaire concerned with the diagnosis of ARI was sent to all registered GPs in Avon Health Authority. GPs were asked to choose a clinical term that would describe the clinical presentation in four hypothetical patients, and the next three questions asked them to define acute bronchitis, upper respiratory tract infection (URTI) and any other term they used for ARI (excluding pneumonia). We measured proportions and compared responses across the three diagnostic categories. The majority (88%) of GPs agreed that cough associated with fever should be labelled as a URTI. When sputum and chest signs were also present, opinion was more ided, with 62% diagnosing acute bronchitis in young patients and 72% lower respiratory tract infection in old patients. This study demonstrates that there is more consistent use of diagnostic labels for URTI than for acute bronchitis or other terms used to label ARI. In the future, researchers should quantify the prognostic significance of symptoms and signs in ARI and provide GPs with a more rational approach to the diagnosis and management of ARI.
Publisher: Royal College of Psychiatrists
Date: 10-2012
DOI: 10.1192/BJP.BP.112.110130
Abstract: Thoughts about death and self-harm in old age have been commonly associated with the presence of depression, but other risk factors may also be important. To determine the independent association between suicidal ideation in later life and demographic, lifestyle, socioeconomic, psychiatric and medical factors. A cross-sectional study was conducted of a community-derived s le of 21290 adults aged 60-101 years enrolled from Australian primary care practices. We considered that participants endorsing any of the four items of the Depressive Symptom Inventory - Suicidality Subscale were experiencing suicidal thoughts. We used standard procedures to collect demographic, lifestyle, psychosocial and clinical data. Anxiety and depressive symptoms were assessed with the Hospital Anxiety and Depression Scale. The 2-week prevalence of suicidal ideation was 4.8%. Male gender, higher education, current smoking, living alone, poor social support, no religious practice, financial strain, childhood physical abuse, history of suicide in the family, past depression, current anxiety, depression or comorbid anxiety and depression, past suicide attempt, pain, poor self-perceived health and current use of antidepressants were independently associated with suicidal ideation. Poor social support was associated with a population attributable fraction of 38.0%, followed by history of depression (23.6%), concurrent anxiety and depression (19.7%), prevalent anxiety (15.1%), pain (13.7%) and no religious practice (11.4%). Prevalent and past mood disorders seem to be valid targets for indicated interventions designed to reduce suicidal thoughts and behaviour. However, our data indicate that social disconnectedness and stress account for a larger proportion of cases than mood disorders. Should these associations prove to be causal, then interventions that succeeded in addressing these issues would contribute the most to reducing suicidal ideation and, possibly, suicidal behaviour in later life.
Publisher: Wiley
Date: 14-03-2017
DOI: 10.1002/GPS.4466
Abstract: General practitioners (GPs) fail to identify more than 50% of dementia cases using the existing passive case-finding approach. Using data from the "Ageing in General Practice" study, we sought to establish the additional benefit of screening all patients over the age of 75 for dementia beyond those patients already identified by passive case-finding. Patients were classified as "case-finding" (n = 425) or "screening" (n = 1006) based on their answers to four subjective memory related questions or their GP's clinical judgement of their dementia status. Cognitive status of each patient was formally assessed by a research nurse using the Cambridge Cognition Examination (CAMCOG-R). Patients then attended their usual GP for administration of the GP assessment of Cognition (GPCOG) dementia screening instrument, and follow-up care and/or referral as necessary in light of the outcome. The prevalence of dementia was significantly higher in the case-finding group (13.6%) compared to the screening group (4.6% p 95% in both groups. GPs and their patients both found the GPCOG to be an acceptable cognitive assessment tool. The dementia cases missed via case-finding were younger (p = 0.024) and less cognitively impaired (p = 0.020) than those detected. There is a very limited benefit of screening for dementia, as most people with dementia could be detected using a case-finding approach, and considerable potential for social and economic harm because of the low PPV associated with screening.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-024797
Abstract: To assess changes in the frequency of vitamin D testing and detection of moderate/severe vitamin D deficiency ( nmol/L) among adults after the introduction of new Medicare Benefits Schedule (MBS) rebate criteria (November 2014), and their relationship to sociodemographic and clinical characteristics. Dynamic (open) cohort study Primary care About 1.5 million ‘active’ patients aged 18+ years visiting a general practitioner and included in the National Prescribing Service MedicineInsight database. The frequency of vitamin D testing (per 1000 consultations) and moderate/severe vitamin D deficiency (%) recorded between October 2013 and March 2016, stratified by the release of the new MBS criteria for rebate. More patients were female (57.7%) and 30.2% were aged 60+ years. Vitamin D testing decreased 47% (from 40.3 to 21.4 tests per 1000 consultations) after the new MBS criteria, while the proportion of tests with no indication for being performed increased from 71.3% to 76.5%. The proportion of patients identified as moderate/severe vitamin D deficient among those tested increased from 5.4% to 6.5%. Practices located in high socioeconomic areas continued to have the highest rates of testing, but moderate/severe vitamin D deficiency detection remained 90% more frequent in practices from low socioeconomic areas after the rebate change. Furthermore, the frequency of in iduals being tested was reduced independent of the patients’ sociodemographic or clinical condition, and the gap in the prevalence of vitamin D deficiency detection between those meeting or not meeting the criteria for being tested remained the same. Moderate/severe vitamin D deficiency detection decreased slightly among patients with hyperparathyroidism or chronic renal failure. Although the new criteria for rebate almost halved the frequency of vitamin D testing, it also lessened the frequency of testing among those at higher risk of deficiency, with only a small improvement in vitamin D deficiency detection.
Publisher: Wiley
Date: 10-10-2023
DOI: 10.1111/DAR.13561
Abstract: We aimed to explore trends and sociodemographic patterns in benzodiazepine (BZD) (by half-life) and Z-drugs prescribing in Australian general practice. This open cohort study used de-identified electronic health records of 1.4 million patients (50,812,413 consultations) from 402 Australian practices (MedicineInsight 2011-2018). Annual prescribing frequency and changes over time were estimated according to sex, age, socioeconomic position and rurality. Between 2011 and 2018, the prescribing of very short-acting BZD increased from 0.10 to 0.29 per 1000 consultations (average annual change +17.2% [95% CI 9.6 25.3]), while it declined for short-intermediate (from 38.5 to 26.6 per 1000 consultations annual change -5.1% [95% CI -5.6 -4.5]), long-acting BZD (from 24.1 to 21.6 per 1000 consultation annual change -1.5% [95% CI -2.2 -0.8]) and Z-drugs (from 4.6 to 4.0 per 1000 consultations annual change -1.9% [95% CI -3.0 -0.7]). Short-intermediate-acting BZD prescribing was three times more frequent among women aged 65+ years than younger women, and long-acting BZD three-to-four times more likely among younger than older men. Z-drugs prescribing was higher among women aged 45-64 years than younger or older females. Short-intermediate- and long-acting BZD were more likely prescribed for patients from more disadvantaged areas, and Z-drugs in more advantaged areas. There were no disparities by rurality. Although most BZD and Z-drugs prescriptions declined over time, short-intermediate BZD prescriptions remained higher among older women and long-acting BZD more frequent among younger men, especially for those living in more disadvantaged areas. Targeted interventions could reduce the prescribing of BZD and Z-drugs in these groups.
Publisher: Springer Science and Business Media LLC
Date: 08-06-2012
Publisher: Wiley
Date: 15-06-2016
DOI: 10.1111/AJD.12493
Abstract: Skin conditions are commonly encountered in general practice but dermatology is underrepresented in undergraduate medical courses. Australian and international studies have shown that the dermatological diagnostic ability of general practitioners (GPs) is suboptimal, contributing to increased dermatology outpatient referrals. Dermatological experience in GP vocational training is thus of particular importance. We aimed to document the prevalence of skin disease presentations and the range of skin diseases encountered by GP trainees. We also sought to establish associations of GP trainee's skin disease experience, including their personal characteristics, consultation factors, and the actions arising from the consultation. This study took place in the Registrars Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing, prospective, multi-site cohort study of Australian GP trainees' consultations. A descriptive cross-sectional analysis was performed on trainees' consultation data. In total, 645 in idual trainees contributed data from 84 615 consultations. Altogether, 11% of all problems managed were skin problems. Infections, dermatitis, injury and wounds were the most common presentations. Associations of consultations for skin problems (compared with all other problems) included seeking in-consultation advice, planning patient follow up and generating learning goals. These findings suggest GP trainees find skin problems challenging and may indicate a need for more and better targeted undergraduate and GP trainee education.
Publisher: Elsevier BV
Date: 11-1999
DOI: 10.1016/S0033-3506(99)00179-1
Abstract: There have been many papers examining the relationship between blood pressure and birthweight but although the association is clearly established in adults and children findings in adolescence and young adults have been inconsistent. The objective of this study was to examine the relationship between blood pressure and birthweight in young adults. The blood pressure of 1358 university students aged 18-25 was recorded at a screening medical examination and their birthweight from parental report. Using linear regression analysis, systolic blood pressure, after adjustment for age, weight and height, decreased by 2.00 mmHg (-3.8, -0.2) for every kg increase in birthweight in females. The relationship was negative but non-significant in males. Substituting body mass index (BMI) for weight in the regression analysis produced similar results. There was a smaller and non-significant relationship between diastolic blood pressure and birthweight which is consistent with other studies. This study confirms the inverse relationship between systolic blood pressure and birthweight in young adults and provides some support for the hypothesis that undernutrition in utero contributes to the development of cardiovascular disease in adults.
Publisher: Oxford University Press (OUP)
Date: 10-07-2019
DOI: 10.1093/IJE/DYZ147
Publisher: Springer Science and Business Media LLC
Date: 29-04-2019
Publisher: No publisher found
Date: 2002
Publisher: Springer Science and Business Media LLC
Date: 21-11-2012
Publisher: AMPCo
Date: 06-1994
DOI: 10.5694/J.1326-5377.1994.TB125942.X
Abstract: To determine the prevalence of trachoma and blindness in the Aboriginal population in the Anangu Pitjantjatjara and Yalata lands of South Australia. A population-based prevalence survey undertaken in conjunction with routine South Australian Aboriginal Trachoma and Eye Health Program trips during 1989 and 1990. A group of 1514 in iduals aged 0-90 years, or approximately 58% of the estimated Aboriginal population in the Anangu Pitjantjatjara and Yalata lands, was examined. Active inflammatory trachoma was found in 17.6% of the group (266 in iduals), cicatricial trachoma in 25.2% (382) and binocular blindness (Australian definition) in 1.5% (22). The major causes of monocular and binocular blindness were trachoma, cataracts and trauma. Two per cent of women (17 of 849) were blind, compared with 0.8% (5 of 665) of men (odds ratio, 3.22 95% confidence interval, 1.03-10.43). Although trachoma is still endemic in the "traditional" Aboriginal population of SA, its prevalence and severity appear to be less than previously recorded. However, the prevalence of blindness is comparable with that found in developing countries and the causes are still largely preventable. Further effort is required to reduce trachoma and preventable or treatable blindness in these communities.
Publisher: Cambridge University Press (CUP)
Date: 30-09-2011
DOI: 10.1017/S1041610210001870
Abstract: Background: Many factors have been associated with the onset and maintenance of depressive symptoms in later life, although this knowledge is yet to be translated into significant health gains for the population. This study gathered information about common modifiable and non-modifiable risk factors for depression with the aim of developing a practical probabilistic model of depression that can be used to guide risk reduction strategies. Methods: A cross-sectional study was undertaken of 20,677 community-dwelling Australians aged 60 years or over in contact with their general practitioner during the preceding 12 months. Prevalent depression (minor or major) according to the Patient Health Questionnaire (PHQ-9) assessment was the main outcome of interest. Other measured exposures included self-reported age, gender, education, loss of mother or father before age 15 years, physical or sexual abuse before age 15 years, marital status, financial stress, social support, smoking and alcohol use, physical activity, obesity, diabetes, hypertension, and prevalent cardiovascular diseases, chronic respiratory diseases and cancer. Results: The mean age of participants was 71.7 ± 7.6 years and 57.9% were women. Depression was present in 1665 (8.0%) of our subjects. Multivariate logistic regression showed depression was independently associated with age older than 75 years, childhood adverse experiences, adverse lifestyle practices (smoking, risk alcohol use, physical inactivity), intermediate health hazards (obesity, diabetes and hypertension), comorbid medical conditions (clinical history of coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, emphysema or cancers), and social or financial strain. We stratified the exposures to build a matrix that showed that the probability of depression increased progressively with the accumulation of risk factors, from less than 3% for those with no adverse factors to more than 80% for people reporting the maximum number of risk factors. Conclusions: Our probabilistic matrix can be used to estimate depression risk and to guide the introduction of risk reduction strategies. Future studies should now aim to clarify whether interventions designed to mitigate the impact of risk factors can change the prevalence and incidence of depression in later life.
Publisher: Wiley
Date: 17-02-2010
Publisher: Wiley
Date: 05-1997
DOI: 10.1111/J.1442-9071.1997.TB01293.X
Abstract: Australia is a developed country. However, Aboriginal Australians have rates of blindness comparable to Third World countries. There have been well-funded eye health programs for 15 years in Central Australia. This paper examines if there has been an improvement in visual disability of one traditional group of Aboriginal Australians. Results from an eye health survey of the Anangu Pitjantjatjara of South Australia in 1990 are presented. These data are compared with results for 'blindness' and 'poor vision' from a national survey undertaken in 1976. The two surveys were comparable in design, both were cross-sectional population-based prevalence surveys. Prevalence rates were adjusted for the size of the source population. Young rural Aboriginal Australians have good visual acuity. Low vision and blindness (WHO definitions) occur in 19.6% and 10.4% of 60+ year olds, respectively. Women were more likely than men to be blind or have low vision (OR = 1.93 1.06-3.58). There was a decline in 'poor vision' between surveys (OR = 2.86 1.86-4.75) but not in 'blindness'. Although there has been a reduction in the prevalence of visual disability in rural Aboriginal Australians, improvements in the provision of eye care for the elderly need to occur.
Publisher: Informa UK Limited
Date: 2001
Publisher: BMJ
Date: 02-2018
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2019-036298
Abstract: Diagnostic tests for influenza in Australia are currently only authorised for use in clinical settings. At-home diagnostic testing for influenza could reduce the need for patient contact with healthcare services, which potentially could contribute to symptomatic improvement and reduced spread of influenza. We aim to determine the accuracy of an app-guided nasal self-swab combined with a lateral flow immunoassay for influenza conducted by in iduals with influenza-like illness (ILI). Adults (≥18 years) presenting with ILI will be recruited by general practitioners (GP) participating in Australian Sentinel Practices Research Network. Eligible participants will have a nasal swab obtained by their GP for verification of influenza A/B status using reverse transcription polymerase chain reaction (RT-PCR) test at an accredited laboratory. Participants will receive an influenza test kit and will download an app that collects self-reported symptoms and influenza risk factors, then instructs them in obtaining a low-nasal self-swab, running a QuickVue influenza A+B lateral flow immunoassay (Quidel Corporation) and interpreting the results. Participants will also interpret an enhanced image of the test strip in the app. The primary outcome will be the accuracy of participants’ test interpretation compared with the laboratory RT-PCR reference standard. Secondary analyses will include accuracy of the enhanced test strip image, accuracy of an automatic test strip reader algorithm and validation of prediction rules for influenza based on self-reported symptoms. A post-test survey will be used to obtain participant feedback on self-test procedures. The study was approved by the Human Research and Ethic Committee (HREC) at the University of Adelaide (H-2019-116). Protocol details and any amendments will be reported to www.tga.gov.au/ . Results will be published in the peer-reviewed literature, and shared with stakeholders in the primary care and diagnostics communities. Australia New Zealand Clinical Trial Registry (U1111-1237-0688).
Publisher: Springer Science and Business Media LLC
Date: 11-02-2017
DOI: 10.1007/S11136-017-1503-Y
Abstract: To investigate if sociodemographic characteristics increase the adverse effects of cardiovascular diseases (CVD) and cardiometabolic risk factors (CMRF) on health-related quality of life (HRQoL). Cross-sectional, face-to-face survey investigating 2379 adults living in South Australia in 2015 (57.1 ± 14 years 51.7% females). Questions included diagnosis of CMRF (obesity, diabetes, hypertension, dyslipidaemia) and CVD. Physical and mental HRQoL were assessed using the SF-12v1 questionnaire. Multiple linear regression models including confounders (sociodemographic, lifestyle, use of preventive medication) and interaction terms between sociodemographic variables and cardiometabolic conditions were used in adjusted analysis. The prevalence of CMRF (one or more) was 54.6% and CVD was 13.0%. The physical HRQoL reduced from 50.8 (95%CI 50.2-51.4) in healthy in iduals to 45.1 (95%CI 44.4-45.9) and 39.1 (95%CI 37.7-40.5) among those with CMRF and CVD, respectively. Adjustment for sociodemographic variables reduced these differences in 33%, remaining stable after controlling for lifestyle and use of preventive medications (p < 0.001). Differences in physical HRQoL according to cardiometabolic conditions were twice as high among those with lower educational level, or if they were not working. Among unemployed, having a CMRF or a CVD had the same impact on the physical HRQoL (9.7 lower score than healthy in iduals). The inverse association between cardiometabolic conditions and mental HRQoL was subtle (p = 0.030), with no evidence of disparities due to sociodemographic variables. A lower educational level and unemployment increase the adverse effects of cardiometabolic conditions on the physical HRQoL. Targeted interventions for reducing CMRF and/or CVD in these groups are necessary to improve HRQoL.
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Elsevier BV
Date: 08-1996
DOI: 10.1111/J.1467-842X.1996.TB01049.X
Abstract: The eye health of rural Aboriginal Australians is known to be poor. Over the past 20 years, Aboriginal communities in remote parts of Australia have had increasing access to eye health services through the National Trachoma and Eye Health Program (NTEHP). Using published and unpublished data, we examined trends in the prevalence of inflammatory trachoma in the Anangu Pitjantjatjara of South Australia. Comparisons using a generalised linear model of surveys in 1976, 1985 and 1990 indicate that there has been a significant reduction in the age-standardised prevalence of inflammatory trachoma in 0- to 20-year-olds. When the 1990 survey was compared with 1976 interim report data from the NTEHP survey, the odds of inflammatory trachoma in 1990 were 0.25 (95 per cent confidence interval (CI) 0.18 to 0.35). When the comparison was with data from the NTEHP survey of the Red Centre, the odds of follicular trachoma in 1990 were 0.51 (CI 0.42 to 0.62), and in comparison with the 1985 NTEHP review data, the odds of inflammatory trachoma in 1990 were 0.28 (CI 0.20 to 0.39). In the older age groups (20 and over), an increase in the prevalence of inflammatory trachoma was found. Although significant, the increase affected a small proportion of the population and may have been because of difficulty in standardising the trachoma grading between surveys, or systematic grading error in the 1990 survey. This study therefore shows that the eye health of Aboriginal people in Central Australia may be improving. The decline in trachoma is welcome and may be caused by improvements in socioeconomic conditions, community development and increasing access to medical care.
Publisher: Oxford University Press (OUP)
Date: 22-01-2019
Publisher: John Wiley & Sons, Ltd
Date: 08-12-2011
Publisher: BMJ
Date: 06-2018
Publisher: American Medical Association (AMA)
Date: 14-01-2008
Publisher: Oxford University Press (OUP)
Date: 12-2002
Publisher: Wiley
Date: 07-2019
DOI: 10.1111/IMJ.14187
Abstract: Australia has among the highest prevalence of Crohn disease and ulcerative colitis in the world. Management of the chronic gastrointestinal disorders results in significant societal costs and the standard of care is inconsistent across Australia. To audit the quality of care received by patients admitted for inflammatory bowel disease (IBD) across Australia against national IBD standards. A retrospective cross-sectional survey and clinical audit was undertaken assessing organisational resources, clinical processes and outcome measures. This study was conducted in Australian hospitals that care for inpatients with Crohn disease or ulcerative colitis. The main outcome measures were adherence to national IBD standards and comparison of quality of care between hospitals with and without multidisciplinary IBD services. A total of 71 hospitals completed the organisational survey. Only one hospital had a complete multidisciplinary IBD service and 17 had a partial IBD service (IBD nurse, helpline and clinical lead). A total of 1440 inpatient records was reviewed from 52 hospitals (mean age 37 years 51% female, 53% Crohn disease), approximately 26% of IBD inpatient episodes over a 12-month period in Australia. These patients were chronically unwell with high rates of anaemia (30%) and frequent readmissions (40% within 2 years). In general, care was inconsistent, and documentation was poor. Hospitals with a partial IBD service performed better in many processes and outcome measures: for ex le, 22% reduction in admissions through emergency departments and greater adherence to standards for safety monitoring of biological (89% vs 59%) and immunosuppressive drugs (79% vs 55%) in those hospitals than those without. Patients admitted to hospital suffering from IBD are young, chronically unwell and are subject to substantial variations in clinical documentation and quality of care. Only one hospital met accepted standards for multidisciplinary care hospitals with even a minimal IBD service provided improved care.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Springer Science and Business Media LLC
Date: 15-02-2015
Publisher: Oxford University Press (OUP)
Date: 27-02-2008
Abstract: An intensive 3-day training programme, the 'Registrar Research Workshop' (RRW), has aimed to build research capacity among Australian general practice registrars since 1994. To investigate the impact of the RRW on participants' skills, confidence, interest in research and research activity. Cross-sectional postal survey in 2006 of five groups of registrars who participated in the annual workshop in 2002-2006 (response rate: 64% 77 of 121). Outcome measures included research experience and skills prior to and after the workshop impact of the workshop on capacity, confidence, attitude and interest in research and research involvement as measured by publications and grant funding. Self-reported research skills increased over time for the whole group (two-way analysis of variance: P = 0.047), most significantly for registrars with little or no research experience (P < 0.001) and research project participants (P = 0.003). The impact of the workshop on capacity, confidence and interest in research was rated highly (mean 3.5-4.0 +/- 0.1 on a five-point scale). Two-thirds of the survey respondents had been research active, 34% presented their findings at conferences, 25% published in peer-reviewed journals and 31% received research funding. Eighty-four per cent of respondents indicated a high interest in undertaking research in the future. All survey respondents recommended the workshop to other registrars. The RRW provides a useful model for effective research training for interested general practice trainees. Such training has the potential to increase knowledge of research methods, which might augment future research activity in general practice.
Publisher: BMJ
Date: 12-2000
Publisher: American Medical Association (AMA)
Date: 28-10-1998
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.JAD.2012.01.021
Abstract: Depression is more frequent in socioeconomically disadvantaged than affluent neighbourhoods, but this association may be due to confounding. This study aimed to determine the independent association between socioeconomic disadvantage and depression. We recruited 21,417 older adults via their general practitioners (GPs) and used the Patient Health Questionnaire (PHQ-9) to assess clinically significant depression (PHQ-9≥10) and major depressive symptoms. We ided the Index of Relative Socioeconomic Disadvantage into quintiles. Other measures included age, gender, place of birth, marital status, physical activity, smoking, alcohol use, height and weight, living arrangements, early life adversity, financial strain, number of medical conditions, and education of treating GPs about depression and self-harm behaviour. After 2 years participants completed the PHQ-9 and reported their use of antidepressants and health services. Depression affected 6% and 10% of participants in the least and the most disadvantaged quintiles. The proportion of participants with major depressive symptoms was 2% and 4%. The adjusted odds of depression and major depression were 1.4 (95% confidence interval, 95%CI=1.1-1.6) and 1.8 (95%CI=1.3-2.5) for the most disadvantaged. The adjusted odds of persistent major depression were 2.4 (95%CI=1.3-4.5) for the most disadvantaged group. There was no association between disadvantage and service use. Antidepressant use was greatest in the most disadvantaged groups. The higher prevalence and persistence of depression amongst disadvantaged older adults cannot be easily explained by confounding. Management of depression in disadvantaged areas may need to extend beyond traditional medical and psychological approaches.
Publisher: Springer Science and Business Media LLC
Date: 05-2002
Abstract: To ascertain the prevalence of cataract in a representative group of men who have been followed since 1979 for cardiovascular disease. Of 2348 men aged 45-63 recruited in 1979 to the Speedwell Cardiovascular Study, 1420 were alive and willing to take part in further studies in 1997. They were sent a questionnaire about their eye health and invited to an ophthalmological examination at Bristol Eye Hospital. Cataract was graded using the Lens Opacities Classification System III (LOCS III) method. Of the 1420 men, 26 died before they could be examined. Out of the remaining 1394 men, 949 presented for examination and full information was available for 936. Some information about eye health was obtainable for 394 men and 51 were not contactable. The prevalence of cataract increased with age and 36 men (3.8%) had had previous cataract surgery in either or both eyes. Of the remaining 903 men with no previous history of cataract surgery, cortical cataract was present in the right eye of 75 men (8.3%), nuclear (opalescence) in 128 (14.2%) and posterior subcapsular in 15 (1.7%). Five men (0.6%) had visual acuity of 6/60 or worse attributable to cataract in the right eye and 232 (25%) had visual acuity in one or both eyes of 6/24 or less at least partially attributable to cataract. There was no association between social class and the presence of cataract. The prevalence of cataract in a representative cohort of men followed since 1979 for cardiovascular disease was comparable to that previously reported in the UK and is consistent with studies from around the world. It appears that substantial amounts of visual loss, attributable to cataract, are present in men. Further studies establishing the reasons for this should be undertaken.
Publisher: Springer Science and Business Media LLC
Date: 09-02-2017
DOI: 10.1007/S10067-016-3205-1
Abstract: Chronic nonspecific musculoskeletal pain (CNMP) is an idiopathic condition often seen in general practice and rheumatology clinics, the aetiology of which may include vitamin D deficiency. The objective of the present study is to evaluate the effectiveness of vitamin D supplementation in the management of CNMP through a systematic review and meta-analysis. According to PRISMA guidelines, PubMed, Embase, Web of Science, Cochrane and Scopus electronic databases were searched for randomised controlled trials comparing vitamin D supplementation to a control or placebo in CNMP patients the search was not limited by language or date. Meta-analysis was performed using the mean and standardised mean difference which was computed with 95 % confidence intervals, and overall effect size was calculated. Both fixed and random effects models were used in meta-analysis to account for heterogeneity in the studies. The initial search identified 107 studies, of which 10 were potentially relevant, with 7 studies excluded because they did not meet selection criteria. Three studies were included in the meta-analysis. We found no effect of vitamin D supplementation (standardised mean difference (SMD) 0.004 95 % confidence interval (CI) -0.248 to 0.256) on pain in CNMP patients. Forest plot is used to present the results from meta-analysis. Contrary to a widespread clinical view, there is a moderate level of evidence that vitamin D supplementation is not helpful for treating CNMP patients.
Publisher: BMJ
Date: 21-03-1998
Abstract: To assess whether antibiotic treatment for acute cough is effective and to measure the side effects of such treatment. Quantitative systematic review of randomised placebo controlled trials. Nine trials (8 published, 1 unpublished) retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists) no restriction on language. Proportion of subjects with productive cough at follow up (7-11 days after consultation with general practitioner) proportion of subjects who had not improved clinically at follow up proportion of subjects who reported side effects from taking antibiotic or placebo. Eight trials contributed to the meta-analysis. Resolution of cough was not affected by antibiotic treatment (relative risk 0.85 (95% confidence interval 0.73 to 1.00)), neither was clinical improvement at re-examination (relative risk 0.62 (0.36 to 1.09)). The side effects of antibiotic were more common in the antibiotic group when compared to placebo (relative risk 1.51 (0.86 to 2.64)). Treatment with antibiotic does not affect the resolution of cough or alter the course of illness. The benefits of antibiotic treatment are marginal for most patients with acute cough and may be outweighed by the side effects of treatment.
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.JAD.2008.08.014
Abstract: To estimate the prevalence of depression among older adults in Australia. All general practitioners in Australia's five most populous states who satisfied certain eligibility criteria (e.g., sufficient weekly working hours, sufficient numbers of elderly patients) were invited to participate. Those who consented were asked to identify all of their patients aged 60+ and invite them (either directly or via the study team) to complete a questionnaire. The questionnaire identified those who had experienced 'clinically significant depression' and those who had experienced a 'major depressive episode' in the past two weeks, via the Patient Health Questionnaire (PHQ-9). Consenting patients completed the questionnaire and returned it to the study team in a reply-paid envelope. In total, 22,251 patients returned questionnaires. Overall, the age-adjusted rate of clinically significant depression was 8.2% (95%CI=7.8%-8.6%), with the age-adjusted rates for males being 8.6% (95%CI=7.9%-9.2%) and for females being 7.9% (95%CI=7.4%-8.4%). The overall, male and female age-adjusted rates for a major depressive episode were 1.8% (95%CI=1.6%-2.0%), 1.9% (95%CI=1.6%-2.2%) and 1.7% (95%CI=1.5%-2.0%), respectively. Our study suggests that depression among older people is a major public health problem. The above estimates provide guidance for efficient planning of services, and establish a baseline against which preventive and treatment interventions can be assessed. Armed with this information, we can progress efforts at reducing this major health problem and its consequences.
Publisher: Springer Science and Business Media LLC
Date: 23-07-2019
DOI: 10.1007/S40271-019-00377-8
Abstract: Medication adherence is poor in patients with chronic conditions. Behavioral economic interventions may reduce biases that are associated with poor adherence. The objective of this review is to map the available evidence on behavioral economic interventions to improve medication adherence in adults with chronic conditions in high-income settings. We conducted a scoping review and reported the study using the Joanna Briggs Institute Reviewers' Manual and the PRISMA Extension for Scoping Review checklist. We searched PubMed, EMBASE, SCOPUS, PsycINFO, EconLit, and CINAHL from database inception to 29 August, 2018 for peer-reviewed studies and included a search of the gray literature. Data on study characteristics, study design, and study outcomes were extracted by one reviewer. Twenty-five percent of the studies were verified by a second reviewer. Thirty-four studies, targeting diabetes mellitus, human immunodeficiency virus, and cardiovascular and renal diseases met our inclusion criteria. All but two studies were from the USA. The majority of interventions used financial incentives, often in conjunction with other behavioral economic concepts. Non-financial interventions included framing, social influences, reinforcement, and feedback. The effectiveness of interventions was mixed. Behavioral economic informed interventions show promise in terms of improving medication adherence. However, there is no single simple intervention. This review highlighted the importance of targeting non-adherent patients, understanding their reasons for non-adherence, providing reminders and feedback to patients and physicians, and measuring clinical outcomes in addition to medication adherence. Further research in settings that differ from the US health system is needed.
Publisher: Wiley
Date: 04-2020
DOI: 10.1111/AJR.12621
Publisher: Wiley
Date: 25-08-2023
DOI: 10.1111/AJR.13032
Abstract: Type 2 diabetes is more prevalent among Aboriginal and Torres Strait Islander Peoples, especially those living in rural than urban areas. However, little is known about how diabetes is managed in different settings. To investigate differences in the prevalence of diabetes and the prescription of antidiabetic medications for Aboriginal and/or Torres Strait Islander Peoples living in urban or rural Australia. Cross‐sectional study using de‐identified electronic medical records of 29,429 Aboriginal and/or Torres Strait Islander adults (60.4% females mean age 45.2 ± 17.3 years) regularly attending 528 ‘mainstream’ Australian general practices (MedicineInsight) in 2018. The prevalence of diabetes was 16.0%, and it was more frequent among those living in rural areas (22.0 95% CI 19.3–24.4) than inner regional (17.6% 95% CI 16.0–19.2) or major cities (15.8% 95% CI 14.7–17.0 p 0.001). The highest prevalence of diabetes was for males living in rural settings (25.0%). Of those with diabetes, 71.6% (95% CI 69.0–74.0) were prescribed antidiabetics, with a similar frequency in urban and rural areas ( p = 0.291). After adjustment for sociodemographics, the only difference in diabetes management was a higher prescription of sulfonylureas in rural areas than in major cities (OR 1.39 1.07–1.80). The prevalence of diabetes was similar to other national data, although we found it was more frequent amongst Aboriginal and/or Torres Strait Islander males, especially those from rural areas. Despite current recommendations, one‐in‐four Indigenous Australians with diabetes were not prescribed antidiabetics. The clinical significance of more frequent prescriptions of sulfonylureas in rural locations remains unclear.
Publisher: Wiley
Date: 08-10-2020
DOI: 10.1002/EAT.23174
Abstract: Lengthy delays in receiving treatment have been reported for people with bulimia nervosa (BN) and binge-eating disorder (BED). This study aimed to investigate healthcare use and predictors of mental health specialist healthcare use in a community s le of in iduals with diagnostic threshold symptoms of BN, BED-Broad, or another eating disorder (Other ED). In 2017, 2,977 in iduals aged ≥15 years were interviewed in a general population survey. Participants were asked questions relating to sociodemographic, ED symptoms, other clinical features, and healthcare use data. Assessment of ED symptoms was based on diagnostic questions derived from the eating disorder examination. Thirty-six participants with symptoms of BN, 33 participants with BED-Broad, and 369 with an Other ED were identified. Fewer people with symptoms of BN/BED-Broad (23%) or an Other ED (6%) had treatment from a mental health specialist than from a general practitioner (GP 80%, 71.6%). Healthcare use differed significantly across type of ED only for treatment from a mental health specialist. In multivariate analyses, being asked about a person's mental health by a GP was the best explanatory variable for receiving treatment from a mental health specialist. A large treatment gap exists in healthcare for people with EDs. Inquiry about an in idual's mental health by a GP was associated with higher rates of treatment from mental health specialists. However, a similar diet/eating inquiry did not have this association. Future research should consider the use of this patient and practitioner consultation in targeting improved detection of EDs.
Publisher: AMPCo
Date: 03-2015
DOI: 10.5694/MJA14.01547
Publisher: AMPCo
Date: 03-2004
Publisher: Oxford University Press (OUP)
Date: 20-01-2017
Publisher: Informa UK Limited
Date: 12-2016
DOI: 10.2147/JPR.S124710
Publisher: Springer Science and Business Media LLC
Date: 29-01-2008
Publisher: Springer Science and Business Media LLC
Date: 07-01-2019
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2022-062823
Abstract: To explore general practitioners’ (GPs) perspectives on the barriers and facilitators to cervical cancer screening (CCS) for women from culturally and linguistically erse (CALD) backgrounds. Qualitative descriptive study involving semi-structured interviews, with interview guide informed by the Theoretical Domains Framework. Adelaide, South Australia. Twelve GPs with experience in providing CCS to women from CALD backgrounds participated. Four main themes emerged: ‘importance of clinician–patient relationship’, ‘patients’ cultural understanding regarding health care and CCS’, ‘communication and language’ and ‘health system related’. Each theme had several subthemes. GPs’ professional relationship with their patients and repeated advice from other clinicians, together with the provision of opportunistic CCS, were described as facilitators, and encompassed the theme of ‘importance of clinician–patient relationship’. This theme also raised the possibility of self-collection human papilloma virus tests. Lack of awareness and knowledge, lower priority for cancer screening and patients’ in idual circumstances contributed to the theme of ‘patients’ cultural understanding regarding health care and CCS’, and often acted as barriers to CCS. ‘Communication and language’ consisted of language difficulties, interpreter use and use of appropriate resources. Language difficulties were a barrier to the provision of CCS, and GPs used interpreters and written handouts to help overcome this. The theme of ‘health system related’ involved the increased time needed for CCS consults for CALD women, access to appointments, funding, health promotion and effective use of practice management software. This study highlights that multiple, inter-related barriers and facilitators influence CALD women’s engagement with CCS, and that GPs needed to manage all of these factors in order to encourage CCS participation. More efforts are needed to address the barriers to ensure that GPs have access to appropriate resources, and CALD patients have access to GPs they trust.
Publisher: Springer Science and Business Media LLC
Date: 16-06-2008
Publisher: Informa UK Limited
Date: 05-07-2021
Publisher: BMJ
Date: 04-2019
DOI: 10.1136/BMJOPEN-2018-026396
Abstract: To investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing. Open cohort study. A representative s le of 550 Australian general practices contributing data to the MedicineInsight programme. 4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition. ILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations. ILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p .05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p .05), antibiotic (30.7% vs 23.4%, p .05) and antiviral (34.2% vs 13.5%, p .05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation rates, higher antibiotic use, but not with antiviral prescribing. However, those with chronic respiratory conditions had a higher frequency of antibiotic and antiviral prescribing in 2017 than in iduals with other comorbidities. Although the apparent decline in antibiotic prescribing for ILI is welcome, the increase in antiviral use may not be targeting those at high risk of complications from infection.
Publisher: Hindawi Limited
Date: 23-03-2022
DOI: 10.1155/2022/1566408
Abstract: Aims. To investigate the epidemiology of diabetes diagnosis and screening in Australian general practice. Methods. Cross-sectional study using electronic health records of 1,522,622 patients aged 18+ years attending 544 Australian general practices (MedicineInsight database). The prevalence of diagnosed diabetes and diabetes screening was explored using all recorded diagnoses, laboratory results, and prescriptions between 2016 and 2018. Their relationship with patient sociodemographic and clinical characteristics was also investigated. Results. Overall, 7.5% (95% CI 7.3, 7.8) of adults had diabetes diagnosis, 0.7% (95% CI 0.6, 0.7) prediabetes, and 0.3% (95% CI 0.3, 0.3) unrecorded diabetes rediabetes (elevated glucose levels without a recorded diagnosis). Patients with unrecorded diabetes rediabetes had clinical characteristics similar to those with recorded diabetes, except for a lower prevalence of overweight/obesity (55.5% and 69.9%, respectively). Dyslipidaemia was 1.8 times higher (36.2% vs. 19.7%), and hypertension was 15% more likely (38.6% vs. 33.8%) among patients with prediabetes than with diabetes. Diabetes screening (last three years) among people at high risk of diabetes was 55.2% (95% CI 52.7, 57.7), with lower rates among young or elderly males. Conclusions. Unrecorded diabetes rediabetes is infrequent in Australian general practice, but prediabetes diagnosis was also lower than expected. Diabetes screening among high-risk in iduals can be improved, especially in men, to enhance earlier diabetes diagnosis and management.
Publisher: Public Library of Science (PLoS)
Date: 09-11-2018
Publisher: AMPCo
Date: 11-2011
DOI: 10.5694/MJA10.10867
Abstract: To describe why, when and to whom general practitioners refer women with symptoms possibly attributable to cervical, endometrial or ovarian cancers, and to identify patient and GP factors that predict referral to either a gynaecologist or a gynaecological oncologist. A national survey of GPs between 1 April and 31 August 2009 using a randomised incomplete block design based on case vignettes, and using a self-completed postal or online questionnaire. A s le of GPs, stratified by location and randomly selected from a database of GPs maintained by the Australasian Medical Publishing Company. Proportion of vignettes that were deemed to reflect a high probability of cancer being referred and the patient and clinician factors that were the strongest predictors of referral. Of the 3082 GPs who were selected for participation, 1402 responded, giving a response rate of 45.5%. Overall, for vignettes identified as describing women with a high probability of cancer, 75% were referred by metropolitan GPs and 73% by rural practitioners. Metropolitan GPs were significantly more likely to refer women in scenarios indicative of endometrial cancer than rural GPs. For all three cancers, GPs were significantly more likely to refer a patient to a gynaecologist (between 70.8% and 95.4%) than a gynaecological oncologist. Metropolitan GPs had significantly greater access to both private and public gynaecological oncologists than their rural counterparts. Referral rates were higher for ovarian and cervical cancer (83% and 80%, respectively) and lower for endometrial cancer (68%). For all three cancers, patient factors were stronger predictors of referral than the demographic factors of participating GPs. There appears to be significant variation in referral practices among GPs and this variation is greater for endometrial cancer, for which there are currently no evidence-based clinical practice guidelines in Australia. There is a need for further research into understanding the basis of these differences, including a review of the existing guidelines for ovarian and cervical cancer and the development of guidelines for endometrial cancer.
Publisher: BMJ
Date: 06-2019
DOI: 10.1136/BMJOPEN-2018-026035
Abstract: To assess the relationship between gastrointestinal conditions, restrictive diets, mental health and health-related quality of life (HRQoL). Cross-sectional population-based face-to-face survey. South Australia. A representative s le of 2912 consenting adults (48.9±18.1 years 50.9% females) investigated in 2015. Participants self-reported diagnosis of gastrointestinal conditions, mental health and current use of restrictive diets. The physical component score (PCS) and mental component score (MCS) of HRQoL were investigated (Study Short Form 12 V.1 questionnaire). Linear regression models were used to test the associations, adjusting for (1) sociodemographic variables, (2) mental health status and (3) lifestyle and body mass index. The prevalence of restrictive diets (36.1% 95% CI 33.9 to 38.3) was higher among those with any self-reported gastrointestinal condition (60.7% vs 31.3% for those without these conditions p .001). PCS was lower among those with a gastrointestinal condition (mean difference=−3.4 95% CI −4.5 to −2.4) or on a restrictive diet (mean difference=−1.9 95% CI −2.7 to −1.1), with a similar pattern, but with a smaller effect, observed for MCS. Being on a restrictive diet did not modify the relationship between having a gastrointestinal condition and reduced HRQoL. However, having a gastrointestinal condition was associated with a 2.4 points lower PCS (95% CI −3.5 to −1.3) among those without a mental health problem, while for those affected by a mental health condition this reduction was greater (mean difference=−5.9 95% CI −8.7 to −3.1). For MCS, there was no evidence of interaction between mental health and gastrointestinal conditions. One-third of Australian adults are restricting their diet, and this is associated with lower HRQoL. Being on a restrictive diet was not associated with a better HRQoL among in iduals with a gastrointestinal condition. Mental health problems were associated with a stronger adverse relationship between gastrointestinal diseases and physical HRQoL. Health professionals should be alert to these associations when trying to improve health outcomes for patients.
Publisher: Public Library of Science (PLoS)
Date: 16-08-2018
Publisher: Annals of Family Medicine
Date: 05-2017
DOI: 10.1370/AFM.2066
Publisher: Massachusetts Medical Society
Date: 18-10-2018
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJOPEN-2020-045418
Abstract: Describe trends and patterns in long-term opioid prescriptions among adults with musculoskeletal conditions (MSK). Interrupted time-series analysis based on an open cohort study. A representative s le of 402 Australian general practices contributing data to the MedicineInsight database. 811 174 patients aged 18+ years with an MSK diagnosis and three or more consultations in any two consecutive years between 2012 and 2018. Males represented 44.5% of the s le, 28.4% were 65+ years and 1.9% were Aboriginal or Torres Strait Islanders. Annual prevalence and cumulative incidence (%) of long-term opioid prescribing (3+ prescriptions in 90 days) among patients with an MSK. Average duration of these episodes in each year between 2012 and 2018. The prevalence of long-term opioid prescribing increased from 5.5% (95% CI 5.2 to 5.8) in 2012 to 9.1% (95% CI 8.8 to 9.7) in 2018 (annual change OR 1.09, 95% CI 1.08 to 1.09), but a slightly lower incidence was observed in 2018 (3.0% vs 3.6%–3.8% in other years annual change OR 0.99, 95% CI 0.98 to 0.99). The incidence was between 37% and 52% higher among practices located in rural Australia or lower socioeconomic areas. In idual risk factors included increasing age (3.4 times higher among those aged 80+ years than the 18–34 years group in 2012, increasing to 4.8 times higher in 2018), identifying as Aboriginal or Torres Strait Islander (1.7–1.9 higher incidence than their peers), or living in disadvantaged areas (36%–57% more likely than among those living in wealthiest areas). Long-term opioid prescriptions lasted in average 287–301 days between 2012 and 2016, reducing to 229 days in 2017 and 140 days in 2018. A longer duration was observed in practices from more disadvantaged areas and females in all years, except in 2018. The continued rise in the prevalence of long-term opioid prescribing is of concern, despite a recent reduction in the incidence and duration of opioid management.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.VACCINE.2019.02.027
Abstract: We estimated the effectiveness of seasonal inactivated influenza vaccine and the potential influence of timing of immunization on vaccine effectiveness (VE) using data from the 2016 southern hemisphere influenza season. Data were pooled from three routine syndromic sentinel surveillance systems in general practices in Australia. Each system routinely collected specimens for influenza testing from patients presenting with influenza-like illness. Next generation sequencing was used to characterize viruses. Using a test-negative design, VE was estimated based on the odds of vaccination among influenza-positive cases as compared to influenza-negative controls. Subgroup analyses were used to estimate VE by type, subtype and lineage, as well as age group and time between vaccination and symptom onset. A total of 1085 patients tested for influenza in 2016 were included in the analysis, of whom 447 (41%) tested positive for influenza. The majority of detections were influenza A/H3N2 (74%). One-third (31%) of patients received the 2016 southern hemisphere formulation influenza vaccine. Overall, VE was estimated at 40% (95% CI: 18-56%). VE estimates were highest for patients immunized within two months prior to symptom onset (VE: 60% 95% CI: 26-78%) and lowest for patients immunized >4 months prior to symptom onset (VE: 19% 95% CI: -73-62%). Overall, the 2016 influenza vaccine showed good protection against laboratory-confirmed infection among general practice patients. Results by duration of vaccination suggest a significant decline in effectiveness during the 2016 influenza season, indicating immunization close to influenza season offered optimal protection.
Publisher: Wiley
Date: 07-2014
DOI: 10.5694/MJA14.00106
Abstract: To estimate influenza vaccine coverage and effectiveness against medically attended laboratory-confirmed influenza for the 2012 season. Test-negative design involving patients recruited as part of the Australian Sentinel Practices Research Network, a network of sentinel general practitioners throughout Australia. Throughout 2012, at the discretion of the GP at one of 102 participating practices, patients presenting with influenza-like illness were swabbed and included in the study. Influenza vaccine effectiveness (VE) estimated as (1-OR)*100% by logistic regression. 1775 patients were swabbed. The epidemic period was identified as Weeks 10 to 43 of 2012. After exclusions, there were 1414 patients for the VE analysis, including 593 (42%) who tested influenza-positive and 821 who tested negative. 27% of test-negative patients were vaccinated, of whom most were aged 50 years and over. The overall VE, adjusted for age group, month of presentation and state or territory, was 23% (95% CI, -4% to 43%) against all influenza types, 15% (95% CI, -17% to 38%) against influenza A, 13% (95% CI, -20% to 36%) against influenza A(not H1) and 53% (95% CI, 5% to 77%) against influenza B. Vaccination against influenza was modestly protective, reducing the risk of medical presentation with influenza by around 23%.
Publisher: Massachusetts Medical Society
Date: 18-10-2018
Publisher: Springer Science and Business Media LLC
Date: 08-02-2009
Publisher: Public Library of Science (PLoS)
Date: 04-03-2016
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/PY15189
Abstract: The AgED Study aimed to evaluate the detection, awareness and management of age-related eye disease (AgED) in South Australian general practice. Three South Australian metropolitan general practices were recruited and all patients aged 75 years and older were invited to participate. A cross-sectional postal questionnaire and retrospective audit of consenting patients’ medical records was performed. On average, patients had their last eye check 9 months ago the majority (64.9%) performed by an optometrist. Only 7.6% had visited their GP for their last eye check, mostly (90.5%) for a mandatory ‘Fitness to Drive’ medical assessment. There were marked differences in GP recording v. self-reported AgED and a marked discrepancy in the prevalence rates of AgED, visual impairment and blindness in this study compared with Australian population-based prevalence surveys. Despite the lack of GP documentation of eye disease, the majority of patients engaged in timely eye checks with either an optometrist or ophthalmologist, and their overall visual function and vision-related quality of life (QoL) were satisfactory.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH14241
Abstract: Learning about interdisciplinary health approaches is important for students of health professions. Yet, interdisciplinary learning programs are sparse within primary health clinics. Larger health care complexes, such as superclinics in Australia, offer interdisciplinary learning opportunities for health, but also pose difficulties. This case study describes the introduction of an interdisciplinary student learning program in Adelaide, South Australia, over a 1-year period. The objectives of the program were for students to: (1) understand the range of patient needs in primary healthcare (PHC) (2) identify circumstances in which the involvement of another professional may benefit patients and (3) learn more about team work. Despite barriers, the practice environment was found to be suitable for student learning. Program modifications were made in response to the need for scheduled time for clinic staff to work with students, non-simultaneous student placements, a need for a coordinator, the availability of discipline-specific supervision and the need to provide incentives for students to participate, particularly giving course credits or recognition. Embedding interdisciplinary programs in a clinic setting requires time and resources. The present case study demonstrates that larger PHC clinics have the potential to implement interdisciplinary learning programs based on an authentic learning approach.
Publisher: Springer Science and Business Media LLC
Date: 18-09-2007
Publisher: Annals of Family Medicine
Date: 07-2012
DOI: 10.1370/AFM.1368
Publisher: BMJ
Date: 04-2023
DOI: 10.1136/BMJOPEN-2022-069875
Abstract: This study investigated whether the monitoring and control of clinical parameters are better among patients with newly compared with past recorded diabetes diagnosis. Retrospective cohort study. MedicineInsight, a national general practice database in Australia. 101 875 ‘regular’ adults aged 18+ years with past recorded (2015–2016) and 9236 with newly recorded (2017) diabetes diagnosis. Two different groups of outcomes were assessed in 2018. The first group of outcomes was the proportion of patients with clinical parameters (ie, glycated haemoglobin A1c (HbA1c), blood pressure (BP), total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, estimated glomerular filtration rate and albumin-to-creatinine ratio) monitored at least once in 2018. The second group of outcomes were those related to diabetes control in 2018 (HbA1c ≤7.0%, (BP) ≤140/90 mm Hg, total cholesterol .0 mmol/L and LDL-C .0 mmol/L). Adjusted ORs (OR adj ) and adjusted probabilities (%) were obtained based on logistic regression models adjusted for practice variables and patients’ socio-demographic and clinical characteristics. The study included 111 111 patients (51.7% men mean age 65.3±15.0 years) with recorded diabetes diagnosis (11.0% of all 1 007 714 adults in the database). HbA1c was monitored in 39.2% (95% CI 36.9% to 41.6%) of patients with newly recorded and 45.2% (95% CI 42.6% to 47.8%) with past recorded diabetes (OR adj 0.78, 95% CI 0.73 to 0.82). HbA1c control was achieved by 78.4% (95% CI 76.7% to 80.0%) and 54.4% (95% CI 53.4% to 55.4%) of monitored patients with newly or past recorded diabetes, respectively (OR adj 3.11, 95% CI 2.82 to 3.39). Less than 20% of patients with newly or past recorded diabetes had their HbA1c, BP and total cholesterol levels controlled (OR adj 1.08, 95% CI 0.97 to 1.21). The monitoring of clinical parameters was lower among patients with newly than past recorded diabetes. However, diabetes control was similarly low in both groups, with only one in five monitored patients achieving control of all clinical parameters.
Publisher: Informa UK Limited
Date: 06-2004
DOI: 10.1080/13697130410001713742
Abstract: To investigate the impact of the Women's Health Initiative (WHI) on the use and perception of hormone therapy (HT) in well-informed and altruistic women who had volunteered for a similar long-term study of HT (Women's International Study of long Duration Oestrogen after Menopause, WISDOM). A total of 840 South Australian WISDOM participants were sent questionnaires asking about their source of information about the WHI, interpretation of the 2002 WHI findings, perception of HT as a risk factor for breast cancer, attitudes towards doctors and the media and intent to use HT in the future. Altogether, 618 participants (74%) responded. Written and verbal information provided by WISDOM were rated as the most helpful sources of information about the WHI. Participants were aware of the increase in breast cancer and decrease in fractures seen with combined estrogen rogestogen hormone therapy (EPT) but were less convinced about the other major findings, including cardiovascular disease and dementia. HT was rated as an important risk factor for breast cancer. Participants valued medical research and were more likely to question therapies without evidence. After WHI and WISDOM, most were willing to participate in a subsequent trial and most past HT users resumed therapy. There are sufficient recruits for future long-term HT studies if they are given sufficient quality information and in idual counselling. Our study also suggests that women who are appropriately informed may choose to take long-term HT despite a more conservative approach advised by some agencies.
Publisher: Wiley
Date: 16-04-2017
DOI: 10.1111/ACPS.12735
Abstract: Although findings suggest that binge eating is becoming increasingly normative, the 'clinical significance' of this behaviour at a population level remains uncertain. We aimed to assess the time trends in binge-eating prevalence and burden over 18 years. Six cross-sectional face-to-face surveys of the Australian adult population were conducted in 1998, 2005, 2008, 2009, 2014, and 2015 (N The prevalence of OBE increased six-fold from 1998 (2.7%) to 2015 (13.0%). Health-related quality of life associated with OBE improved from 1998 to 2015, where it more closely approximated population norms. Days out of role remained higher among participants who reported OBE, although decreased over time. Half of participants who reported weekly (56.6%) and twice-weekly (47.1%) OBE reported that they were not distressed by this behaviour. However, the presence of distress related to OBE in 2015 was associated with greater health-related quality-of-life impairment. As the prevalence of binge eating increases over time, associated disability has been decreasing. Implications for the diagnosis of disorders associated with binge eating are discussed.
Publisher: Springer Science and Business Media LLC
Date: 28-06-2010
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.HLC.2016.10.013
Abstract: Telehealth, the delivery of health care services at a distance using information and communications technology, is one means of redressing inequalities in cardiovascular outcomes for disadvantaged groups in Australia. This critical review argues that there is sufficient evidence to move to larger-scale implementation of telehealth for acute cardiac, acute stroke, and cardiac rehabilitation services. For cardiovascular chronic disease and risk factor management, telehealth-based services can deliver value but the evidence is less compelling, as the outcomes of these programs are variable and depend upon the context of their implementation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2019
DOI: 10.11124/JBISRIR-2017-003971
Abstract: The objective of this review is to map the evidence on the use of behavioral economic insights to improve medication adherence in adults with chronic conditions. Medication non-adherence is a barrier to effectively managing chronic conditions, leading to poorer patient outcomes and placing an additional financial burden on healthcare systems. As the population ages and the prevalence of chronic disease increases, new ways to influence patient behavior are needed. Approaches that use insights from behavioral economics may help improve medication adherence, thus reducing morbidity, mortality and financial costs of unmanaged chronic diseases. Eligible studies will include adults taking medication for a chronic condition. All interventions relevant to high-income settings using insights from behavioral economics to improve medication adherence in adults will be considered. Contexts may include, but are not limited to, primary health care, corporate wellness programs and health insurance schemes. Any study design published in English will be considered. Studies in facilities where medication is administered to patients will be excluded. PubMed, Embase, Scopus, PsycINFO, EconLit and CINAHL will be searched from database inception to present. Gray literature will be searched using Google Scholar, OpenGrey and the Grey Literature Report. One reviewer will review titles, and then two reviewers will independently review abstracts to identify eligible studies. One reviewer will extract data on study characteristics, study design and study outcomes. A second reviewer will validate 25% of the extracted information. The results of the data extraction will be presented in a table, and a narrative summary will be presented.
Publisher: The Royal Australian College of General Practitioners
Date: 08-2019
Publisher: S. Karger AG
Date: 2016
DOI: 10.1159/000450992
Abstract: b i Background/Aims: /i /b The General Practitioner Assessment of Cognition (GPCOG) is a brief cognitive test. This study compared the GPCOG to the Mini-Mental State Examination (MMSE), the most widely used test, in terms of their ability to detect likely dementia in primary care. b i Methods: /i /b General practitioners across three states in Australia recruited 2,028 elderly patients from the community. A research nurse administered the GPCOG and the MMSE, as well as the Cambridge Examination for Mental Disorders of the Elderly Cognitive Scale-Revised that we used to define likely dementia. b i Results: /i /b Overall, the GPCOG and the MMSE were similarly effective at detecting likely dementia. The GPCOG, however, had a higher sensitivity than the MMSE when using published cutpoints. b i Conclusion: /i /b The GPCOG is an effective screening tool for dementia in primary care. It appears to be a viable alternative to the MMSE, whilst also requiring less time to administer.
Publisher: Springer Science and Business Media LLC
Date: 07-03-2012
Abstract: Dementia is increasing in prevalence as the population ages. An earlier rather than later diagnosis allows persons with dementia and their families to plan ahead and access appropriate management. However, most diagnoses are made by general practitioners (GPs) later in the course of the disease and are associated with management that is poorly adherent to recommended guidelines. This trial examines the effectiveness of a peer led dementia educational intervention for GPs. The study is a cluster randomised trial, conducted across three states and five sites. All GPs will complete an audit of their consenting patients aged 75 years or more at three time points - baseline, 12 and 24 months. GPs allocated to the intervention group will receive two educational sessions from a peer GP or nurse, and will administer the GPCOG to consenting patients at baseline and 12 months. The first education session will provide information about dementia and the second will provide in idualised feedback on audit results. GPs in the waitlist group will receive the RACGP Guidelines by post following the 12 month audit Outcomes: Primary outcomes are carer and consumer quality of life and depression. Secondary outcomes include: rates of GP identification of dementia compared to a more detailed gold standard assessment conducted in the patient's home GP identification of differential diagnoses including reversible causes of cognitive impairment and GP referral to specialists, Alzheimers' Australia and support services. A "case finding" and a "screening" group will be compared and the psychometrics of the GPCOG will be examined. S le size: Approximately 2,000 subjects aged 75 years and over will be recruited through approximately 160 GPs, to yield approximately 200 subjects with dementia (reducing to 168 by 24 months). The trial outlined in this paper has been peer reviewed and supported by the Australian National Health and Medical Research Council. At the time of submission of this paper 2,034 subjects have been recruited and the intervention delivered to 114 GPs. Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12607000117415 .
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.VACCINE.2019.06.057
Abstract: To assess influenza immunisation rates and coverage in adult patients from Australian general practice and identify whether practice or patients' characteristics are associated with vaccination uptake. Open cohort study. 550 Australian general practices included in the MedicineInsight database. Patients aged 18+ years who had at least one consultation during influenza season between 2015 and 2017. Two s les were considered: (1) 'active' patients (at least three consultations in any two consecutive years) and (2) 'every year' patients (at least one consultation per year). Influenza vaccination rates per 1,000 consultations and coverage (% vaccinated among those who consulted) from 2015 to 2017. Between 2015 and 2017 the influenza vaccine rate changed from 57.4 to 51.7 and 67.0 per 1,000 consultations, while correspondent values for coverage were 29.3%, 25.2% and 27.6% (in 'active' patients). Vaccine coverage was at least 30% higher in inner regional areas, among patients aged 65+ years or those with comorbidities. Similar associations were found among 'every year' patients, but average coverage across the three years was higher (41% vs 27%). Aboriginal and Torres Strait Islander people, either with or without comorbidity, showed a vaccine coverage 10-30% higher than non-Indigenous people for those aged less than 65 years (p-value for interaction < 0.001). MedicineInsight data is a useful and low-cost method to monitor influenza immunisation coverage. Independent of the s le used, vaccination coverage among Indigenous people or patients with comorbidities could be improved. Targeted strategies for high-risk groups need to be developed.
Publisher: AMPCo
Date: 07-2007
DOI: 10.5694/J.1326-5377.2007.TB01161.X
Abstract: An attractive strategy to meet the increasing need for medical education is teaching in community general practice. General practice will be in a position to meet and sustain this need only if various conditions are met, including: Teaching is undertaken in general practice at all levels of medical education (medical student, postgraduate years 1-3 and GP vocational training) Standards and quality of teaching are maintained while the number of sites involved increases Further Australian research is conducted into innovative models of general practice teaching and their cost-effectiveness and Appropriate remuneration and infrastructure is available to support practices and general practitioners involved in teaching.
Publisher: Elsevier BV
Date: 07-2014
Publisher: BMJ
Date: 07-2019
DOI: 10.1136/BMJOPEN-2018-027869
Abstract: Access to primary healthcare (PHC) has a fundamental influence on health outcomes, particularly for members of vulnerable populations. Innovative Models Promoting Access-to-Care Transformation (IMPACT) is a 5-year research programme built on community-academic partnerships. IMPACT aims to design, implement and evaluate organisational innovations to improve access to appropriate PHC for vulnerable populations. Six Local Innovation Partnerships (LIPs) in three Australian states (New South Wales, Victoria and South Australia) and three Canadian provinces (Ontario, Quebec and Alberta) used a common approach to implement six different interventions. This paper describes the protocol to evaluate the processes, outcomes and scalability of these organisational innovations. The evaluation will use a convergent mixed-methods design involving longitudinal (pre and post) analysis of the six interventions. Study participants include vulnerable populations, PHC practices, their clinicians and administrative staff, service providers in other health or social service organisations, intervention staff and members of the LIP teams. Data were collected prior to and 3–6 months after the interventions and included interviews with members of the LIPs, organisational process data, document analysis and tools collecting the cost of components of the intervention. Assessment of impacts on in iduals and organisations will rely on surveys and semistructured interviews (and, in some settings, direct observation) of participating patients, providers and PHC practices. The IMPACT research programme received initial ethics approval from St Mary’s Hospital (Montreal) SMHC #13–30. The interventions received a range of other ethics approvals across the six jurisdictions. Dissemination of the findings should generate a deeper understanding of the ways in which system-level organisational innovations can improve access to PHC for vulnerable populations and new knowledge concerning improvements in PHC delivery in health service utilisation.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.VACCINE.2016.08.067
Abstract: A record number of laboratory-confirmed influenza cases were notified in Australia in 2015, during which type A(H3) and type B Victoria and Yamagata lineages co-circulated. We estimated effectiveness of the 2015 inactivated seasonal influenza vaccine against specific virus lineages and clades. Three sentinel general practitioner networks conduct surveillance for laboratory-confirmed influenza amongst patients presenting with influenza-like illness in Australia. Data from the networks were pooled to estimate vaccine effectiveness (VE) for seasonal trivalent influenza vaccine in Australia in 2015 using the case test-negative study design. There were 2443 eligible patients included in the study, of which 857 (35%) were influenza-positive. Thirty-three and 19% of controls and cases respectively were reported as vaccinated. Adjusted VE against all influenza was 54% (95% CI: 42, 63). Antigenic characterisation data suggested good match between vaccine and circulating strains of A(H3) however VE for A(H3) was low at 44% (95% CI: 21, 60). Phylogenetic analysis indicated most circulating viruses were from clade 3C.2a, rather than the clade included in the vaccine (3C.3a). VE point estimates were higher against B/Yamagata lineage influenza (71% 95% CI: 57, 80) than B/Victoria (42%, 95% CI: 13, 61), and in younger people. Overall seasonal vaccine was protective against influenza infection in Australia in 2015. Higher VE against the B/Yamagata lineage included in the trivalent vaccine suggests that more widespread use of quadrivalent vaccine could have improved overall effectiveness of influenza vaccine. Genetic characterisation suggested lower VE against A(H3) influenza was due to clade mismatch of vaccine and circulating viruses.
Publisher: Springer Science and Business Media LLC
Date: 26-05-2011
Publisher: BMJ
Date: 21-08-2008
DOI: 10.1136/BMJ.A1190
Publisher: American College of Physicians
Date: 05-0060
DOI: 10.7326/M21-3823
Publisher: Hindawi Limited
Date: 07-04-2014
DOI: 10.1111/JCPT.12163
Abstract: The elderly are at increased risk of adverse effects resulting from drug interactions due to decreased drug clearance and polypharmacy. This study examines the prevalence of the co-administration of clinically relevant cytochrome P450 (CYP) enzyme inhibitors with drugs that are substrates for these enzymes, in the community-dwelling elderly in Australia. Participants aged 75 years or older (n = 1045) were recruited via their general practitioners at four Australian sites (Newcastle, Sydney, Melbourne and Adelaide). A research nurse visited the home of each patient to compile a list of all prescription medications (including doses) currently used by the patient, and to complete assessments for depression, quality of life and cognitive status. The medication data were searched for the co-prescription of clinically relevant CYP inhibitor and corresponding substrate drugs. Potentially inappropriate CYP inhibitor-substrate combinations were found in 6·2% (65/1045) of patients. These patients were on significantly more medications (6·1 ± 3·0 vs. 3·9 ± 2·5 P = 0·001) and had a significantly lower physical quality of life (P = 0·047) than those who were not on any CYP inhibitor-substrate combinations. The most commonly prescribed inhibitor-substrate combinations involved the CYP 3A4 inhibitors, diltiazem and verapamil, with the substrates simvastatin or atorvastatin. Only 1 of 41 patients on a CYP3A4 inhibitor and a statin was prescribed a non-CYP 3A4 metabolized statin. Metoprolol was another substrate commonly co-prescribed with a CYP2D6 inhibitor. In many cases, the risks and benefits of potential interactions may have been considered by the GP as the prescribed doses of both the inhibitor and substrate were relatively low. There were, however, some notable exceptions, also involving the substrates simvastatin, atorvastatin and metoprolol. There were no GP factors that were associated with co-prescription of CYP inhibitors and substrates. There is not a particular GP demographic that should be targeted for education regarding CYP interactions, but a focus on particular medications such as the statins may reduce the potential for clinically significant drug-drug interactions. As CYP drug-drug interactions are more common in patients on higher number of medications, particular vigilance is required at the time of prescribing and dispensing medications for elderly patients with multiple conditions.
Publisher: Informa UK Limited
Date: 21-11-2018
DOI: 10.1080/10640266.2017.1383788
Abstract: Mental health treatment status and antidepressant use were investigated among men and women with an eating disorder (ED) who were interviewed in a general population survey of 3005 adults (aged ≥15 years). Compared to women, men with an ED were significantly less likely to receive treatment for a mental health problem or to be currently using an antidepressant. On multivariate analyses, female gender, lower mental health-related quality of life, and lower weight/shape overvaluation were significant predictors of receiving treatment and antidepressant use. Treatment was less likely in men and in people with higher ED cognitions.
Publisher: BMJ
Date: 08-2018
DOI: 10.1136/BMJOPEN-2017-021125
Abstract: Test effectiveness of an educational intervention for general practitioners (GPs) on quality of life and depression outcomes for patients. Double-blind, cluster randomised controlled trial. General practices in Australia between 2007 and 2010. General practices were randomly allocated to the waitlist (n=37) or intervention (n=66) group, in a ratio of 1:2. A total of 2030 (1478 intervention 552 waitlist) community-dwelling participants aged 75 years or older were recruited via 168 GPs (113 intervention 55 waitlist). A practice-based academic detailing intervention led by a peer educator that included: (1) training in use of the GP assessment of cognition dementia screening instrument (2) training in diagnosis and management based on Royal Australian College of General Practitioners Dementia Guidelines (3) addressing GPs’ barriers to dementia diagnosis and (4) a business case outlining a cost-effective dementia assessment approach. Primary outcome measures were patient quality of life and depression secondary outcome measures were: (1) sensitivity and specificity of GP identification of dementia (2) referral to medical specialists and/or support services (3) patient satisfaction with care and (4) carer quality of life, depression and satisfaction with care. The educational intervention had no significant effect on patient quality of life or depression scores after 12 months. There were however improvements in secondary outcome measures including sensitivity of GP judgement of dementia (p=0.002 OR 6.0, 95% CI 1.92 to 18.73), satisfaction with GP communication for all patients (p=0.024 mean difference 2.1, 95% CI 0.27 to 3.93) and for patients with dementia (p=0.007 mean difference 7.44, 95% CI 2.02 to 12.86) and enablement of carers (p=0.0185 mean difference 24.77, 95% CI 4.15 to 45.40). Practice-based academic detailing did not improve patient quality of life or depression scores but did improve detection of dementia in primary care and patient satisfaction with GP communication. ACTRN12607000117415 Pre-results.
Publisher: Springer Science and Business Media LLC
Date: 04-03-2023
Publisher: AMPCo
Date: 07-2006
Publisher: World Scientific Pub Co Pte Lt
Date: 09-2019
DOI: 10.1142/S2661318219500154
Abstract: Objective: Although polycystic ovary syndrome (PCOS) is considered a lifelong disorder, very little is understood about the diagnosis and impact of this condition in women outside of the peak reproductive years. We examined the frequency of diagnosed PCOS and concurrent health conditions in women across the lifespan. Methods: Data were analysed from 1509 women aged 15–95 years participating in a cross-sectional, face-to-face population survey in South Australia, 2015. We assessed the prevalence of PCOS in 10-year age groups and the frequency of comorbidities in women with and without PCOS subgrouped by age ( 45, [Formula: see text] 45 years). The main outcome measures were Diagnosed PCOS and other chronic conditions lifestyle factors. Logistic regression analyses determined the risk of comorbidities in women with PCOS adjusting for age and BMI. Results: Overall prevalence of PCOS was 5.6% (95% confidence interval (CI) 4.6–6.9%), peaking in the 35–44 year age group (9.1%), and lowest in those aged 15–24 (4.1%) or [Formula: see text] 65 (3.7%) years. Women with PCOS and aged years were more likely to report diabetes (16.7% vs. 3.8%), cardiovascular disease (15.5% vs. 7.2%) and arthritis (15.5% vs. 7.2%) than their peers these differences were diminished in the [Formula: see text] 45 year age group. The odds of diabetes and cardiovascular disease were more than doubled among women with PCOS (adjOR 2.23, 95% CI 1.49–4.31 adjOR 3.18, 95% CI 1.31–7.68). Conclusion: PCOS is underdiagnosed in young and post-menopausal women. Diabetes and cardiovascular disease are key comorbidities requiring greater attention in younger women with PCOS.
Publisher: BMJ
Date: 20-11-2012
DOI: 10.1136/BMJ.E7156
Publisher: Wiley
Date: 16-07-2013
DOI: 10.1111/JCH.12164
Publisher: Walter de Gruyter GmbH
Date: 19-03-2018
Abstract: Chronic pain affects an estimated 1 in 10 adults globally regardless of age, gender, ethnicity, income or geography. Chronic pain, a multifactorial problem requires multiple interventions. One intervention which demonstrates promising results to patient reported outcomes is pain education. However, patient perspective on pain education and its impact remains fairly unknown. A cross-sectional study involving in iduals with chronic pain examined their perspectives on pain education did it change their understanding about their pain and self-management and did it have any impact on their perceived pain intensity and recovery. The study complied with CHERRIES guidelines and the protocol was locked prior to data collection. Primary outcomes were pain intensity and participants’ expectation of recovery. Univariate and multiple logistic regressions were used to analyze the data. Five hundred and seventy three people participated full data sets were available for 465. Participants who observed changes in their pain cognition and self-management following pain education reported lower pain intensity and greater expectation of recovery than participants who did not observe changes to cognition and management. The results suggest that in iduals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. Pain intensity and expectations about recovery are primary considerations for people in pain. What influences these factors is not fully understood, but education about pain is potentially important. The results suggest that in iduals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. The results from this study highlight the importance of effective pain education focused on reconceptualization of pain and its management.
Publisher: Springer Science and Business Media LLC
Date: 08-11-2018
Publisher: Springer Science and Business Media LLC
Date: 11-07-2018
Publisher: BMJ
Date: 09-1998
DOI: 10.1136/ADC.79.3.225
Abstract: To assess the risks and benefits of antibiotic treatment in children with symptoms of upper respiratory tract infection (URTI). Quantitative systematic review of randomised trials that compare antibiotic treatment with placebo. Twelve trials retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists) no restriction on language. The proportion of children in whom the clinical outcome was worse or unchanged the proportion of children who suffered complications or progression of illness the proportion of children who had side effects. 1699 children were randomised in six trials that contributed to the meta-analysis. Six trials were not used in the meta-analysis because of different outcomes or incomplete data. Clinical outcome was not improved by antibiotic treatment (relative risk 1.01, 95% confidence interval (CI) 0.90 to 1.13), neither was the proportion of children suffering from complications or progression of illness (relative risk 0.71, 95% CI 0.45 to 1.12). Complications from URTI in the five trials that reported this outcome was low (range 2-15%). Antibiotic treatment was not associated with an increase in side effects compared with placebo (relative risk 0.8, 95% CI 0.54 to 1.21). In view of the lack of efficacy and low complication rates, antibiotic treatment of children with URTI is not supported by current evidence from randomised trials.
Publisher: Cambridge University Press (CUP)
Date: 12-06-2012
DOI: 10.1017/S104161021200107X
Abstract: Background: This study aimed to determine: (1) the prevalence of depression, anxiety, and depression associated with anxiety (DA) (2) the risk factor profile of depression, anxiety, and DA (3) the course of depression, anxiety, and DA over 24 months. Methods: Two-year longitudinal study of 20,036 adults aged 60+ years. We used the Patient Health Questionnaire and the Hospital Anxiety and Depression Scale anxiety subscale to establish the presence of depression and anxiety, and standard procedures to collect demographic, lifestyle, psychosocial, and clinical data. Results: The prevalence of anxiety, depression, and DA was 4.7%, 1.4%, and 1.8%. About 57% of depression cases showed evidence of comorbid anxiety, while only 28% of those with clinically significant anxiety had concurrent depression. There was not only an overlap in the distribution of risk factors in these diagnostic groups but also differences. We found that 31%, 23%, and 35% of older adults with anxiety, depression, and DA showed persistence of symptoms after two years. Repeated anxiety was more common in women and repeated depression in men. Socioeconomic stressors were common in repeated DA. Conclusions: Clinically significant anxiety and depression are distinct conditions that frequently coexist in later life when they appear together, older adults endure a more chronic course of illness.
Publisher: Springer Science and Business Media LLC
Date: 21-05-2018
Publisher: Springer Science and Business Media LLC
Date: 08-07-2009
Publisher: Springer Science and Business Media LLC
Date: 03-09-2015
Publisher: Springer Science and Business Media LLC
Date: 12-2002
DOI: 10.1007/S00127-002-0592-1
Abstract: Deliberate self-harm (DSH, attempted suicide) is one of the most common reasons for emergency hospital admission in Great Britain. Approximately 20 % of patients repeat self-harm in the 12 months after admission. The GP's role in DSH aftercare and the prevention of repeat episodes is unclear. The data were obtained from a 12-month follow-up of a series of 968 consecutive patients from 49 practices who attended an accident and emergency (A&E) department in Bristol or Bath, UK, following an episode of self-harm between 26(th) May 1997 and 1(st) March 1999. Information on consultation patterns were available for 681 (70 %) of the patients. Two hundred and fourteen (31 %) of these consulted their GP in the week following the episode, 360 (53 %) within 4 weeks. Of the subjects, 44 % were discharged directly from A & E these patients were more likely to consult their GP in the 4 weeks after the episode. Over the 12-month follow-up, 117 (17 %) attended hospital for a repeat episode of DSH 9 % of these repeats occurred within 1 week and 28 % within 4 weeks of the index event. Although few (2 out of 11 patients--18 %) of those repeating in the first week after the index episode consulted their GP prior to repeating, 50 % (11/22) of those who repeated in the 1-4 weeks after an episode did so. Consultation patterns indicate that most people who deliberately self-harm consult their GP soon after the episode. This consultation may provide an opportunity for preventing repeat DSH and suicide.
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.MATURITAS.2010.06.001
Abstract: To assess the effect, tolerability and acceptability of aged garlic extract as an adjunct treatment to existing antihypertensive medication in patients with treated, but uncontrolled, hypertension. A double-blind parallel randomised placebo-controlled trial involving 50 patients whose routine clinical records in general practice documented treated but uncontrolled hypertension. The active treatment group received four capsules of aged garlic extract (960 mg containing 2.4 mg S-allylcysteine) daily for 12 weeks, and the control group received matching placebos. The primary outcome measures were systolic and diastolic blood pressure at baseline, 4, 8 and 12 weeks, and change over time. We also assessed tolerability during the trial and acceptability at 12 weeks. In patients with uncontrolled hypertension (SBP ≥ 140 mmHg at baseline), systolic blood pressure was on average 10.2 ± 4.3 mmHg (p=0.03) lower in the garlic group compared with controls over the 12-week treatment period. Changes in blood pressure between the groups were not significant in patients with SBP<140 mmHg at baseline. Aged garlic extract was generally well tolerated and acceptability of trial treatment was high (92%). Our trial suggests that aged garlic extract is superior to placebo in lowering systolic blood pressure similarly to current first line medications in patients with treated but uncontrolled hypertension.
Publisher: Cambridge University Press (CUP)
Date: 21-02-2018
DOI: 10.1017/S0950268818000286
Abstract: Acute respiratory infections cause significant morbidity and mortality accounting for 5.8 million deaths worldwide. In Australia, influenza-like illness (ILI), defined as cough, fever and fatigue is a common presentation in general practice and results in reduced productivity and lost working days. Little is known about the epidemiology of ILI in working-age adults. Using data from the ASPREN influenza surveillance network in Australia (2010–2013) we found that working-age adults made up 45.2% of all ILI notifications with 55% of s les positive for at least one respiratory virus. Viruses most commonly detected in our study included influenza A (20.6%), rhinovirus (18.6%), influenza B (6.2%), human meta-pneumovirus (3.4%), respiratory syncytial virus (3.1%), para-influenza virus (2.6%) and adenovirus (1.3%). We also demonstrated that influenza A is the predominant virus that increases ILI (by 1.2% per month for every positive influenza A case) in working-age adults during autumn–winter months while other viruses are active throughout the year. Understanding the epidemiology of viral respiratory infections through a year will help clinicians make informed decisions about testing, antibiotic and antiviral prescribing and when the beginning of the ‘flu season’ can be more confidently predicted.
Publisher: Informa UK Limited
Date: 17-01-2020
Publisher: BMJ
Date: 10-10-1998
Publisher: BMJ
Date: 28-04-2001
Publisher: Elsevier BV
Date: 10-2023
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).
Publisher: AMPCo
Date: 21-12-2018
DOI: 10.5694/MJA2.12060
Publisher: Informa UK Limited
Date: 07-10-2020
Publisher: Informa UK Limited
Date: 2004
DOI: 10.3109/13814780409044302
Abstract: Postal questionnaires are a frequently used method of obtaining information from general practitioners. However, getting GPs to return questionnaires or participate in research can be challenging. We wanted to ascertain reasons why GPs identified as 'routine non-responders' to postal questionnaires, do not participate in this type of research. Qualitative study using semi-structured interviews of 14 GPs who had returned only one or none of five questionnaires sent to them during a five-year period between 1994-1999. Participants were classified into one of three groups--binners, filers and fillers--according to their behavior when faced with a questionnaire. Each group had slightly different attitudes toward research in general practice. Although standard strategies such as incentives and good design could influence the decision to complete a questionnaire, poor research experiences or a poor relationship between the participant and researchers were also very important. The decision not to return a postal questionnaire is multifactorial and reflects personal and professional attitudes, experiences and organisation of in idual GPs as well as time pressure and interest. The development of a positive relationship with a researcher or academic department may be influential in encouraging the return of postal questionnaires and when trying to enhance response rates amongst 'routine non-responders' researchers should take into account the broader values ans practices GPs bring to their work.
Publisher: Wiley
Date: 25-03-2009
DOI: 10.1111/J.1440-1584.2009.01043.X
Abstract: To assess differences in statin prescribing across Australia by geographic area. A cross-sectional study using Pharmaceutical Benefits Scheme data on statin prescribing by rurality, gender and patient postcode for the period May to December 2002. Participants were the Australian population, stratified by gender, quintile of index of relative socioeconomic disadvantage and rural, remote and metropolitan areas classification. Statin prescribing (scripts per 1000 population per month) was higher in urban areas (women, 51.915 men, 51.892) than in rural (women, 48.311 men, 48.098) or remote (women, 39.679 men, 34.145) areas. In urban areas, weighted least squares regression analysis showed a significant negative linear association between statin prescribing and socioeconomic status for both women (weighted least squares slope, -3.358 standard error (SE) 0.057 P < 0.0001) and men (slope, -0.507 SE 0.056 P < 0.0001). A similar association occurred in rural areas: women (slope, -4.075 SE 0.122 P < 0.0001) and men (slope, -3.455 SE 0.117 P < 0.0001), but not in remote areas where there was a positive linear association (slope, 3.120 SE 0.451 P < 0.0001) and men (slope, 3.098 SE 0.346 P < 0.0001). Our results suggest differences in statin prescribing in Australia across geographic location, adjusting for age, gender and socioeconomic status. These findings suggest that health inequalities due to geography should be addressed.
Publisher: Wiley
Date: 25-04-2017
Publisher: American Thoracic Society
Date: 04-2022
Publisher: John Wiley & Sons, Ltd
Date: 15-08-2012
Start Date: 2023
End Date: 12-2025
Amount: $461,134.00
Funder: Australian Research Council
View Funded Activity