Narayanan, Ajit; Greco, Michael
The number of data-based research articles focusing on patient sociodemographic profiling and experience with healthcare practices is still relatively small. One of the reasons for this relative lack of research is that categorizing patients into different demographic groups can lead to significant reductions in sample numbers for homogeneous subgroups. The aim of this article is to identify problems and issues when dealing with big data that contains information at two levels: patient experience of their general practice, and scores received by practices. The Practice Accreditation and Improvement Survey (PAIS) consisting of 27 five-point Likert items and 11 sociodemographic questions is a Royal Australian College of General Practitioners (RACGP)-endorsed instrument for seeking patient views as part of the accreditation of Australian general practices. The data were collected during the 3-year period May 2011-July 2014, during which time PAIS was completed for 3734 individual general practices throughout Australia involving 312,334 anonymous patients. This represents over 60% of practices in Australia, and ∼75% of practices that undergo voluntary accreditation. The sampling method for each general practice was convenience sampling. The results of our analysis show how sociodemographic profiles of Australian patients can affect their ratings of practices and also how the location of the practice (State/Territory, remote access area) can affect patient experience. These preliminary findings can act as an initial set of results against which future studies in patient experience trends can be developed and measured in Australia. Also, the methods used in this article provide a methodological framework for future patient experience researchers to use when dealing with data that contain information at two levels, such as the patient and practice. Finally, the outcomes demonstrate that different subgroups can experience healthcare provision differently, especially
Australia has a government-subsidized, private medical system in which general practitioners (GPs) form the core component of primary care. There are approximately 20,000 active GPs and 80% of the population consults a GP each year. A new vocational register of GPs has been set up that requires training in general practice, followed by formal continuing education. I briefly review sources of information about Australian GPs' practices and knowledge of and attitudes toward nutrition. About 15-17% of GPs say they have a special interest in nutrition (20% of female GPs and 13% of male GPs). The main conditions for which advice is given are heart disease, hyperlipidemia, obesity, and diabetes. The extent of nutrition counseling by GPs is considerably less than might be expected from the strength of their statements about the importance of nutrition and long-term health. Obstacles to nutrition counseling are lack of time, lack of confidence, and inadequate nutrition knowledge, the last documented by objective testing. GPs express interest in learning more about nutrition (which may be partly driven by consumer pressure) but there is still little coherent teaching on the subject, specifically tailored for GPs. When asked their preferences for nutrition education, GPs tend to prefer educational material (such as diet charts) to give to patients. PMID:9174498
Caryl A. Nowson
Full Text Available Nutrition knowledge, attitudes, and confidence were assessed in General Practice Registrars (GPRs throughout Australia. Of approximately 6,000 GPRs invited to complete a nutrition survey, 93 respondents (2% completed the online survey, with 89 (20 males, 69 females providing demographic and educational information. Fifty-one percent had graduated from medical school within the last two years. From a list of 11 dietary strategies to reduce cardiovascular risk, respondents selected weight loss (84%, reducing saturated fats (90%, a maximum of two alcoholic drinks/day (82%, and increasing vegetables (83% as “highly appropriate” strategies, with only 51% indicating that salt reduction was “highly appropriate.” Two-thirds of registrars felt “moderately” (51% or “very” confident (16% providing nutrition advice. Most of them (84% recalled receiving information during training, but only 34% recalled having to demonstrate nutritional knowledge. The results indicate that this group of Australian GPRs understood most of the key dietary recommendations for reducing cardiovascular risk but lacked consensus regarding the recommendation to reduce salt intake and expressed mixed levels of confidence in providing nutritional advice. Appropriate nutrition education before and after graduation is recommended for GPRs to ensure the development of skills and confidence to support patients to make healthy dietary choices and help prevent chronic diseases.
Hays, Richard B; Morgan, Simon
General practice training in Australia continues to evolve. It is now the responsibility of an independent organisation, is delivered by regional training providers, and comprises a structured training program. Overseas, general practice varies in its importance to health care systems, and training models differ considerably. In some cases training is mandatory, in others voluntary, but the aim is always similar--to improve the quality of care delivered to the large majority of populations that access health care through primary care. We review the current status of vocational general practice training in Australia, compare it with selected training programs in international contexts, and describe how the local model is well placed to address future challenges. Challenges include changes in population demographics, increasing comorbidity, increasing costs of technology-based health care, increasing globalisation of health, and workforce shortages. Although general practice training in Australia is strong, it can improve further by learning from other training programs to meet these challengers. PMID:21644855
White, K N
This article examines the development of general practice in the latter half of the 20th century, documenting the issues of concern to both the profession and the state. General practice developed hand in hand with the welfare state in Australia. As the structural changes associated with restructuring of the welfare state have advanced, so have the fortunes of general practice declined, despite significant attempts in the 1970s and 1980s to "save" general practice by both the profession and the state. These structural changes have operated on two fronts, the economic and the cultural. On the economic, changes to the employment of general practitioners clearly indicate ongoing proletarianization, particularly in a changing environment of labor-capital relations. At the cultural level, development of the self-help and the women's movements and the elective affinity of these groups with the individualism of the new right are leading to deprofessionalization. The author advances this argument in a review of general practice over the last 40 years and in a case study of community health services. Theoretically he argues for a combination of the proletarianization and the deprofessionalization theses.
Discussion Australian GP publications have shown an impressive growth from 1980 to 2007 with a 15- fold increase. This increase may be due in part to the actions of the Australian government over the past decade to financially support research in primary care, as well as the maturing of academic general practice. This analysis can assist governments, researchers, policy makers and others to target resources so that further developments can be encouraged, supported and monitored.
Neil, Amanda L; Nelson, Mark; Palmer, Andrew J
In July 2015, a national scheme for after-hours incentive funding for general practices was re-introduced in Australia, 2-years after funding was transferred to regional primary health care organisations (Medicare Locals). The re-introduction was recommended in a 2014 review of after-hours primary care reflecting the "overwhelming desire" among general practice. Given the centrality of after-hours care provision in rural and remote practices identified in the review, we compare and contrast the current and historical after-hours incentive funding mechanisms focussing on fairness towards rural general practices. While there are similarities between the current and historical mechanisms, significant differences exist. The comparison is not straightforward. The major consistency is utilisation of practice standardised whole patient equivalents (SWPE) as the basis of funding, inherently favouring large urban general practices. This bias is expected to increase given a shift in focus from practices with no option but to provide 24/7 care to any practice providing 24/7 care; and an associated increased funding per SWPE. Differences primarily pertain to classification processes, in which the realities of rural service provision and recognition of regional support mechanisms are given minimal consideration. Rapid introduction of the new general practice after-hours incentive funding mechanism has led to inconsistencies and has exacerbated inherent biases, particularly inequity towards rural providers. Impact on morale and service provision in non-urban areas should be monitored.
Neil, Amanda L; Nelson, Mark; Palmer, Andrew J
In July 2015, a national scheme for after-hours incentive funding for general practices was re-introduced in Australia, 2-years after funding was transferred to regional primary health care organisations (Medicare Locals). The re-introduction was recommended in a 2014 review of after-hours primary care reflecting the "overwhelming desire" among general practice. Given the centrality of after-hours care provision in rural and remote practices identified in the review, we compare and contrast the current and historical after-hours incentive funding mechanisms focussing on fairness towards rural general practices. While there are similarities between the current and historical mechanisms, significant differences exist. The comparison is not straightforward. The major consistency is utilisation of practice standardised whole patient equivalents (SWPE) as the basis of funding, inherently favouring large urban general practices. This bias is expected to increase given a shift in focus from practices with no option but to provide 24/7 care to any practice providing 24/7 care; and an associated increased funding per SWPE. Differences primarily pertain to classification processes, in which the realities of rural service provision and recognition of regional support mechanisms are given minimal consideration. Rapid introduction of the new general practice after-hours incentive funding mechanism has led to inconsistencies and has exacerbated inherent biases, particularly inequity towards rural providers. Impact on morale and service provision in non-urban areas should be monitored. PMID:27237945
Liaw, Siaw-Teng; Sulaiman, Nabil; Pearce, Christopher; Sims, Jane; Hill, Keith; Grain, Heather; Tse, Justin; Ng, Choon-Kiat
The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM) framework. The online FRAMS implementation used available Internet (TC...
Cooke Georga PE; Doust Jenny A; Steele Michael C
Abstract Background Burnout and intolerance of uncertainty have been linked to low job satisfaction and lower quality patient care. While resilience is related to these concepts, no study has examined these three concepts in a cohort of doctors. The objective of this study was to measure resilience, burnout, compassion satisfaction, personal meaning in patient care and intolerance of uncertainty in Australian general practice (GP) registrars. Methods We conducted a paper-based cross-sectional...
Halcomb, Elizabeth J; Salamonson, Yenna; Davidson, Patricia M; Kaur, Rajneesh; Young, Samantha AM
Background Nursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time. Methods In the nascence of the exp...
Full Text Available INTRODUCTION: Nutrition care refers to nutrition-related advice or counselling provided by health professionals in an attempt to improve the nutrition behaviour of patients. AIM: The aim of this study was to describe the practices of a sample of Australian general practitioners (GPs when providing nutrition care to adult patients. METHODS: Eighteen GPs (13 male, 5 female were observed by fourth-year medical students during their general practice rotation. Each GP was observed for five consultations that included nutrition care, totalling 90 observed consultations. In each consultation, students completed a 31-item nutrition care checklist of nutrition care practices that could feasibly occur in a standard consultation. Each practice was marked with either a ‘yes’ (completed, ‘no’ (did not complete or ‘completed by practice nurse prior to or after the consultation’. RESULTS: Twenty-eight nutrition care practices were observed at least once. The most frequently observed practices were measuring and discussing blood pressure (76.7%; n=69, followed by general questions about current diet (74.4%; n=67. Approximately half of the consultations included a statement of a nutrition-related problem (52.2%; n=47, and the provision of nutrition advice that focused on a nutrient (45.6%; n=41 or food group (52.2%; n=47. Consultations with male GPs, as well as GPs with more than 25 years of experience, were associated with an increased number of nutrition care practices per consultation. DISCUSSION: The GPs performed nutrition care practices in varying frequencies. Further research is required to identify the most effective GP nutrition care practices to improve the nutrition behaviour of patients.
Halcomb, Elizabeth J; Peters, Kath; McInnes, Susan
Internationally, the delivery of health services has shifted from secondary to primary care, necessitating an exponential growth of the nursing workforce and expansion of the nursing role in general practice. This growth, and the subsequent need to develop this workforce, has created a need to expose undergraduate nurses to general practice nursing as a viable career option. Concurrently, universities are struggling to find sufficient clinical places for their undergraduate students to gain clinical experience. It is logical, therefore, to increase the number of undergraduate nursing student placements in general practice. Through qualitative research methods, this paper seeks to explore the experiences of practice nurses mentoring undergraduate students on clinical placements within the general practice setting. Findings are presented in the following three themes: (1) Promoting Practice Nursing: We really need to get students in, (2) Mentoring future co-workers: Patience and reassurance, and (3) Reciprocity in learning: It's a bit of a two way street, which show the benefits of such placements. Clinical placements in general practice settings can be mutually beneficial in terms of providing quality teaching and learning experiences for students. Conversely, the experience provides an impetus for practice nurses to maintain currency of their clinical skills and knowledge through mentoring student nurses. PMID:21908081
Bayram, Clare; Ryan, Rowena; Harrison, Christopher; Gardiner, Joanne; Bailes, Marion Jean; Obeyesekere, Nayantara; Miller, Graeme; Britt, Helena
This study sought to determine the need for, and use of, professional interpreters in general practice. This is a sub-study of the Bettering the Evaluation and Care of Health (BEACH) program - a continuous, national, cross-sectional survey of Australian general practitioner (GP) activity. Data were provided by 206 randomly sampled GPs between December 2013 and March 2014. Of 6074 patients sampled, there were 986 (16.2%; 95% confidence interval [CI]: 13.2-19.3) who reported speaking a language other than English (LOTE) at home. Five per cent of all GP consultations involved communicating in a LOTE. Of these, 1% involved professional interpreters, 82.3% were conducted by multilingual GPs who spoke the patient's language, and 17.7% involved a family member or friend. GPs thought a professional interpreter would/may have improved the quality of 27.8% of these consultations. Our study suggests that GPs see the opportunity to improve the quality of LOTE consultations by using professional interpreters to replace family member/friend interpreters. PMID:27051980
Cooke Georga PE
Full Text Available Abstract Background Burnout and intolerance of uncertainty have been linked to low job satisfaction and lower quality patient care. While resilience is related to these concepts, no study has examined these three concepts in a cohort of doctors. The objective of this study was to measure resilience, burnout, compassion satisfaction, personal meaning in patient care and intolerance of uncertainty in Australian general practice (GP registrars. Methods We conducted a paper-based cross-sectional survey of GP registrars in Australia from June to July 2010, recruited from a newsletter item or registrar education events. Survey measures included the Resilience Scale-14, a single-item scale for burnout, Professional Quality of Life (ProQOL scale, Personal Meaning in Patient Care scale, Intolerance of Uncertainty-12 scale, and Physician Response to Uncertainty scale. Results 128 GP registrars responded (response rate 90%. Fourteen percent of registrars were found to be at risk of burnout using the single-item scale for burnout, but none met the criteria for burnout using the ProQOL scale. Secondary traumatic stress, general intolerance of uncertainty, anxiety due to clinical uncertainty and reluctance to disclose uncertainty to patients were associated with being at higher risk of burnout, but sex, age, practice location, training duration, years since graduation, and reluctance to disclose uncertainty to physicians were not. Only ten percent of registrars had high resilience scores. Resilience was positively associated with compassion satisfaction and personal meaning in patient care. Resilience was negatively associated with burnout, secondary traumatic stress, inhibitory anxiety, general intolerance to uncertainty, concern about bad outcomes and reluctance to disclose uncertainty to patients. Conclusions GP registrars in this survey showed a lower level of burnout than in other recent surveys of the broader junior doctor population in both Australia
Hamirudin, Aliza Haslinda; Charlton, Karen; Walton, Karen; Bonney, Andrew; Potter, Jan; Milosavljevic, Marianna; Hodgkins, Adam; Albert, George; Ghosh, Abhijeet; Dalley, Andrew
Background Nutrition screening in older adults is not routinely performed in Australian primary care settings. Low awareness of the extent of malnutrition in this patient group, lack of training and time constraints are major barriers that practice staff face. This study aimed to demonstrate the feasibility of including a validated nutrition screening tool and accompanying nutrition resource kit for use with older patients attending general practice. Secondary aims were to assess nutrition-re...
Liaw, Siaw-Teng; Sulaiman, Nabil; Pearce, Christopher; Sims, Jane; Hill, Keith; Grain, Heather; Tse, Justin; Ng, Choon-Kiat
The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM) framework. The online FRAMS implementation used available Internet (TCP/IP), messaging (HL7, XML), knowledge representation (Arden Syntax), and classification (ICD10-AM, ICPC2) standards. Although it could accommodate most of the falls prevention information elements, the GPDM required extension for prevention and prescribing risk management. Existing classifications could not classify all falls prevention concepts. The lack of explicit rules for terminology and data definitions allowed multiple concept representations across the terminology-architecture interface. Patients were more enthusiastic than clinicians. A usable standards-based online-distributed decision support system for falls prevention can be implemented within the GPDM, but a comprehensive terminology is required. The conceptual interface between terminology and architecture requires standardization, preferably within a reference information model. Developments in electronic decision support must be guided by evidence-based clinical and information models and knowledge ontologies. The safety and quality of knowledge-based decision support systems must be monitored. Further examination of falls and other clinical domains within the GPDM is needed. PMID:12807809
Full Text Available Abstract Background Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policy-makers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate. Methods This three year, multimethod study undertook rapid appraisal of 25 general practices and year-long studies in seven practices where a change was introduced to the role of the nurse. Data collected included interviews with nurses (n = 36, doctors (n = 24, and managers (n = 22, structured observation of the practice nurse (51 hours of observation, and detailed case studies of the change process in the seven year-long studies. Results Despite specific fee-for-service funding being available, only 6% of nurse activities generated such a fee. Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice. Conclusions Interprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms. These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice.
Full Text Available Abstract Background Obesity is a significant public health concern. General practitioners (GPs see a large percentage of the population and are well placed to provide weight management advice. There has been little examination of the types of weight loss strategies used in Australian general practice patients. This cross-sectional study aimed to describe the proportion of normal weight, overweight and obese general practice patients who report trying to lose weight in the past 12 months, the types of weight loss strategies and diets used as well as the proportion consulting their GP prior to trying to lose weight. Methods Adult patients completed a touchscreen computer survey while waiting for their appointment. Responses from 1335 patients in twelve Australian practices are reported. Results A larger proportion of obese patients had tried to lose weight in the past 12 months (73% compared to those who were overweight (55% and normal weight (33%. The most commonly used strategy used was changing diet and increasing exercise in all BMI categories. Less than 10% used strategies such as prescription medication, over the counter supplements and consulted a weight loss specialist. Low calorie and low fat diets were the most frequently reported diets used to lose weight in those who were normal weight, overweight and obese. Overall, the proportion seeking GP advice was low, with 12% of normal weight, 15% of overweight and 43% of obese patients consulting their GP prior to trying to lose weight. Conclusions A large proportion of overweight or obese patients have tried to lose weight and utilized strategies such as changing diet and increasing exercise. Most attempts however were unassisted, with low rates of consultation with GPs and weight loss specialists. Ways to assist overweight and obese general practice patients with their weight loss attempts need to be identified.
BACKGROUND: Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policy-makers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement d...
Phillips, Christine; Dwan, Kathryn; Pearce, Christopher; Hall, Sally; Porritt, Julie; Yates, Rachel; Sibbald, Bonnie
In Australia, more nurses are entering general practice, and nurses' work is being funded in increasingly complex ways through Medicare. Little research has explored the ways doctors and nurses realign their priorities and activities when working together in general practice. We undertook rapid, intensive multimethod studies of 25 general practices to explore the ways in which the labour of nurses and doctors was structured, and the implicit decisions made by both professions about the values placed on different ways of working and on their time. Data collected included photographs, floor-plans, interviews with 37 nurses, 24 doctors and 22 practice managers, and 50 hours of structured observation. Nursing time was constructed by both nurses and doctors as being fluid and non-contingent; they were regarded as being 'available' to patients in a way that doctors were not. Compared to medical time, nursing time could be disposed more flexibly, underpinning a valorized attribute of nursing: deep clinical and personal contact with patients. The location of practice nurses' desks in areas of traffic, such as administrative stations, or in the treatment room, underpinned this valuable unstructured contact with patients. Changes to the practice nurse role through direct fee-for-service items for nurses may lead to greater congruence between the microeconomies of nursing and medicine in general practice. In a time of pressure upon a primary care workforce, this is likely to lead to more independent clinical work by nurses, but may also lead to a decrease in flexible contact with patients. PMID:18041994
David Alejandro González-Chica
Full Text Available Appropriate understanding of health information by patients with cardiovascular disease (CVD is fundamental for better management of risk factors and improved morbidity, which can also benefit their quality of life.To assess the relationship between health literacy and health-related quality of life (HRQoL in patients with ischaemic heart disease (IHD, and to investigate the role of sociodemographic and clinical variables as possible confounders.Cross-sectional study of patients with IHD recruited from a stratified sample of general practices in two Australian states (Queensland and South Australia between 2007 and 2009. Health literacy was measured using a validated questionnaire and classified as inadequate, marginal, or adequate. Physical and mental components of HRQoL were assessed using the Medical Outcomes Study Short Form (SF12 questionnaire. Analyses were adjusted for confounders (sociodemographic variables, clinical history of IHD, number of CVD comorbidities, and CVD risk factors using multiple linear regression.A total sample of 587 patients with IHD (mean age 72.0±8.4 years was evaluated: 76.8% males, 84.2% retired or pensioner, and 51.4% with up to secondary educational level. Health literacy showed a mean of 39.6±6.7 points, with 14.3% (95%CI 11.8-17.3 classified as inadequate. Scores of the physical component of HRQoL were 39.6 (95%CI 37.1-42.1, 42.1 (95%CI 40.8-43.3 and 44.8 (95%CI 43.3-46.2 for inadequate, marginal, and adequate health literacy, respectively (p-value for trend = 0.001. This association persisted after adjustment for confounders. Health literacy was not associated with the mental component of HRQoL (p-value = 0.482. Advanced age, lower educational level, disadvantaged socioeconomic position, and a larger number of CVD comorbidities adversely affected both, health literacy and HRQoL.Inadequate health literacy is a contributing factor to poor physical functioning in patients with IHD. Increasing health literacy
Decreased management of genital warts in young women in Australian general practice post introduction of national HPV vaccination program: results from a nationally representative cross-sectional general practice study.
Full Text Available OBJECTIVES: Since the introduction of Australia's human papillomavirus vaccination program, the management rate of genital warts in sexual health clinics and private hospitals has decreased in women of vaccine-eligible age. However, most genital warts in Australia are managed in general practice. This study examines whether a similar decrease occurred in Australian general practice after the introduction of the program. METHODS: Analysis of a nationally representative cross-sectional database of Australian general practice activity (1,175,879 patient encounters with 11,780 general practitioners. Genital warts management rates were estimated for the periods before and after introduction of the program (Pre-program, July 2002-June 2006; Post-program, July 2008-June 2012. Control conditions included genital herpes and gardnerella/bacterial vaginosis in female patients and genital herpes and urethritis in male patients. Trends in management rates by year, pre-vaccine (July 2000-June 2007 and post-vaccine (July 2007-June 2012 were also calculated. RESULTS: Management rate of genital warts among women potentially covered by program (aged 15-27 years decreased by 61% from 4.33 per 1,000 encounters in the Pre-program period to 1.67 in the Post-program period. Trend analysis of the post-vaccine period showed, among women of vaccine eligible age, a significant year-on-year reduction in the rate of genital warts management (p<0.0001 and a significant increase in the management rate of control conditions per year (p<0.0001. For all other age-sex groups there was no significant change in the management rate of genital warts between the Pre- and Post-program periods. CONCLUSION: The large decrease in general practice management of genital warts in women of vaccine-eligible age highlights the success of the program in the wider community.
Full Text Available Introduction. Diabetic retinopathy (DR is the leading cause of preventable blindness in Australia. Up to 50% of people with proliferative DR who do not receive timely treatment will become legally blind within five years. Innovative and accessible screening, involving a variety of primary care providers, will become increasingly important if patients with diabetes are to receive optimal eye care. Method. An open controlled trial design was used. Five intervention practices in urban, regional, and rural Australia partnered with ophthalmologists via telehealth undertook DR screening and monitoring of type 2 diabetes patients and were compared with control practices undertaking usual care 2011–2014. Results. Recorded screening rates were 100% across intervention practices, compared with 22–53% in control practices. 31/577 (5% of patients in the control practices were diagnosed with mild-moderate DR, of whom 9 (29% had appropriate follow-up recorded. This was compared with 39/447 (9% of patients in the intervention group, of whom 37 (95% had appropriate follow-up recorded. Discussion and Conclusion. General practice-based DR screening via Annual Cycle of Care arrangements is effective across differing practice locations. It offers improved recording of screening outcomes for Australians with type 2 diabetes and better follow-up of those with screen abnormalities.
Full Text Available Abstract Background General practitioners (GPs are ideally placed to bridge the widely noted evidence-practice gap between current management of NVAF and the need to increase anticoagulant use to reduce the risk of fatal and disabling stroke in NVAF. We aimed to identify gaps in current care, and asked GPs to identify potentially useful strategies to overcome barriers to best practice. Methods We obtained contact details for a random sample of 1000 GPs from a national commercial data-base. Randomly selected GPs were mailed a questionnaire after an advance letter. Standardised reminders were administered to enhance response rates. As part of a larger survey assessing GP management of NVAF, we included questions to explore GPs' risk assessment, estimates of stroke risk and GPs' perceptions of the risks and benefits of anticoagulation with warfarin. In addition, we explored GPs' perceived barriers to the wider uptake of anticoagulation, quality control of anticoagulation and their assessment of strategies to assist in managing NVAF. Results 596 out of 924 eligible GPs responded (64.4% response rate. The majority of GPs recognised that the benefits of warfarin outweighed the risks for three case scenarios in which warfarin is recommended according to Australian guidelines. In response to a hypothetical case scenario describing a patient with a supratherapeutic INR level of 5, 41.4% of the 596 GPs (n = 247 and 22.0% (n = 131 would be "highly likely" or "likely", respectively, to cease warfarin therapy and resume at a lower dose when INR levels are within therapeutic range. Only 27.9% (n = 166/596 would reassess the patient's INR levels within one day of recording the supratherapeutic INR. Patient contraindications to warfarin was reported to "usually" or "always" apply to the patients of 40.6% (n = 242/596 of GPs when considering whether or not to prescribe warfarin. Patient refusal to take warfarin "usually" or "always" applied to the patients of 22
Hegney, Desley G; Patterson, Elizabeth; Eley, Diann S; Mahomed, Rosemary; Young, Jacqui
This was the first Australian study investigating the acceptability, feasibility and sustainability of a nurse-led model of chronic disease management in general practice. A concurrent mixed-methods design was used within a 12-month intervention of nurse-led care in three general practices. Adult patients with type 2 diabetes, hypertension and/or stable ischaemic heart disease were randomized into nurse-led or standard care. Semi-structured interviews explored perceptions of key stakeholders towards this model including patients in the nurse-led arm, and all practice staff pre- and posttrial. The data were thematically analysed and the emergent themes were: importance of time; collaborative relationships; nurse job satisfaction, confidence and competence; patient self-management and choice. Our findings showed that nurses provided chronic disease management that was acceptable, feasible and sustainable. The collaborative involvement of doctors was intrinsic to patient acceptability of nurse-led care that facilitated job satisfaction, and therefore retention and growth within this nursing speciality.
Full Text Available Colonisation in Australia has had a devastating and lasting impact on the wellbeing of Aboriginal and Torres Strait Islander peoples in Australia (herein referred to as Indigenous Australians. This paper discusses the role of psychology in Australia and the negative impact that certain disciplinary theories and practices have had on Indigenous Australians. The impact has been further exacerbated by the failure of mainstream policy makers and mental health practitioners to recognise the key, distinctive cultural and social determinants that contribute to Aboriginal health and wellbeing. There is a growing response by Aboriginal psychologists, critical social theorists, and their allies to decolonise psychological theory and practice to redress this situation. This paper outlines key decolonising strategies that have been effective in interrupting those aspects of psychology that are inimical to Aboriginal wellbeing.
Full Text Available Abstract Background There is little published on provider continuity in Australian general practice and none on its effect on inequality of care for children. Method Questionnaire administered to parents of the ACT Kindergarten Health Screen asking the name of their child's usual GP and practice address between 2001 and 2008. Results Parents of 30,789 children named 433 GPs and 141 practices. In each year, an average of 77% of parents could name both the GP and the practice, an average of 11% of parents could name only the practice, and an average of 12% of parents could name neither. In each year, 25% of parents could not name a usual GP for children of Aboriginal or Torres Straight Islander descent, or children born outside of Australia, compared to 10% of all other children (p = Conclusions Many GPs (39% were reported to provide continuity of care for in the ACT region and some GPs (20% displayed transient care. Indigenous children or children born outside of Australia had less equity of access to a nominated GP than all other children. Such inequity might disappear if voluntary registration of children was adopted in Australian general practice.
Martin Carmel M
Full Text Available Abstract Background Chronic disease is a major global challenge. However, chronic illness and its care, when intruding into everyday life, has received less attention in Asia Pacific countries, including Australia, who are in the process of transitioning to chronic disease orientated health systems. Aim The study aims to examine experiences of chronic illness before and after the introduction of Australian Medicare incentives for longer consultations and structured health assessments in general practice. Methods Self-help groups around the conditions of diabetes, epilepsy, asthma and cancer identified key informants to participate in 4 disease specific focus groups. Audio taped transcripts of the focus groups were coded using grounded theory methodology. Key themes and lesser themes identified using a process of saturation until the study questions on needs and experiences of care were addressed. Thematic comparisons were made across the 2002/3 and 1992/3 focus groups. Findings At times of chronic illness, there was need to find and then ensure access to 'the right GP'. The 'right GP or specialist' committed to an in-depth relationship of trust, personal rapport and understanding together with clinical and therapeutic competence. The 'right GP', the main specialist, the community nurse and the pharmacist were key providers, whose success depended on interprofessional communication. The need to trust and rely on care providers was balanced by the need for self-efficacy 'to be in control of disease and treatment' and 'to be your own case manager'. Changes in Medicare appeared to have little penetration into everyday perceptions of chronic illness burden or time and quality of GP care. Inequity of health system support for different disease groupings emerged. Diabetes, asthma and certain cancers, like breast cancer, had greater support, despite common experiences of disease burden, and a need for research and support programs. Conclusion Core
This paper, which was presented at the Annual General Meeting of the Royal Australian College of General Practitioners in September 1991, outlines possible roles for the general practitioner in the public health system. Four fundamental steps need to be taken: affirmative action by health boards to include GPs in all activities; representation of the RACGP on health boards; adequate remuneration; and part time employment of GPs in all health care delivery service units. PMID:1520131
Brodribb, Wendy E; Mitchell, Benjamin L; van Driel, Mieke L
Background While there is a significant focus on the health and well-being of women during pregnancy, labour and birth, much less emphasis is placed on the care of postpartum women and their infants in primary care following the birth. Some studies have investigated the role of GPs in postpartum care, and others examined facilitators and barriers to mothers accessing care. However there is little information available to investigate the effect of practice related factors on access to care of ...
Coates, J.R.; Steven, I.D.; Beilby, J.; Coffey, G.; Litt, J.C.B.; Wagner, C.
AIM. This study, carried out in 1989, set out to assess general practitioners' knowledge of asthma management and their reported management practices. METHOD. Of 153 randomly selected South Australian general practitioners 127 (83%) completed a questionnaire designed to explore issues relating to th
Optimizing Stroke Prevention in Patients With Atrial Fibrillation: A Cluster-Randomized Controlled Trial of a Computerized Antithrombotic Risk Assessment Tool in Australian General Practice, 2012–2013
Magin, Parker J.; Hilmer, Sarah N.; Krass, Ines
Introduction Clinicians have expressed a need for tools to assist in selecting treatments for stroke prevention in patients with atrial fibrillation. The objective of this study was to evaluate the impact of a computerized antithrombotic risk assessment tool (CARAT) on general practitioners’ prescribing of antithrombotics for patients with atrial fibrillation. Methods A prospective, cluster-randomized controlled trial was conducted in 4 regions (in rural and urban settings) of general practice in New South Wales, Australia (January 2012–June 2013). General practitioner practices were assigned to an intervention arm (CARAT) or control arm (usual care). Antithrombotic therapy prescribing was assessed before and after application of CARAT. Results Overall, the antithrombotic therapies for 393 patients were reviewed by 48 general practitioners; we found no significant baseline differences in use of antithrombotics between the control arm and intervention arm. Compared with control patients, intervention patients (n = 206) were 3.1 times more likely to be recommended warfarin therapy (over any other treatment option; P benefits of these new therapy options. PMID:27418212
Martin Carmel M; Peterson Chris; Robinson Rowena; Sturmberg Joachim P
Abstract Background Chronic disease is a major global challenge. However, chronic illness and its care, when intruding into everyday life, has received less attention in Asia Pacific countries, including Australia, who are in the process of transitioning to chronic disease orientated health systems. Aim The study aims to examine experiences of chronic illness before and after the introduction of Australian Medicare incentives for longer consultations and structured health assessments in gener...
王欣怡; 崔爽; 段丽萍
澳大利亚全科医学教育具有成熟和健全的考核评估体系，考核体系根据参加考核评估对象的不同类别设置不同内容。澳大利亚皇家全科医生学会（RACGP）通过会员制（Fellowship）的方式对全科医生候选人（以下简称候选人）进行评估和资格认证。候选人在成为会员之前应通过学会组织的一系列评估考核。这些多元化的评估考核方式实现了全科医学教育理论与实践的统一，为全科医生在澳大利亚独立行医提供了保障。本文指出我国全科医学教育正处于起步和探索阶段，故吸收澳大利亚全科医学教育考核评估体系的先进经验，将有利于完善我国全科医学教育培养制度，规范我国全科医生的培养过程。%There is a mature and robust examination and evaluation system in Australian general practice education, which set up different contents based on different sorts of examined and evaluated objects. Rural Australian Institute of General Practitioners( RACGP)evaluates GP candidates through Fellowship and gives them certifications. Considering the situation of general practice in China which is still adolescing,this paper offers advices in order to improve the development of general prac-tice education in China by learning valuable lessons from Australia.
Internationally, rising financial costs and increasing expectations of health care delivery have increased regulation and decreased the autonomy of general practitioners and other health care professionals. This article explores professional autonomy within Australian general practice, and outlines the importance of autonomy in systems approaches to organisational change in general practice. PMID:16680218
Paix, D. (South Australian Inst. of Tech., Adelaide)
The findings of a 1980 Australian Radiation Laboratory study of genetic and bone-marrow doses to the population from medical, dental and chiropractic uses of ionising radiation are discussed. Attention is drawn to the large variability in patient exposure: maximum values were from five to eleven times greater than the means.
Березуцкий, Владимир И
The article is devoted to manual therapy practice for diagnostics and treatment of vertebrogenic pain syndrome in general practice. Analytical roundup of sources proves medical advantage of implementation of manual therapy basic methods by general practice specialists.
Reid, C M; Ryan, P; Nelson, M; Beckinsale, P; McMurchie, M; Gleave, D; DeLoozef, F; Wing, L M
1. The second Australian National Blood Pressure Study (ANBP2) is an outcome trial of the treatment of hypertension in the elderly conducted entirely in general practices across Australia. Prior to ANBP2, no study of this size and nature had been undertaken in Australian general practice and the response of General Practitioners (GPs) to becoming involved in long-term cardiovascular research was unknown. 2. Academic departments and Divisions of General Practice were approached to support the project. General Practitioners were approached by letter of invitation and contacted by a regional medical coordinator (RMC) either at a face-to-face meeting or by telephone. 3. At the close of recruitment to ANBP2, 1938 GPs from 950 practices had registered as investigators. Sixty-two Divisions of General Practice were approached to support the study in five mainland Australian states with 39 (63%) participating, although participation by state was highly variable (range: 18-100%). Thirty divisional or promotional dinner meetings were held, with 56% (368/658) of those attending registering as investigators. Of the 8098 GPs sent a letter of invitation to participate in the study, 1357 (17%) expressed interest and eventually enrolled as investigators, ranging from 8% in Queensland to 28% in New South Wales. Ninety-six per cent of GPs who had a personal face-to-face contact (696/724) with the RMC registered in the study. 4. The GP recruitment phase of ANBP2 has been successfully completed. Peer-to-peer recruitment was the most successful strategy; however, success varied between states. General Practitioner recruitment to long-term clinical trials appears to be successful with a multifactorial approach focusing on peer-to-peer recruitment. PMID:11473534
In this article, I argue that the existing literature on qualitative methodologies tend to discuss analytical generalization at a relatively abstract and general theoretical level. It is, however, not particularly straightforward to “translate” such abstract epistemological principles into more...... operative methodological strategies for producing analytical generalizations in research practices. Thus, the aim of the article is to contribute to the discussions among qualitatively working researchers about generalizing by way of exemplifying some of the methodological practicalities in analytical...
Jensen, Jacob Reinholdt; Møller, Henrik; Thomsen, Janus Laust;
Initiation of cancer investigations in general practice Background Close to 90% of all cancers are diagnosed because the patient presents symptoms and signs. Of these patients, 85% initiate the diagnostic pathway in general practice. Therefore, the initiation of a diagnostic pathway in general...... react on very different and vague symptoms to ensure early cancer diagnosis. To enable earlier cancer diagnosis, we need much more knowledge and a better understanding of the initiation of cancer-specific tests and investigations in general practice. Aim To investigate how, how often and on which...... background investigation for suspected cancer is initiated in general practice. Methods Participating Danish GPs will fill in an electronic questionnaire after random consultations. A total of 70,000 consultations will be included. Perspectives The results will show how often and why GPs suspect cancer, how...
Full Text Available This paper describes ten months' experience with MIQUEST software used for the collection of data from computerised databases in General Practice. We report on the following: the MIQUEST software in use, the time costs to the practice, the completeness of confidentiality barriers and the accuracy of data collected using MIQUEST compared with similar data collected by the practice system (EMIS. There were no problems encountered with installation of MIQUEST-related software. With experience, MIQUEST was equal to the practice system for speed and ease of use. The confidentiality safeguards were found to be in accordance with the GMSC/RCGP Guidelines - patients could not be directly, or indirectly, identified from the data extracted by external searches. Inaccuracies in the data collected using MIQUEST were identified, but these were largely attributable to problems with the EMIS-written interpreter available on the practice system at the time, or with the coding schemes used by the practice. In an individual practice, MIQUEST represents an alternative data collection method to the practice-based software. For data collection from multiple general practices it should prove an invaluable tool for Health Authorities and research organisations.
Boyle, Christopher; Scriven, Brooke; Durning, Sara; Downes, Carissa
This article considers the positive aspects of inclusion in Australian primary schools through a historical account of the nation's journey to adopting current policies and practices. The authors suggest that across the different states the picture is positive as there are clear attempts to make Australian schools as inclusive as possible. The…
This article outlines a constraints-led process of exploring, modifying, experimenting, adapting, and developing game appreciation known as Game Sense (Australian Sports Commission, 1997; den Duyn, 1996, 1997) for the teaching of Australian football. The game acts as teacher in this constraints-led process. Rather than a linear system that…
Psychiatric nurses\\' practice with parents who have mental illness, their children and families is an important issue internationally. This study provides a comparison of Irish and Australian psychiatric nurses\\' family-focused practices in adult mental health services. Three hundred and forty three nurses across Ireland and 155 from Australia completed the Family Focused Mental Health Practice Questionnaire. Cross-country comparisons revealed significant differences, in terms of family-focused skill, knowledge, confidence and practice. Australian psychiatric nurses engaged in higher family-focused practice compared to Irish nurses. The comparative differences between countries may be attributable to differences in training, workplace support and policy.
Hawkins, Robert C; Badrick, Tony
In this study we aimed to compare the reporting unit size used by Australian laboratories for routine chemistry and haematology tests to the unit size used by learned authorities and in standard laboratory textbooks and to the justified unit size based on measurement uncertainty (MU) estimates from quality assurance program data. MU was determined from Royal College of Pathologists of Australasia (RCPA) - Australasian Association of Clinical Biochemists (AACB) and RCPA Haematology Quality Assurance Program survey reports. The reporting unit size implicitly suggested in authoritative textbooks, the RCPA Manual, and the General Serum Chemistry program itself was noted. We also used published data on Australian laboratory practices.The best performing laboratories could justify their chemistry unit size for 55% of analytes while comparable figures for the 50% and 90% laboratories were 14% and 8%, respectively. Reporting unit size was justifiable for all laboratories for red cell count, >50% for haemoglobin but only the top 10% for haematocrit. Few, if any, could justify their mean cell volume (MCV) and mean cell haemoglobin concentration (MCHC) reporting unit sizes.The reporting unit size used by many laboratories is not justified by present analytical performance. Using MU estimates to determine the reporting interval for quantitative laboratory results ensures reporting practices match local analytical performance and recognises the inherent error of the measurement process.
Jones, R.; Wilmot, J; Fry, J.
The General Practice Research Club was established in 1969, and now has 120 members. A meeting of the club is held twice a year, at which various papers, from research ideas through to completed, published studies are presented. A survey of 40 individuals who had presented papers at meetings during the period 1984-89 showed that almost half (18) had presented papers on clinical topics. As a result of the presentation, 29 individuals had modified their research, with 11 undertaking major alter...
<正>Invited by the Australian Local Government Association (ALGA), a 11-member delegation of the Chinese local government, sent by the CPAFFC, attended the 2005 National General Assembly of Australian Local Government from November 6 to 9 in Canberra. The National General Assembly The ALGA convenes a national general assembly annually to discuss issues concerning the local government. The theme of this General Assembly was Good to Great: Pursuing Progress Through Partnership, that is, asking the federal government to give the local government more financial support, equitable treatment and formal recognition. Local government representatives and well-known experts and scholars of Australia, and
In rheumatology there may occur emergencies especially in the field of inflammable diseases, the sudden occlusion of the central retinal artery in temporal arteritis as an example. Such incidents are rare. The general practitioner is more often confronted with not necessarily threatening, but very painful and function obstructing acute cases. In this paper four typical problems are represented which can be seen in everyday practice, sometimes misleading to wrong actions and therefore needing to be recognized in time and treated correctly: acute low back pain, periarthropathy of the shoulder joint, crystal arthritis and ruptured Baker's cyst. PMID:25533251
Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247\\/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.
Pharo, Emma; Davison, Aidan; McGregor, Helen; Warr, Kristin; Brown, Paul
We report on the establishment of communities of practice at four Australian institutions and evaluate their effectiveness and durability as a means of building staff and institutional capacity for interdisciplinary teaching. A community of practice approach is a potentially valuable methodology for overcoming dynamics of fragmentation, isolation…
Reilly, T; Crawford, G; Lobo, R; Leavy, J; Jancey, J
Issue addressed Evidence-informed practice underpinned by ethics is fundamental to developing the science of health promotion. Knowledge and application of ethical principles are competencies required for health promotion practice. However, these competencies are often inconsistently understood and applied. This research explored attitudes, practices, enablers and barriers related to ethics in practice in Western Australian health organisations. Methods Semistructured, in-depth interviews were conducted with 10 health promotion practitioners, purposefully selected to provide a cross-section of government and non-government organisations. Interviews were recorded, transcribed and then themed. Results The majority of participants reported consideration of ethics in their practice; however, only half reported seeking Human Research Ethics Committee (HREC) approval for projects in the past 12 months. Enablers identified as supporting ethics in practice and disseminating findings included: support preparing ethics applications; resources and training about ethical practice; ability to access HRECs for ethics approval; and a supportive organisational culture. Barriers included: limited time; insufficient resourcing and capacity; ethics approval not seen as part of core business; and concerns about academic writing. Conclusion The majority of participants were aware of the importance of ethics in practice and the dissemination of findings. However, participants reported barriers to engaging in formal ethics processes and to publishing findings. So what? Alignment of evidence-informed and ethics-based practice is critical. Resources and information about ethics may be required to support practice and encourage dissemination of findings, including in the peer-reviewed literature. Investigating the role of community-based ethics boards may be valuable to bridging the ethics-evidence gap. PMID:27041127
Reilly, T; Crawford, G; Lobo, R; Leavy, J; Jancey, J
Issue addressed Evidence-informed practice underpinned by ethics is fundamental to developing the science of health promotion. Knowledge and application of ethical principles are competencies required for health promotion practice. However, these competencies are often inconsistently understood and applied. This research explored attitudes, practices, enablers and barriers related to ethics in practice in Western Australian health organisations. Methods Semistructured, in-depth interviews were conducted with 10 health promotion practitioners, purposefully selected to provide a cross-section of government and non-government organisations. Interviews were recorded, transcribed and then themed. Results The majority of participants reported consideration of ethics in their practice; however, only half reported seeking Human Research Ethics Committee (HREC) approval for projects in the past 12 months. Enablers identified as supporting ethics in practice and disseminating findings included: support preparing ethics applications; resources and training about ethical practice; ability to access HRECs for ethics approval; and a supportive organisational culture. Barriers included: limited time; insufficient resourcing and capacity; ethics approval not seen as part of core business; and concerns about academic writing. Conclusion The majority of participants were aware of the importance of ethics in practice and the dissemination of findings. However, participants reported barriers to engaging in formal ethics processes and to publishing findings. So what? Alignment of evidence-informed and ethics-based practice is critical. Resources and information about ethics may be required to support practice and encourage dissemination of findings, including in the peer-reviewed literature. Investigating the role of community-based ethics boards may be valuable to bridging the ethics-evidence gap.
This article draws on data from the 2006 Australian census to explore the education and employment outcomes of sign languages users living in Victoria, Australia, and to compare them with outcomes reported in the general population. Census data have the advantage of sampling the entire population on the one night, avoiding problems of population…
Full text: At the presen time, there is no national surveillance of the increasing ionising radiation dose to the population from diagnostic imaging procedures. As the number of procedures undertaken is increasing, it is expected that the population dose will also increase. A substantial component of that contribution is from multi-detector computed tomography (MDCT) systems. The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) estimates that the growth in MDCT scans, based on Medicare Benefits Sch due data, is increasing at approximately 9% per annum, with over 2 million DCT scans being performed in 2009. The caput effective dose (mSv) from this modality is expected to be approaching 1.2 mSv per annum. If cu nt dose-detriment models are accurate, the risk of induction of carcinogenic detriment from current MDCT scanning patterns is a significant public health issue that requires a concerted and ongoing response. For the application of ionising radiation in medicine, the International Commission on Radiological Protection recommends the conservative philosophy of Justification and Optimisation via the measurement of 'Diagnostic Reference Levels' to limit the potential overexposure of patients and decrease the overall population burden. The Australian government has commissioned ARPANSA to survey, calculate and construct representative national diagnostic reference levels for diagnostic imaging modalities that use ionising radiation. This will be achieved in close consultation with the professional organisations who represent the professionals responsible for the use of ionising radiation in diagnostic imaging.
Hatt, Belinda E; Deletic, Ana; Fletcher, Tim D
With the use of water approaching, and in some cases exceeding, the limits of sustainability in many locations, there is an increasing recognition of the need to utilise stormwater for non-potable requirements, thus reducing the demand on potable sources. This paper presents a review of Australian stormwater treatment and recycling practices as well as a discussion of key lessons and identified knowledge gaps. Where possible, recommendations for overcoming these knowledge gaps are given. The review of existing stormwater recycling systems focussed primarily on the recycling of general urban runoff (runoff generated from all urban surfaces) for non-potable purposes. Regulations and guidelines specific to stormwater recycling need to be developed to facilitate effective design of such systems, and to minimise risks of failure. There is a clear need for the development of innovative techniques for the collection, treatment and storage of stormwater. Existing stormwater recycling practice is far ahead of research, in that there are no technologies designed specifically for stormwater recycling. Instead, technologies designed for general stormwater pollution control are frequently utilised, which do not guarantee the necessary reliability of treatment. Performance modelling for evaluation purposes also needs further research, so that industry can objectively assess alternative approaches. Just as many aspects of these issues may have impeded adoption of stormwater, another impediment to adoption has been the lack of a practical and widely accepted method for assessing the many financial, social and ecological costs and benefits of stormwater recycling projects against traditional alternatives. Such triple-bottom-line assessment methodologies need to be trialled on stormwater recycling projects. If the costs and benefits of recycling systems can be shown to compare favourably with the costs and benefits of conventional practices this will provide an incentive to overcome
Simpson, Lyn; Daws, Leonie; Wood, Leanne
To overcome barriers to participation in small business training faced by rural Australian women, training needs and delivery issues were identified and a good practice matrix was developed with the following components: marketing, content, delivery, support, impact, and innovation. Underlying principles included unique needs, diversity, use of…
Cooke, Penelope R.; Hemmings, Brian C.
The authors of this article report on a qualitative study of Australian community-based natural resource management groups known as Landcare groups. They discuss how four Landcare groups contributed to sustainability practices and how a policy change implemented in 2003 influenced the efforts of the groups to remain active in their activities.…
Ingham, Gerard; Fry, Jennifer; O’Meara, Peter; Tourle, Vianne
Background In medical education, a learner-centred approach is recommended. There is also a trend towards workplace-based learning outside of the hospital setting. In Australia, this has resulted in an increased need for General Practitioner (GP) supervisors who are receptive to using adult learning principles in their teaching. Little is known about what motivates Australian GP supervisors and how they currently teach. Methods A qualitative study involving semi-structured interviews with 20 ...
Full Text Available Social constructions of education historically have impacted adversely on marginalised Indigenous Australian students whose mobile lifestyles and cultural positioning challenge teachers’ social inclusion practices. This paper examines the preparation and capacity of pre-service teachers to engage with mobile Indigenous students and their communities. Evidence is drawn from practicing teachers who reflected on their experiences in working with Indigenous students and their communities since graduation and how their experiences, both pre- and post-graduation, impacted on their beliefs and practices. Individual interviews were conducted with four teachers who also participated in the first stage of the study as a group of 24 second year primary pre-service teachers at a regional Australian university. It was found that pre-service teachers representing a range of world views benefit from positive, scaffolded experiences that provide opportunities to develop practices that foster social justice and inclusion. The findings of this study have implications for providing pre-service teachers with opportunities to understand how historical factors impact on Indigenous student mobility in contemporary Australian educational settings and the development of socially inclusive pedagogical practices. Further longitudinal research to expand the evidence base around developing culturally-appropriate pedagogical practices in pre-service teachers is needed to support their transition into teaching.
Sturmberg, Joachim; Heard, Sam
General practice education is rapidly changing. Medical students now have exposure to general practice at most year levels, vocational training has been opened to competition, and continuing professional development is a mandatory requirement for maintenance of Health Insurance Commission recognition, and increasingly for state registration. This article outlines the foundations for, and challenge to, building a framework for quality general practice education in Australia. PMID:15227866
Schofield Deborah J
Full Text Available Abstract Background One group often identified as having low socioeconomic status, those living in remote or rural areas, are often recognised as bearing an unequal burden of illness in society. This paper aims to examine equity of utilisation of general practitioner services in Australia. Methods Using the 2005 National Health Survey undertaken by the Australian Bureau of Statistics, a microsimulation model was developed to determine the distribution of GP services that would occur if all Australians had equal utilisation of health services relative to need. Results It was estimated that those who are unemployed would experience a 19% increase in GP services. Persons residing in regional areas would receive about 5.7 million additional GP visits per year if they had the same access to care as Australians residing in major cities. This would be a 18% increase. There would be a 20% increase for inner regional residents and a 14% increase for residents of more remote regional areas. Overall there would be a 5% increase in GP visits nationally if those in regional areas had the same access to care as those in major cities. Conclusion Parity is an insufficient goal and disadvantaged persons and underserved areas require greater access to health services than the well served metropolitan areas due to their greater poverty and poorer health status. Currently underserved Australians suffer a double disadvantage: poorer health and poorer access to health services.
Jie, Ferry; Parton, Kevin A.; Cox, Rodney J.
This research focuses on an Australian agribusiness supply chain, the Australian Beef Supply Chain. The definition of the Australian Beef Supply Chain is the chain or sequence of all activities from the breeding property to the domestic or overseas consumers. The beef sector in Australia is undergoing rapid change because of globalisation, a highly competitive beef market (local and export), quicker production cycle and delivery times and consequently reduced inventories, a general speed-up o...
Full Text Available Abstract Background Medication-related problems are a serious concern in Australian primary care. Pharmacist interventions have been shown to be effective in identifying and resolving these problems. Collaborative general practitioner-pharmacist services currently available in Australia are limited and underused. Limitations include geographical isolation of pharmacists and lack of communication and access to patient information. Co-location of pharmacists within the general practice clinics is a possible solution. There have been no studies in the Australian setting exploring the role of pharmacists within general practice clinics. The aim of this study is to develop and test a multifaceted practice pharmacist role in primary care practices to improve the quality use of medicines by patients and clinic staff. Methods/design This is a multi-centre, prospective intervention study with a pre-post design and a qualitative component. A practice pharmacist will be located in each of two clinics and provide short and long patient consultations, drug information services and quality assurance activities. Patients receiving long consultation with a pharmacist will be followed up at 3 and 6 months. Based on sample size calculations, at least 50 patients will be recruited for long patient consultations across both sites. Outcome measures include the number, type and severity of medication-related problems identified and resolved; medication adherence; and patient satisfaction. Brief structured interviews will be conducted with patients participating in the study to evaluate their experiences with the service. Staff collaboration and satisfaction with the service will be assessed. Discussion This intervention has the potential to optimise medication use in primary care clinics leading to better health outcomes. This study will provide data about the effectiveness of the proposed model for pharmacist involvement in Australian general practice clinics
Paracchini, S; Ang, Q W; Stanley, F J; Monaco, A. P.; Pennell, C E; Whitehouse, A J O
Several genes have been suggested as dyslexia candidates. Some of these candidate genes have been recently shown to be associated with literacy measures in sample cohorts derived from the general population. Here, we have conducted an association study in a novel sample derived from the Australian population (the Raine cohort) to further investigate the role of dyslexia candidate genes. We analysed markers, previously reported to be associated with dyslexia, located within the MRPL19/C2ORF3, ...
Full Text Available Objectives: To examine student perceptions regarding online lectures and quizzes undertaken during a pharmaceutical practice course for first year undergraduate students enrolled in the Bachelor of Pharmacy course at an Australian University.Methods: The University uses a standard instrument to collect feedback from students regarding unit satisfaction. Data were collected for three different teaching modalities: traditional face-to-face, online and partially online. Results: Descriptive statistics support that, from a student's perspective, partial online delivery is the preferred teaching methodology for an introductory pharmaceutical practice unit. Conclusion: This study has served to highlight that while there are a few points of significant difference between traditional and online teaching and learning, a combination of the two provides a reasonable avenue for teaching exploration. This result has implications for teaching practice generally, and within the pharmacy discipline, specifically.
Booth, Jodie; Nelson, Alison
This paper aims to fill a gap in existing literature by using examples of reflective practice and how these informed service delivery and development with First Australians within a population health paradigm. Population-based approaches have been proposed as useful for providing services that reach beyond the individual. They may be particularly helpful in providing a framework for occupational therapists working with First Australians, when modified appropriately. "Healthy Ears" is a statewide ear health programme for First Australians. It is an example of a health promotion programme working to partner with First Australian communities using a community-driven and strengths-based approach. The occupational therapy role within this service has been recently established. Collaborative autoethnography was used to produce narrative reflection and discussion between the first and second authors in order to illustrate the role of critical reflection in developing this new occupational therapy service. The narratives presented are based on three main themes, which emerged as important guiding principles; these are core occupational therapy knowledge and skills, partnerships with communities and organizations and cultural safety. Each theme comprises narrative excerpts followed by interpretations based on the literature. The findings from these narratives, whilst limited to a particular context, suggest there is a need for greater professional preparation and support for occupational therapists working cross-culturally through undergraduate training and professional development opportunities. This paper highlights the usefulness of reflective practice as a tool for developing culturally safe occupational therapy services and emphasizes the importance of relationships with key First Australians as a platform for culturally safe practice. PMID:23319148
Booth, Jodie; Nelson, Alison
This paper aims to fill a gap in existing literature by using examples of reflective practice and how these informed service delivery and development with First Australians within a population health paradigm. Population-based approaches have been proposed as useful for providing services that reach beyond the individual. They may be particularly helpful in providing a framework for occupational therapists working with First Australians, when modified appropriately. "Healthy Ears" is a statewide ear health programme for First Australians. It is an example of a health promotion programme working to partner with First Australian communities using a community-driven and strengths-based approach. The occupational therapy role within this service has been recently established. Collaborative autoethnography was used to produce narrative reflection and discussion between the first and second authors in order to illustrate the role of critical reflection in developing this new occupational therapy service. The narratives presented are based on three main themes, which emerged as important guiding principles; these are core occupational therapy knowledge and skills, partnerships with communities and organizations and cultural safety. Each theme comprises narrative excerpts followed by interpretations based on the literature. The findings from these narratives, whilst limited to a particular context, suggest there is a need for greater professional preparation and support for occupational therapists working cross-culturally through undergraduate training and professional development opportunities. This paper highlights the usefulness of reflective practice as a tool for developing culturally safe occupational therapy services and emphasizes the importance of relationships with key First Australians as a platform for culturally safe practice.
Helms, Christopher; Crookes, Jo; Bailey, David
This case study examines the financial viability, benefits and challenges of employing a primary healthcare (PHC) nurse practitioner (NP) in a bulk-billing healthcare cooperative in the Australian Capital Territory. There are few empirical case reports in the Australian literature that demonstrate financial sustainability of this type of healthcare professional in primary healthcare. This case study demonstrates that the costs of employing a PHC-NP in general practice are offset by direct and indirect Medicare billings generated by the PHC-NP, resulting in a cost-neutral healthcare practitioner. The success of this model relies on bidirectional collaborative working relationships amongst general practitioners and NPs. PHC-NPs should have a generalist scope of practice and specialist expertise in order to maximise their utility within the general practice environment. PMID:25528465
Fiona Judd; Leon Piterman; Grant Blashki; Hui Yang
The Journal presents the Column of Case Studies of Mental Health in General Practice;with aca-demic support from Australian eXperts in general practice,psychology and psychiatry from Monash University and the University of Mel-bourne. The Columnˊs purpose is to respond to the increasing need for the development of mental health services in China. Through study and analysis of mental health cases,we hope to improve understanding of mental illnesses in Chinese primary health settings,and to build capaci-ty amongst community health professionals in managing mental illnesses and psychological problems in general practice. A patient - centred whole - person approach in general practice is the best way to maintain and improve the physical and mental health of residents. Our hope is that these case studies will lead the new wave of general practice and mental health service development both in practice and research. A num-ber of Australian eXperts from the disciplines of general practice,mental health and psychiatry will contribute to the Column. Professor Blash-ki,Professor Judd and Professor Piterman are authors of the teXt General Practice Psychiatry;the Chinese version of the book to be published in 2014. The Journal cases are helping to prepare for the translation and publication of a Chinese version of the book in China. We believe Chi-nese mental health in primary health care will reach new heights under this international cooperation.
Donker, G.A.; Foets, M.; Spreeuwenberg, P.
BACKGROUND AND OBJECTIVES: A descriptive study on 118 MS patients in general practice, to describe the family physician's role in diagnosis, treatment and follow-up of patients. METHOD: Random sample of 103 general practices (161 family physicians) throughout The Netherlands with a total list of 335
A Quality Assurance and Continuing Education Program has been developed in Australian general practice over the past nine years. This effectively integrates audit and education within a coherent strategy for quality improvement. The programme fulfils many of the same aims as current proposals for reaccreditation in the United Kingdom (UK). This report describes the operation of the programme and an analysis of the effects of the scheme. A similar quality assurance strategy is proposed for the...
Andersen, John Sahl
Organization and change in general practice Abstract for a symposium at Nordic Congress for General Practice Thursday 14 May at 15.30-17.00 General practice is under increasing pressure to assume new tasks, adopt new technologies and engage in new organizational structures. However, in a field...... of multiple actors and concerns such visions are rarely straightforward to realize. This symposium explores the significance of various organizational, cultural and regulative features of general practice in relation to proposals for change in the sector. Presentations: Thorkil Thorsen, Marius Kousgaard...... the challenge of ensuring coherent cancer treatment can be handled by a case manager or if other modes should also be considered. Lars Borgquist. A new model for General Practice in Sweden- consequences for quality of care and economics. Many Swedish county councils will introduce new models for organizing...
Background: While the number of GP services provided in Australia increased steadily from the inception of Medicare in 1984 until the mid 1990s, it declined by 6.6% from 1997-8 to 2003-4. This reflects a decline in average number of services provided per GP of 8.0%. In Australia, as in the US and Canada, there has been a change in the composition of the GP workforce in recent years, in particular an increased feminisation and aging of the GP workforce. We explore whether the decline in averag...
Mellish, Leigh; Karanges, Emily A.; Litchfield, Melisa J.; Schaffer, Andrea L.; Blanch, Bianca; Daniels, Benjamin J.; Segrave, Alicia; Pearson, Sallie-Anne
Background The Pharmaceutical Benefits Scheme (PBS) is Australia’s national drug subsidy program. This paper provides a practical guide to researchers using PBS data to examine prescribed medicine use. Findings Excerpts of the PBS data collection are available in a variety of formats. We describe the core components of four publicly available extracts (the Australian Statistics on Medicines, PBS statistics online, section 85 extract, under co-payment extract). We also detail common analytical...
Wit, M.A.S. de; Koopmans, M.P.G.; Kortbeek, L.M.; Leeuwen, N.J. van; Bartelds, A.I.M.; Duynhoven, Y.T.H.P. van
From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for gastroe
Lau, Rosalind; Cross, Wendy; Moss, Cheryle; Campbell, Annie; De Castro, Magali; Oxley, Victoria
A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing. PMID:25679023
Lau, Rosalind; Cross, Wendy; Moss, Cheryle; Campbell, Annie; De Castro, Magali; Oxley, Victoria
A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.
Kerssens, J.J.; Verhaak, P.F.M.; Bartelds, A.I.M.; Sorbi, M.J.; Bensing, J.M.
The aim of this study was to estimate the prevalence of unexplained severe chronic pain (USCP) in general practice and to report medical as well as psychological descriptions of patients suffering from this condition. A total of 45 GPs in 35 different practices included patients throughout the year
Ji Yinlin; Ren Ting; Wynne Peter; Wan Zhijun; Ma Zhaoyang; Wang Zhimin
Mine dust is one of the main hazards in underground longwall mines worldwide. In order to solve the mine dust problem, a significant number of studies have been carried out regarding longwall mine dust control, both in China and Australia. This paper presents a comparative study of dust control practices in Chinese and Australian longwall mines, with particular references to statutory limits, dust monitoring methods and dust management practices, followed by a brief discussion on the research status of long-wall mine dust control in both countries. The study shows that water infusion, face ventilation controls, water sprays, and deep and wet cutting in longwall shearer operations are commonly practiced in almost all underground longwall mines and that both Chinese and Australian longwall mine dust control prac-tices have their own advantages and disadvantages. It is concluded that there is a need for further devel-opment and innovative design of more effective dust mitigation products or systems despite the development of various dust control technologies. Based on the examinations and discussions, the authors have made some recommendations for further research and development in dust control in long-wall mines. It is hoped that this comparative study will provide beneficial guidance for scholars and engi-neers who are engaging in longwall mine dust control research and practice.
Penning-van Beest, F.J.A.; Sturkenboom, M.C.; Bemelmans, B.L.H.; Herings, R.M.C.
BACKGROUND: In the urinary incontinence guidelines that are issued by the Dutch College of General Practitioners, treatment guidelines are related to the type of incontinence. It is unknown whether treatment of urinary incontinence in general practice complies with these guidelines. OBJECTIVE: To de
Neuwelt, Pat M; Kearns, Robin A; Cairns, Isobel R
INTRODUCTION The care work of general practice receptionists has received limited research attention, despite receptionists position at the beginning of patients' journeys in many health care systems. We examine receptionists' perceptions of their work and the opportunities and constraints they experience in caring for patients while providing administrative support to practices. METHODS Data were collected in focus group interviews with 32 receptionists from urban and rural general practices in the Auckland and Northland regions of New Zealand. We employed tools from inductive thematic analysis and Straussian grounded theory in interpreting the data. FINDINGS We found that the way receptionists identified with a caring role strongly challenged the pejorative view of them in public discourse. Receptionists provide care in two key ways: for the practice and for patients. The juggling they do between the demands of the practice and of patients creates considerable work tensions that are often invisible to other staff members. CONCLUSION Receptionists have a critical role as the first step in the patient care pathway, bridging health care system and community. For general practice to be patient-centred and improve accessibility for the most vulnerable, the care work of receptionists must be considered core. KEYWORDS Receptionists; general practice; care; New Zealand. PMID:27477554
Objectives The objective of the review was to summarise the best available evidence supporting overseas nurses' adjustment to Australian nursing practice. The specific review question was: what supportive interventions assist overseas nurses to adjust to Australian nursing practice? Inclusion criteria The review considered qualitative and quantitative papers that addressed adjustment issues of overseas qualified nurses coming and working in Australia. The types of participants were nurses who have received basic nursing education outside Australian, and either nurses who already registered and were working as nurses in Australia or nurses who were undertaking courses required for registration in Australia. Interventions of interest included creating positive work and educational environments that support overseas qualified overseas nurses' adjustment to nursing practice in Australia. Search strategy The search strategy sought to find both published and unpublished papers in English language. The search was performed using the following databases: Medline, CINAHL, ERIC, AUSTRUM, APAIS, Sociological Abstract, ProQuest, Dissertation Abstract. In addition, the reference lists and bibliographies of the articles were also hand-searched to identify other studies. Relevant worldwide websites were also searched. Methodological quality Each paper was assessed by two reviewers for methodological quality prior to inclusion in the review using a critical appraisal instrument from Qualitative Assessment and Review Instrument (QARI) software developed by the Joanna Briggs Institute (JBI). Results A total of 12 papers, qualitative, quantitative and textual in nature, were included in the review. Sixty-four papers were identified and 52 papers were excluded as they did not meet the inclusion criteria. There were: three papers utilising qualitative methodology (two phenomenology, one grounded theory), three program evaluation reports, two descriptive studies, and four
Bowden Francis J
Full Text Available Abstract Background Genital chlamydia is the most commonly notified sexually transmissible infection (STI in Australia and worldwide and can have serious reproductive health outcomes. Partner notification, testing and treatment are important facets of chlamydia control. Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. Patient-delivered partner therapy (PDPT has been shown to improve the treatment of sexual partners. In Australia, General Practitioners (GPs are responsible for the bulk of chlamydia testing, diagnosis, treatment and follow up. This study aimed to determine the views and practices of Australian general practitioners (GPs in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis. Methods In-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs from rural, regional and urban Australia from November 2006 to March 2007. Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT. Transcripts were imported into NVivo7 and subjected to thematic analysis. Data saturation was reached after 32 interviews had been completed. Results Perceived barriers to patients telling partners (patient referral included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. Barriers to GPs undertaking partner notification (provider referral included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT - many felt concerned that it is not
Roghmann, M C; Sexton, M
Adherence to asthma practice guidelines is low. Improved compliance could potentially improve care of patients with asthma. The purpose of this study was to determine if patients managed in a general practice with an associated asthma clinic are more likely to use asthma medications according to clinical practice guidelines than patients managed in the general surgery of the practice. A cross-sectional study of adult asthmatics, aged 18-55 years, was conducted in six British general practices. Prescription data on all asthma medication was collected for a 6-month period. Information on asthma clinic attendance, age, sex, employment status, other medical illness, and how patients used their inhaled beta2-agonist was collected through questionnaire. The prescription data for asthma medication and patient use of inhaled beta2-agonist were compared to the British Thoracic Society's (BTS) Guidelines for Management of Asthma in Adults to determine if the patient's asthma medication regimen was appropriate. There was no significant association found between appropriate asthma medication and asthma clinic attendance or other patient characteristics. Adherence to the BTS guidelines was low. Fifty-eight percent of the asthma patients used asthma medication regimens that were not consistent with the BTS guidelines published 1 year earlier. Adherence to the BTS guidelines was low regardless of patient characteristics, including asthma clinic attendance, age, sex, employment status, other medical illness, or individual practice. These findings underscore the need to document the utility of clinical practice guidelines which may improve physician compliance.
Johnson, D A
With the co-operation of the family doctors in five selected urban general practices the general-practitioner treatment of 73 patients suffering from a new episode of depressive illness was evaluated over a period of four months. The purpose was to test the belief that general practitioners are best fitted to manage most psychological ailments, and depression was chosen as the psychiatric illness most commonly seen in general practice. Medication was the principal treatment offered, and this was often inadequate in dosage or the patient defaulted. Drug defaulting was thought to be due partly to failure of supervision and follow-up and to too low a consultation rate. The low consultation rate was also thought to explain why few patients thought there was a therapeutic value in the doctor-patient relationship. The results of the study indicate that patients with depressive illness do not receive the best treatment in general practice. The reasons are several and responsibility must be shared by the medical practitioners, the current system of the general practice, and the patients themselves.
al-Shehri, A; Stanley, I; Thomas, P
Vision is a fashionable but ill defined term in management circles. Nevertheless, it embodies a significant concept related to guiding an organisation from present realities, through opportunities and hazards, to a viable future. Until recently a typical general practice could assume a stable external environment, but now it is caught up in the uncertainties stemming from the NHS reforms. For such a practice to undertake effective strategic planning it will have to develop a vision connecting...
Advanced practice for radiation therapists has been a part of the international landscape for several years; however formal implementation into the Australian health care system is yet to happen. Despite this, three short course radiation therapy advanced practitioner programs have been established by an Australian tertiary institution in response to clinical service needs at several organisations. This paper describes the rationale for curriculum design and development of the program materials, the small-scale implementation of the programs at pilot sites, and the evolution of the curriculum to be available to registered radiation therapists nationally. Each program has been designed around a specific clinical role, where flexibility of delivery to busy practitioners was central to the decision to offer them via distance education. The curriculum comprises theoretical units of study which run in parallel to and underpin clinical practice units, where advanced competence in the specific area of practice is overseen by an experienced radiation oncologist mentor. Given the nature of the disparate clinical services requiring an advanced radiation therapy practitioner, the workplace learning component of the course is individually negotiated at a local level. Outcomes suggest that the flexible clinically based training underpinned by a distance education academic curriculum is able to support the development of advanced radiation therapy practitioners responsive to local service need, and ultimately may improve the patient experience
In Volume 35, Issue 1 of the "Australasian Journal of Special Education," Carter, Stephenson and Strnadova (2011) replicated a study by Burns and Ysseldyke (2009). In Carter et al.'s study, 194 Australian special educators were asked to rate the extent to which they used eight instructional practices. These practices were applied behaviour…
Koehler, Nicole; McMenamin, Christine
Australia will continue to face a general practitioner (GP) shortage unless a significant number of medical students make general practice their chosen career. Perceptions regarding general practice may influence career choices. Thus this study investigated what Australian medical students perceived to be the advantages and disadvantages of pursuing a career in general practice via an anonymous online survey. Fifty-one students indicated general practice to be their first ranked career preference, 200 indicated a career other than general practice, and 106 were undecided. Two-hundred and two students reported having been on a GP placement, whereas 88 students had not. Flexibility, continuity of patient care and work-life balance were the three most common stated advantages to pursuing a career in general practice whereas general practice being boring, poorly paid, and of low prestige were the three most common disadvantages stated. Some disadvantages stated by those with a non-GP preference were not stated by those with a GP preference (e.g. lack of procedural skills, lack of career advancement opportunities). Students with more than 80 h of GP placement experience were more likely to list the advantages of work-life balance and a diversity of problems/illnesses/patients than those with no placement experience but were also more likely to list the disadvantage of low prestige. Negative stereotypes regarding general practice continue to exist which may influence students' career choices.
Sánchez, Cecilia A; Baker, Michelle L
Interactions with flying foxes pose disease transmission risks to volunteer rehabilitators (carers) who treat injured, ill, and orphaned bats. In particular, Australian bat lyssavirus (ABLV) can be transmitted directly from flying foxes to humans in Australia. Personal protective equipment (PPE) and rabies vaccination can be used to protect against lyssavirus infection. During May and June 2014, active Australian flying fox carers participated in an online survey (SOAR: Survey Of Australian flying fox Rehabilitators) designed to gather demographic data, assess perceptions of disease risk, and explore safety practices. Responses to open-ended questions were analysed thematically. A logistic regression was performed to assess whether rehabilitators' gender, use of PPE, threat perception, and years of experience predicted variation in their odds of being bitten or scratched. Eligible responses were received from 122 rehabilitators located predominantly on the eastern coast of Australia. Eighty-four percent of respondents were female. Years of experience ranged from viruses in flying foxes as a potential threat to their health, yet 74% of carers reported using PPE when handling flying foxes. Eighty-three percent of rehabilitators had received a flying fox bite or scratch at some point during their career. Carers provide an important community service by rescuing and rehabilitating flying foxes. While rehabilitators in this study have many excellent safety practices, including a 100% vaccination rate against rabies, there is room for improvement in PPE use. We recommend 1) the establishment of an Australia-wide set of guidelines for safety when caring for bats and 2) that the responsible government agencies in Australia support carers who rescue potentially ABLV-infected bats by offering compensation for PPE. PMID:26829399
Cecilia A Sánchez
Full Text Available Interactions with flying foxes pose disease transmission risks to volunteer rehabilitators (carers who treat injured, ill, and orphaned bats. In particular, Australian bat lyssavirus (ABLV can be transmitted directly from flying foxes to humans in Australia. Personal protective equipment (PPE and rabies vaccination can be used to protect against lyssavirus infection. During May and June 2014, active Australian flying fox carers participated in an online survey (SOAR: Survey Of Australian flying fox Rehabilitators designed to gather demographic data, assess perceptions of disease risk, and explore safety practices. Responses to open-ended questions were analysed thematically. A logistic regression was performed to assess whether rehabilitators' gender, use of PPE, threat perception, and years of experience predicted variation in their odds of being bitten or scratched. Eligible responses were received from 122 rehabilitators located predominantly on the eastern coast of Australia. Eighty-four percent of respondents were female. Years of experience ranged from <1 to 30 years (median 5 years. Respondents were highly educated. All rehabilitators were vaccinated against rabies and 94% received a rabies titre check at least every two years. Sixty-three percent of carers did not perceive viruses in flying foxes as a potential threat to their health, yet 74% of carers reported using PPE when handling flying foxes. Eighty-three percent of rehabilitators had received a flying fox bite or scratch at some point during their career. Carers provide an important community service by rescuing and rehabilitating flying foxes. While rehabilitators in this study have many excellent safety practices, including a 100% vaccination rate against rabies, there is room for improvement in PPE use. We recommend 1 the establishment of an Australia-wide set of guidelines for safety when caring for bats and 2 that the responsible government agencies in Australia support
Gaal, S.; Smits, M.; Verstappen, W.H.J.M.; Giesen, P.H.J.; Wensing, M.J.P.
OBJECTIVE: To gain insight into the frequency, severity, causes and consequences of potentially preventable patient-safety incidents in Dutch primary care. DESIGN: Retrospective medical record review study. METHOD: We screened a sample of 1000 medical records in 20 general practices and 1145 medical
Conclusions This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake.
Bech, Per; Paykel, Eugene; Sireling, Lester;
BACKGROUND: Our objective was to investigate to what extent the Clinical Interview for Depression (CID) used in the general practice setting covers clinically valid subscales (depression, anxiety, and apathy) which can measure outcome of antidepressant therapy as well as identifying subsyndromes ...
A survey of stoma care in general practice is reported. It demonstrates a wide diversity in the patterns of care provided to ostomates, with only half of the general practitioners reporting regular follow-up by a member of the health care team. Dealing with appliance difficulties was found to be an aspect of stoma care in which a majority of general practitioners have little confidence. The district nurse and stoma nurse are considered to be the most valuable sources of back-up. It is suggest...
Full Text Available Indigenous Australian studies necessarily addresses emotionally-difficult topics related to race, history, colonialism and our identities as Indigenous and non-Indigenous Australians. As educators in this discipline, it is important for us to find teaching and learning approaches which make space for these topics to be accessed, understood, discussed and engaged with in meaningful ways. Problem-Based Learning (PBL, because of its emphasis on dialogic learning, is a pedagogical tool used in many Indigenous Australian studies classrooms in preference to other methods. In this presentation we want to explore the potential of PBL to allow personal and emotional responses to become accessible, dialogic and discursive, so that the resulting new awareness translates into practical action and change. We will focus on a practice-based initiative which involves the implementation of PBL in a first year introductory course at The University of Queensland and provide practical guidance on the incorporation of PBL in curriculum development.
Dickinson, J A; Hall, J; Logan, J; McDonald, M L
The public perceives that doctors earn too much, while general practitioners complain that their income is dwindling . In the absence of reliable data on doctors' incomes, it is impossible to determine whether medical fees are set appropriately, and what effects Medicare might have on general practice. An economic model of practice, using estimates of income and expenditure derived from specified assumptions, was constructed. Then, the effects of changes in various parameters of the model were examined in turn to show how economic forces are likely to affect the behaviour of doctors. It is shown that a general practitioner working at a moderate rate during a normal working week will earn a low income under current schedule fees. Some implications of these findings for practitioners, fee setting, and the public are explored. PMID:6717350
Full Text Available OBJECTIVES: To determine whether current care for common shoulder problems in Australian general practice is in keeping with rheumatologist expectations and the best available evidence. METHODS: We performed a mailed survey of a random sample of 3500 Australian GPs and an online survey of all 270 rheumatologists in Australia in June 2009. Each survey included four vignettes (first presentation of shoulder pain due to rotator cuff tendinopathy, acute rotator cuff tear in a 45 year-old labourer and early and later presentation of adhesive capsulitis. For each vignette, GPs were asked to indicate their management, rheumatologists were asked to indicate appropriate primary care, and we determined best available evidence from relevant Cochrane and other systematic reviews and published guidelines. RESULTS: Data were available for at least one vignette for 614/3500 (17.5% GPs and 64 (23.8% rheumatologists. For first presentation of rotator cuff tendinopathy, 69% and 82% of GPs and 50% and 56% rheumatologists would order a shoulder X-ray and ultrasound respectively (between group comparisons P = 0.004 and P<0001. Only 66% GPs and 60% rheumatologists would refer to an orthopaedic surgeon for the acute rotator cuff tear. For adhesive capsulitis, significantly more rheumatologists recommended treatments of known benefit (e.g. glucocorticoid injection (56% versus 14%, P<0.0001, short course of oral glucocorticoids (36% versus 6%, p<0.0001 and arthrographic distension of the glenohumeral joint (41% versus 19%, P<0.0001. CONCLUSIONS: There is a mismatch between the stated management of common shoulder problems encountered in primary care by GPs, rheumatologist expectations of GP care and the available evidence.
Kjeldsen, Hans Christian; Kier, Svend; Husum, Gitte;
practitioner (GP) finds indication for treatment with antisecretory therapy and/or diagnostic Helicobacter Pylori test were included in general practice between June 2000 and June 2002. Patients the GP want to refer to endoscopy were not included. Dyspepsia definition: persistent or recurrent pain...... after 3 months. Results: Response rate GPs after two weeks were 92% (330/357). Response rate patients after three months were 71% (252/357). There were no significant difference between the groups randomised to strategy 1(PPI group) and strategy 2 (endoscopy group) concerning, age, gender, duration...... of dyspepsia, dyspeptic episodes, main symptom, previous contact to general practice, previous gastroscopia, use of antacids or NSAID's, Helicobacter Pylori status and mental/physical well being (SF-36 measurement scale) (Table 1). After two weeks the GPs assessed 46 % of the patients to be free of symptoms...
Ulrik, Charlotte Suppli; Sørensen, Tina Brandt; Højmark, Torben Brunse;
BACKGROUND: The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD). AIMS: To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD...... guidelines. METHODS: A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted...... were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity. RESULTS: Data for 102 participating GP practices were analysed...
Thomas, K.J.; Nicholl, J P; Fall, M.
BACKGROUND: The popularity of complementary medicine continues to be asserted by the professional associations and umbrella organisations of these therapies. Within conventional medicine there are also signs that attitudes towards some of the complementary therapies are changing. AIM: To describe the scale and scope of access to complementary therapies (acupuncture, chiropractic, homoeopathy, hypnotherapy, medical herbalism, and osteopathy) via general practice in England. DESIGN OF STUDY: A ...
Halcomb, Elizabeth J; Davidson, Patricia M; Brown, Nicola
The Australian health care system is currently in a state of reform and there is increasing pressure to provide care in community settings. Rising costs, demands and population ageing underscore the importance of adopting models of health care delivery to address changing epidemiological patterns. Population ageing and the increase of chronic conditions challenge models based on acute care. Changes to the Medicare benefits schedule have facilitated the development of a range of expanded nursing services in the general practice setting. In particular, item number 10997 was introduced to reimburse practice nurses and Aboriginal health workers (AHWs) for providing monitoring and support to people with a chronic disease for and on behalf of a general practitioner (GP). The uptake of Medicare Item 100997 from 2007 to 2009, to monitor chronic disease interventions provided by general practice nurses has increased dramatically. The rate of uptake of Item 100997 has not been consistent across States and Territories, even allowing for population distributions. Exploring reasons for these regional variations and linking uptake of Medicare Item numbers to patient outcomes is important in developing the nursing role in Australian general practice.
Nastasie, Daniela L.
In 2011 a group of Australian Library and Information Science academics led by Prof. Helen Partridge conducted an investigation into the Australian Library and Information Science education in the 21st century. The project was funded by the Australian Learning and Teaching Council (ALTC) and the final report, titled "Re-conceptualising and…
disease was present in 6% of GP consultations, and the suspicion was associated with an increased use referrals and diagnostic imaging. The suspicion was associated with an increased risk of being diagnosed with serious disease including cancer and had a positive predictive value for a new diagnosis...... to reduce patients’ mortality and morbidity from cancer, but also because it probably pays to do so from a cost-effectiveness perspective. The findings in Study II underscore that the current guidelines regarding PSA testing for general practice should be followed to avoid inflicting iatrogenic harm...
Full Text Available The purpose of this study was to identify examples of good and innovative practices of Flexible Work Practices to benchmark against and then to use the information to develop strategies of implementation that will assist South African organisations to emulate their success. One hundred-and-twenty (120 individuals, representing different stakeholder groups were requested to complete a questionnaire, based on an Australian study. Comparative findings of both countries strongly confirmed variables that are positively associated with the adoption and successful implementation of Flexible Work Practices (FWP. Opsomming Die doel van hierdie studie was om voorbeelde van goeie en innoverende gebruike van Buigsame Werkspraktyke te identifiseer ten einde daarteen te kan vergelyk, en dan om hierdie inligting te gebruik ten einde implementeringstrategieë te ontwikkel wat Suid Afrikaanse maatskappye kan gebruik om sukses na te volg. Honderd en twintig (120 individue, wat verskillende belangegroepe verteenwoordig, is genader om ‘n vraelys, gebaseer op ‘n Australiese studie, te voltooi. Vergelykende bevindinge van beide lande bevestig veranderlikes wat positief geassosieer word met die aanvaarding en suksesvolle implementering van Buigsame Werkspraktyke (BWP.
Symes, Sally; Goldsmith, Paul; Haines, Heather
Seed sprouts have been implicated as vehicles for numerous foodborne outbreaks worldwide. Seed sprouts pose a unique food safety concern because of the ease of microbiological seed contamination, the inherent ability of the sprouting process to support microbial growth, and their consumption either raw or lightly cooked. To examine seed sprout safety in the Australian state of Victoria, a survey was conducted to detect specific microbes in seed sprout samples and to investigate food handling practices relating to seed sprouts. A total of 298 seed sprout samples were collected from across 33 local council areas. Escherichia coli was detected in 14.8%, Listeria spp. in 12.3%, and Listeria monocytogenes in 1.3% of samples analyzed. Salmonella spp. were not detected in any of the samples. A range of seed sprout handling practices were identified as potential food safety issues in some food businesses, including temperature control, washing practices, length of storage, and storage in proximity to unpackaged ready-to-eat potentially hazardous foods.
Ashman, Freya; Sturgiss, Elizabeth; Haesler, Emily
Background. Obesity is a leading cause of morbidity and mortality in the Australian community, and general practitioners (GPs) are commonly approached by patients for assistance in losing weight. Previous studies have shown that GPs have low self-efficacy and low outcome expectation when it comes to managing overweight and obese patients, which affects their willingness to initiate and continue with weight counselling. This qualitative survey study aimed to explore the factors influencing confidence and behaviour in obesity management in GPs. Method. Twelve GPs recruited to deliver a pilot of an obesity management program participated in semistructured interviews, and interpretive analysis underpinned by social cognitive theory was performed on the transcripts. Results. Analysis identified five main themes: (1) perceived knowledge and skills, (2) structure to management approach, (3) the GP-patient relationship, (4) acknowledged barriers to weight loss and lifestyle change, and (5) prior experience and outcome expectation. Conclusions. GPs are likely to welcome tools which provide a more structured approach to obesity management. Shifting away from weight and BMI as sole yardsticks for success or failure and emphasising positive lifestyle changes for their own sake may improve GP self-efficacy and allow for a more authentic GP-patient interaction. PMID:27274872
Kim Rose Olsen
Full Text Available Background: General practice systems in the Nordic countries share certain common features. The sector is based on the Nordic model of a tax-financed supply of services with a political objective of equal access for all. The countries also share the challenges of increased political expectations to deliver primary prevention and increased workload as patients from hospital care are discharged earlier. However, within this common framework, primary care is organized differently. This is particularly in relation to the private-public mix, remuneration systems and the use of financial and non-financial incentives. Objective: The objective of this paper is to compare the differences and similarities in primary care among the Nordic countries, to create a mapping of the future plans and reforms linked to remuneration and incentives schemes, and to discuss the pros and cons for these plans with reference to the literature. An additional objective is to identify gaps in the literature and future research opportunities. Results/Conclusions: Despite the many similarities within the Nordic health care systems, the primary care sectors function under highly different arrangements. Most important are the differences in the gate-keeping function, private versus salaried practices, possibilities for corporate ownership, skill-mix and the organisational structure. Current reforms and political agendas appear to focus on the side effects of the individual countries’ specific systems. For example, countries with salaried systems with geographical responsibility are introducing incentives for private practice and more choices for patients. Countries with systems largely based on private practice are introducing more monitoring and public regulation to control budgets. We also see that new governments tends to bring different views on the future organisation of primary care, which provide considerable political tension but few actual changes. Interestingly
Collijn, D.H.; Verhaak, P.; Wijkel, D.; van der Feltz-Cornelis, C. M.; Huyse, F.J.
OBJECTIVE: The purpose of the study was to assess the feasibility of a psychiatric consultation intervention for somatizing patients in the family practice setting in terms of 1) patient compliance, 2) patient satisfaction, and 3) compliance and satisfaction of general practitioners (GPs). METHOD: In a period of nine months, forty-six patients were selected for psychiatric consultation in six solo family practices in a semi-urban area in the Netherlands. The consultation included an interview...
Waters, W H; Udy, S C; Lunn, J E
This paper describes three years' experience of running a domiciliary physiotherapy service based on general practice and financed by limited voluntary funds.The need arose from the remoteness of, and lack of, open access to, hospital physiotherapy. This was particularly so for elderly patients who were often frail and mentally confused. In addition there were obvious advantages in properly instructing relatives in management and treatment, especially since many of the patients and their relatives expressed a desire for home treatment.There was also a desire on the part of the general practitioners, nurses, and ancillary workers to develop further the teamwork in the health services of the four villages involved. Details of the constitution of the voluntary service and its financial arrangements are given.The results of the service and the nature of its work are described. There were no difficulties experienced in selecting the correct patients for treatment and the type of equipment required was almost all normally available through the health authority nursing service. There was no great need for expensive or heavy equipment and no transport problems arose.It was found that one hour of physiotherapist's time per 1,000 patients per week was adequate to cover all patients requiring short-term intensive therapy and to allow a small amount of palliative therapy in addition, although this had not been the original intention of the service.The physiotherapist averaged about 40 hours work per month and under these conditions the travelling and costs averaged 1.54 miles and 83 pence per visit. With self-determined hours of work and flexible timing, these conditions proved ideal for a married physiotherapist with the responsibility of a young family. Expansion of the hours of work in this particular area would have led to wasteful visits devoted to palliative and placebo therapy; and extension of the service beyond the area defined, would have increased travelling time at
Full Text Available Globalization and global education implies changes to practices at the classroom level to adapt to new imperatives associated with technology use and awareness, and environmental sustainability. It also implies much more. It implies that teachers apply their classroom pedagogy to take account of students’ new found global understandings of which they, and the school community, is largely unaware. This article addresses and discuses three key consequences of globalization for classrooms worldwide; an increased diversity of experience of the students within the classroom, an increased competitiveness of educational outcomes between national states and subsequently some standardisation of curriculum across nations to enable this, and an increased emphasis on teaching skills and values associated with intercultural understanding. Young children’s map knowledge and their resultant, and associated, interpretations of the world from a comparative study a from Swedish and Australian primary classrooms is used as examples of some of these implications of the impact of ‘global culture’ and ‘global issues’ on current and future classroom practice.
Fitzgerald, Angela; Dawson, Vaille; Hackling, Mark
With trends across many countries still indicating the decline of student interest in school science and diminishing numbers of students studying science beyond the compulsory years, it seems that the field remains in crisis. To address these unfortunate trends, there needs to be a greater emphasis on science education research that highlights the good news stories. For example, what are science teachers actually doing in their classrooms to increase student interest and understanding in science? This article focuses on the science teaching beliefs and practices of four Western Australian primary school teachers. The teachers were nominated by a professional colleague as effective practitioners. The study involved gathering information from classroom observations and teacher interviews to provide background information to assist in developing understandings of these teachers and their science teaching. This article reports on the initial findings drawn from Deanne A, Kate B, Lisa C and Rebecca D. Their practices were organised into the following six categories: classroom environment; conceptual knowledge and procedural skills; teaching strategies and approaches; student-specific considerations; teacher-specific considerations; and context-specific considerations. In examining the components contributing to these categories, it was evident that the teachers' beliefs, as well as the contextual factors inherent in each classroom environment, influenced how and why they teach science in the ways they do.
Sydenham, Rikke Vognbjerg; Plejdrup Hansen, Malene; Pedersen, Line Bjørnskov;
factors (microbiological diagnostics, point-of-care tests, patients’ expectations) in the management of infectious diseases. 3. Results This PhD project is scheduled to be carried out in 2016-2019. The hypotheses and anticipated perspectives will be discussed at the conference. 4. Conclusions The project......1. Background & Aim The overall aim of the project is to describe antibiotic consumption in Danish general practice with emphasis on specific types of antibiotics. The project will shed light on the impact of microbiological diagnostic methods (MDM) on the choice of antibiotic and the project...... will assess and quantify the usage of MDM prior to antibiotic prescription. Furthermore we will investigate associations between GP characteristics, use of MDM and description patterns. A questionnaire comprising a discrete choice experiment will allow us to investigate the relative importance of selected...
Farrow, S C; Zeuner, D; Hall, C
Infection control measures in the health care setting should protect patients and staff from cross-infection. The prevention of harm is an essential part of good medical practice and failure might result in professional misconduct proceedings by the General Medical Council (GMC) and prosecution under the Health and Safety at Work legislation, as well as civil liability. For a health authority, overall responsibility for public health includes arrangements for the control of communicable diseases and infection in hospital and the community (NHS Management Executive, 1993), a function usually led by the Consultant in Communicable Disease Control (CCDC). This paper describes one district's collaborative approach between public health and GPs to assess and improve local infection control standards.
Lundstrøm, Sanne Lykke
and relationship networks through which work is coordinated across functional and organisational boundaries. Previous studies have shown that relational coordination is positively associated with delivery of care for patients with chronic illness. Organisational social capital is used when analysing......-line service and mindful gatekeeping. General practice are faced with a series of growing demands - from many GPs being close to retirement, to the increasing demands for comprehensive management and coordination of patient care. Neither researchers nor politicians have found solutions to overcome the growing....... The dissertation present the research study and a collection of three research papers prepared during the period from May 2010 to June 2014. Relational coordination and organisational social capital are measures of novel aspects of an organisation's performance. Relational coordination analyse the communication...
Andersen, John Sahl; Lindberg, Laura Maria Glahder; Nixon, Michael Simon;
Introduction: In Denmark about 600,000 persons are treated for hypertension and more than 300,000 people are receiving cholesterol lowering drugs. The prevalence of hypertension in people aged 80 years is 70%. For antidepressants the defined daily doses/1000 aged >80 years/day exceed 200. By far...... the most preventive drugs are prescribed in general practice. Special considerations exist in relation to medication of elderly patients. The prevalence of polypharmacy and the subsequent increased risk of side effects and drug interactions is high. Drug-related problems represent the fifth leading cause...... of death in the United States. The public expenses to drug treatment are constantly increasing. The possibility to withdraw the medication must be taken into account but the decision to discontinue drugs is complex and poorly understood. Planned studies: 1. Patients’ views upon discontinuation...
Devlin, Brooke L; Belski, Regina
Nutrition knowledge is believed to influence nutritional intake, which in turn influences performance in elite athletes. There is currently no published data on the nutrition knowledge of elite Australian Football (AF) players. The purpose of this study was to gain insight into the current level of general and sports nutrition knowledge in elite male AF athletes. Forty six elite male AF players (23.5 ± 2.8 years) answered 123 questions relating to five areas of nutrition knowledge: dietary recommendations, sources of nutrients, choosing everyday foods, alcohol and sports nutrition. Demographic details and perceptions of nutrition knowledge were collected for all participants. The mean nutrition knowledge score was 74.4 ± 10.9 (60.5%). The highest score was obtained in sports nutrition section (17.9 ± 3.0, 61.7%). The dietitian was selected as the first source of information by 98% of athletes, with club trainer and teammates as second choice for 45.7% and 23.9% of athletes, respectively. The majority of athletes correctly answered questions regarding recommendations to increase fruit and vegetable intake and decrease fat intake (95.6%, 91.1% and 93.3% correct respectively). While 80% of the athletes were aware fat intake should predominately be made up of unsaturated fat, they were less able to identify food sources of unsaturated fats (35.6% and 24.4% correct for statements regarding monounsaturated and polyunsaturated fats, respectively). Broad nutrition messages and recommendations appear to be well understood; however, gaps in nutrition knowledge are evident. A better understanding of nutrition knowledge in athletes will allow nutrition education interventions to target areas in need of improvement.
Full Text Available Purpose: Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice’s linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. Methods: An interview to measure surgery-level (rather than individual clinician-level clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations. Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. Results: The resulting General Practice Clinical Linkages Interview (GP-CLI is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. Conclusions: The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples
Full Text Available This research reports on a student audience engaging in an Australian university’s undergraduate commerce program core unit that is offered across three separate geographic campus locations and online. The research extends upon work undertaken on student engagement in online settings and lies in the domain of blended learning design and practice in the Australian higher education business context. Findings, inter alia, are presented across six major student engagement dimensions as applied to the interplay between online and located/campus learning (i.e. Online Active Learning, Online Social Interaction, Online Collaboration, Online Teaching, Online Assessment, and Online Contact with Staff. Implications for blended learning design, eLearning and practice in such complex environments are examined.
Benino D; Girardi A; Czarniak P
Objectives: To examine student perceptions regarding online lectures and quizzes undertaken during a pharmaceutical practice course for first year undergraduate students enrolled in the Bachelor of Pharmacy course at an Australian University.Methods: The University uses a standard instrument to collect feedback from students regarding unit satisfaction. Data were collected for three different teaching modalities: traditional face-to-face, online and partially online. Results: Descriptive stat...
Elston, Mary Ann; Gabe, Jonathan
This article focuses on the extent to which violence against family doctors in England is experienced in gendered terms. It draws on data from two studies: a postal survey of 1,300 general practitioners (GPs) (62% response rate) and in-depth interviews with 26 doctors who have been assaulted or threatened; and 13 focus groups with primary care teams and 19 in-depth interviews with GPs who had expressed an interest in the topic of violence against doctors. Most GPs, regardless of gender, reported receiving verbal abuse over the last two years, often interpreted as a consequence of declining deference to professionals, while actual physical assaults and threats were much rarer and more likely to be reported by men. Overall, women GPs were much more likely to express concern about violence and to take personal precautions, although younger male GPs working in inner-city practices also had high levels of concern. The study shows how some aspects of family doctors' work has been organised on gendered lines and how these contribute to the differences in experience of violence. We suggest that the increasing proportion of women among family doctors may have implications for these, often tacit, organisational routines. PMID:26498299
Life Satisfaction of Young Australians: Relationships between Further Education, Training and Employment and General and Career Satisfaction. Longitudinal Surveys of Australian Youth Research Report 43
Hillman, Kylie; McMillan, Julie
Prepared by the Australian Council for Educational Research (ACER) under an agreement with the Australian Government Department of Education, Science and Training (DEST), this report has three broad aims: (1) To describe the relationship between life satisfaction and participation in a range of post-school education, training and labour market…
Full Text Available Abstract Background Pharmacists are viewed as highly trained yet underutilised and there is growing support to extend the role of the pharmacist within the primary health care sector. The integration of a pharmacist into a general practice medical centre is not a new concept however is a novel approach in Australia and evidence supporting this role is currently limited. This study aimed to describe the opinions of local stakeholders in South-East Queensland on the integration of a pharmacist into the Australian general practice environment. Methods A sample of general practitioners, health care consumers, pharmacists and practice managers in South-East Queensland were invited to participate in focus groups or semi-structured interviews. Seeding questions common to all sessions were used to facilitate discussion. Sessions were audio recorded and transcribed verbatim. Leximancer software was used to qualitatively analyse responses. Results A total of 58 participants took part in five focus groups and eighteen semi-structured interviews. Concepts relating to six themes based on the seeding questions were identified. These included positively viewed roles such as medication reviews and prescribing, negatively viewed roles such as dispensing and diagnosing, barriers to pharmacist integration such as medical culture and remuneration, facilitators to pharmacist integration such as remuneration and training, benefits of integration such as access to the patient’s medical file, and potential funding models. Conclusions These findings and future research may aid the development of a new model of integrated primary health care services involving pharmacist practitioners.
Until recently, technological advances in general practice have generally been thought of as the applications of microcomputers in practice organization and record keeping. Advances in miniaturization and versatility of diagnostic technology will have a similarly large impact on the way general practitioners practice medicine in the next decade. This article reviews some of the newer tests that are already available to general practitioners, particularly in diagnostic biochemistry and microbi...
Dowling, Nicki; Hoiles, Lauren; Corney, Tim; Clark, David
In two studies of young Australian workers, participants generally displayed positive attitudes towards financial management practices; however, a substantial proportion failed to display positive financial management practices, experienced financial problems and dissatisfaction, and reported low rates of seeking financial assistance, particularly…
Burton, Suzanne L., Ed.
Middle school general music may be a student's last encounter with school music. A practical book with accessible pedagogical resources on middle school general music is needed for methods courses and music practitioners' use. The book "Engaging Musical Practices: A Sourcebook for Middle School General Music" presents numerous ways to engage…
Ee-Ming Khoo; Kidd, Michael Richard
The Australian and Malaysian systems of general practice were examined and compared. The issues of similarity and difference identified are discussed in this paper. Quality clinical practice and the importance of compulsory vocational training prior to entry into general practice and continuing professional development is one important area. A move towards preventive health care and chronic disease management was observed in both countries. Practice incentive programmes to support such initiatives as improved rates of immunisation and cervical smear testing and the implementation of information technology and information management systems need careful implementation. The Medicare system used in Australia may not be appropriate for general practitioners in Malaysia and, if used, a pharmaceutical benefit scheme would also need to be established. In both countries the corporatisation of medical practice is causing concern for the medical profession. Rural and aboriginal health issues remain important in both countries. Graduate medical student entry is an attractive option but workforce requirements mean that medical education will need individual tailoring for each country. Incorporating nurses into primary health care may provide benefits such as cost savings. The integration model of community centres in Malaysia involving doctors, nurses and allied health professionals, such as physiotherapists, in a single location deserves further examination. PMID:12862408
Hay, K E; Morton, J M; Clements, A C A; Mahony, T J; Barnes, T S
Bovine respiratory disease (BRD) is the major cause of clinical disease and death in feedlot cattle. A prospective longitudinal study was conducted in a population of Australian feedlot cattle to assess associations between factors related to feedlot management and risk of BRD. In total, 35,131 animals in 170 pens (cohorts) inducted into 14 feedlots were included in statistical analyses. Causal diagrams were used to inform model building to allow separate estimation of total and direct effects. Multilevel mixed effects logistic regression models were fitted within the Bayesian framework. The placement of pen water troughs such that they could be accessed by animals in adjoining pens was associated with markedly increased risk of BRD (OR 4.3, 95% credible interval: 1.4-10.3). Adding animals to pens over multiple days was associated with increased risk of BRD across all animals in those pens compared to placing all animals in the pen on a single day (total effect: OR 1.9, 95% credible interval: 1.2-2.8). The much attenuated direct effect indicated that this was primarily mediated via factors on indirect pathways so it may be possible to ameliorate the adverse effects of adding animals to pens over multiple days by altering exposure to these intervening factors (e.g. mixing history). In pens in which animals were added to the pen over multiple days, animals added ≥7 days (OR: 0.7, credible interval: 0.5-0.9) or 1-6 days (OR: 0.8, credible interval: 0.7-1.0) before the last animal was added were at modestly reduced risk of BRD compared to the animals that were added to the pen on the latest day. Further research is required to disentangle effects of cohort formation patterns at animal-level and higher levels on animal-level risk of BRD. Vaccination against Bovine herpesvirus 1 at feedlot entry was investigated but results were inconclusive and further research is required to evaluate vaccine efficacy. We conclude that there are practical interventions available to
Cassidy, Robert E.
The currently used internal and external program evaluation processes for general practice residency and advanced education in general dentistry programs are discussed, noting accrediting and evaluation groups, criteria, and designs. A generalized evaluation plan is proposed. (MSE)
Darbar, Arun A.
This is a clinical presentation on the use of laser therapy in a private dental practice using a 810nm diode. A wide range of conditions involving pain management, treatment and as an adjunct to procedures to enhance patient comfort and experience. This will include cases treated for TMD (Temporo mandibular dysfunction), apthous ulcers, angular chelitis, cold sores, gingival retraction, periodontal treatment and management of failing dental implants. The case presentation will include the protocols used and some long term reviews. The results have been very positive and will be shared to enable this form of treatment to be used more frequently and with confidence within dental practice.
Full Text Available Abstract Background The clinical audit of vitamin D health promotion in one Australian general practice was undertaken by measuring health service use and serum 25-hydroxyvitamin D levels in 995 patients aged 45 to 49 years. Findings Over 3 years, 486 (51% patients had a Medicare funded Health Assessment. More women (54% were assessed than men (46% p = 0.010. Mean 25-OHD was higher for men (70.0 nmol/l than women (60.3 nmol/l p Among 266 patients who had a 25-OHD test, 68 (26% had normal levels 80+ nmol/l, 109 (41% were borderline 51-79 nmol/l, and 89 (33% were low Conclusions Health promotion information about vitamin D was provided to 50% of a targeted group of patients over a one-year period. Provision of this information had no effect on the uptake rates of an invitation to attend for a general health assessment.
Ivan Toshio Maruo
Full Text Available OBJECTIVE: General dentist orthodontic practice is a controversial issue and this paper aims to analyze it comparing foreign laws to Brazilian Legal System. METHODS: Regulations and scientific texts concerning orthodontic practice by general dentists, in Portuguese or English language, were sought. RESULTS AND CONCLUSION: Portugal clearly forbids general dentist orthodontic practice; United States of America do not clearly forbid general dentist orthodontic practice, but do regulate and promote campaigns to encourage public to seek specialist service; in Australia and England, corrective orthodontics are offered both by orthodontists and general dentists; it was not possible to evaluate how orthodontic services are provided in Eastern Europe; and the fact that general dentists are forbidden to practice corrective orthodontics in Brazilian Legal System is compatible to other countries policy.
Chapman, Anne; Pyvis, David
This paper reports the findings of qualitative case studies aimed at exploring student experiences of offshore programmes delivered in Singapore, Hong Kong and Malaysia by Australian universities. The paper draws on a cross-case analysis of the studies to develop propositions about student experience and identity formation in the context of…
Hodge, Paul; Wright, Sarah; Barraket, Jo; Scott, Marcelle; Melville, Rose; Richardson, Sarah
Ideas of "how we learn" in formal academic settings have changed markedly in recent decades. The primary position that universities once held on shaping what constitutes learning has come into question from a range of experience-led and situated learning models. Drawing on findings from a study conducted across three Australian universities, the…
Rambaldi, A; Todisco, N; Gluud, C;
heavy alcohol consumption had a predictive negative value of 97.2% (95% CI 90.2-99.7%) and a predictive positive value of 73.1% (95% CI 59.0-84.4%) in relation to MAST positive patients. It is suggested that general practitioners should incorporate this question about heavy alcohol consumption...
Aim of the study The aim of this thesis was to investigate changes in doctor-patient communication, within the context of changes over the course of time in general practice care in the Netherlands. We focused on the question: How are changes in general practice (shifts in approaches) reflected in d
Derksen, F.; Bensing, J.; Lagro-Janssen, A.
BACKGROUND: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. Th
Derksen, F.; Bensing, J.; Lagro-Janssen, A.
Background: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. Th
Gerrits, M.; Avery, A.J.; Lagro-Janssen, A.L.M.
OBJECTIVES: In several Western European countries guidelines regarding urinary incontinence (UI) management in general practice have been drawn up. The aim of this study was to evaluate guideline adherence with feedback in general practice in order to improve UI management. METHODS: First, a retrosp
Gerrits, M.; Avery, A.J.; Lagro-Janssen, A.L.M.
Objectives In several Western European countries guidelines regarding urinary incontinence (UI) management in general practice have been drawn up. The aim of this study was to evaluate guideline adherence with feedback in general practice in order to improve UI management. Methods First, a retrospec
Kooijman, M.; Swinkels, I.; Veenhof, C.
Purpose: The aim of this study is to describe the patient population and the process of care in patients with subacromial shoulder complaints both in physiotherapy and in general practice. Relevance: Shoulder complaints are common in the daily practice of a general practitioner (GP) and physiotherap
Thomas, J M
In Belgium, the GP can perform euthanasia or be called as a consultant. He must know the laws concerning the end of life and be able to explain his rights to his patients. He will know the best practices and techniques for euthanasia. If necessary, he will call help or refer to a more competent colleague. He negotiates with the patient an advanced care planning following the evolution of its pathologies and will witness its wishes regarding end of life against other institutions and doctors.
Full Text Available Abstract Background Human rights violations have adverse consequences for health. However, to date, there remains little empirical evidence documenting this association, beyond the obvious physical and psychological effects of torture. The primary aim of this study was to investigate whether Australian asylum policies and practices, which arguably violate human rights, are associated with adverse health outcomes. Methods We designed a mixed methods study to address the study aim. A cross-sectional survey was conducted with 71 Iraqi Temporary Protection Visa (TPV refugees and 60 Iraqi Permanent Humanitarian Visa (PHV refugees, residing in Melbourne, Australia. Prior to a recent policy amendment, TPV refugees were only given temporary residency status and had restricted access to a range of government funded benefits and services that permanent refugees are automatically entitled to. The quantitative results were triangulated with semi-structured interviews with TPV refugees and service providers. The main outcome measures were self-reported physical and psychological health. Standardised self-report instruments, validated in an Arabic population, were used to measure health and wellbeing outcomes. Results Forty-six percent of TPV refugees compared with 25% of PHV refugees reported symptoms consistent with a diagnosis of clinical depression (p = 0.003. After controlling for the effects of age, gender and marital status, TPV status made a statistically significant contribution to psychological distress (B = 0.5, 95% CI 0.3 to 0.71, p ≤ 0.001 amongst Iraqi refugees. Qualitative data revealed that TPV refugees generally felt socially isolated and lacking in control over their life circumstances, because of their experiences in detention and on a temporary visa. This sense of powerlessness and, for some, an implicit awareness they were being denied basic human rights, culminated in a strong sense of injustice. Conclusion Government asylum policies
O'Riordan, M.; Dahinden, A.; Akturk, Z.; Ortiz, J.M.; Dagdeviren, N.; Elwyn, G.; Micallef, A.; Murtonen, M.; Samuelson, M.; Struk, P.; Tayar, D.; Thesen, J.
Many patients attending general practice do not have an obvious diagnosis at presentation. Skills to deal with uncertainty are particularly important in general practice as undifferentiated and unorganised problems are a common challenge for general practitioners (GPs). This paper describes the mana
A random sample of general practitioners and their nursing staff was interviewed to examine the extent to which the doctors delegated medical tasks to the nurses and to analyse attitudes towards delegation. A significant minority of both doctors and nurses were reluctant to have minor clinical tasks delegated and a majority did not think that nurses should carry out delegated diagnostic procedures. Doctors and nurses who had completed their training since 1960 were more likely to favour deleg...
Ulrik, Charlotte Suppli; Løkke, Anders; Dahl, Ronald; Dollerup, Jens; Hansen, Gert; Cording, Patrick Hagge; Andersen, Klaus Kaae
Background and aim Early detection enables the possibility for interventions to reduce the future burden of COPD. The Danish National Board of Health recommends that individuals >35 years with tobacco/occupational exposure, and at least 1 respiratory symptom should be offered a spirometry to facilitate early detection of COPD. The aim, therefore, was to provide evidence for the feasibility and impact of doing spirometry in this target population. Methods Participating general practitioners (G...
Robertson Jan A
Full Text Available Abstract Background In Australia generally, smoking prevalence more than halved after 1980 and recently commenced to decline among Australia's disadvantaged Indigenous peoples. However, in some remote Indigenous Australian communities in the Northern Territory (NT, extremely high rates of up to 83% have not changed over the past 25 years. The World Health Organisation has called for public health and political leadership to address a global tobacco epidemic. For Indigenous Australians, unprecedented policies aim to overcome disadvantage and close the 'health gap' with reducing tobacco use the top priority. This study identifies challenges and opportunities to implementing these important new tobacco initiatives in remote Indigenous communities. Methods: With little empirical evidence available, we interviewed 82 key stakeholders across the NT representing operational- and management-level service providers, local Indigenous and non-Indigenous participants to identify challenges and opportunities for translating new policies into successful tobacco interventions. Data were analysed using qualitative approaches to identify emergent themes. Results The 20 emergent themes were classified using counts of occasions each theme occurred in the transcribed data as challenge or opportunity. The 'smoke-free policies' theme occurred most frequently as opportunity but infrequently as challenge while 'health workforce capacity' occurred most frequently as challenge but less frequently as opportunity, suggesting that policy implementation is constrained by lack of a skilled workforce. 'Smoking cessation support' occurred frequently as opportunity but also frequently as challenge suggesting that support for individuals requires additional input and attention. Conclusions These results from interviews with local and operational-level participants indicate that current tobacco policies in Australia targeting Indigenous smoking are sound and comprehensive
Full Text Available Well-organised medical records are the prerequisite for achieving a high level of performance in primary healthcare settings. Recording balanced structured and coded data as well as free text can improve both quality and organisation of work in the office. It provides a more substantiated support of financial transactions and accountancy, allows better communication with other facilities and institutions, and is a source of valuable scientific research material. This article is the result of an individual experience gained in general practice use of various programs/ systems employed within the family medicine frame, and the frame of evaluation of available and commonly- exploited program solutions. The use of various programs allows for systematic adjustments as to the increasingly complex requirements imposed on electronic medical records (EMRs. The experience of a general practitioner, presented in this paper, confirms the assumption that an adequate program to be employed with EMRs should be developed, provided that family medicine practitioners, that is, the final users, have been involved in each and every stage of its development, adjustment, implementation and evaluation.
Bergman-Marković, Biserka; Katić, Milica; Kern, Josipa
Well-organised medical records are the prerequisite for achieving a high level of performance in primary healthcare settings. Recording balanced structured and coded data as well as free text can improve both quality and organisation of work in the office. It provides a more substantiated support of financial transactions and accountancy, allows better communication with other facilities and institutions, and is a source of valuable scientific research material. This article is the result of an individual experience gained in general practice use of various programs/systems employed within the family medicine frame, and the frame of evaluation of available and commonly-exploited program solutions. The use of various programs allows for systematic adjustments as to the increasingly complex requirements imposed on electronic medical records (EMRs). The experience of a general practitioner, presented in this paper, confirms the assumption that an adequate program to be employed with EMRs should be developed, provided that family medicine practitioners, that is, the final users, have been involved in each and every stage of its development, adjustment, implementation and evaluation.
Liu, X. Y.
A low-top version of SEMANS (Spectral Element Model with Atmospheric Near Space resolved) has been used to carry out numerical simulation on characteristics of Asian- Australian Monsoon (A-AM) in the work. The simulation results are validated with ERA- Interim reanalysis dataset and precipitation data from satellite remote sensing. It's shown that the model can reproduce the major climatic features of A-AM with stronger easterly in the tropical Eastern Pacific, and a weaker northerly component in the Northern Hemisphere.The simulated precipitation rate is larger and the double ITCZ (Inter-Tropical Convergence Zone) in the tropical Eastern Pacific in the northern spring is not reproduced. A due to the absence of variation longer than a year in the bottom boundary conditions, the model cannot reproduce the relationships between the monsoon indexes and the surface air temperature in the broad area near the equator.
... 19 Customs Duties 2 2010-04-01 2010-04-01 false General ruling practice and definitions. 177.1 Section 177.1 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY (CONTINUED) ADMINISTRATIVE RULINGS General Ruling Procedure § 177.1 General...
The World Health Organization's Ottawa Charter for Health Promotion has been influential in guiding the development of 'settings' based health promotion. Over the past decade, settings such as schools have flourished and there has been a considerable amount of academic literature produced, including theoretical papers, descriptive studies and evaluations. However, despite its central importance, the health-promoting general practice has received little attention. This paper discusses: the significance of this setting for health promotion; how a health promoting general practice can be created; effective health promotion approaches; the nursing contribution; and some challenges that need to be resolved. In order to become a health promoting general practice, the staff must undertake a commitment to fulfil the following conditions: create a healthy working environment; integrate health promotion into practice activities; and establish alliances with other relevant institutions and groups within the community. The health promoting general practice is the gold standard for health promotion. Settings that have developed have had the support of local, national and European networks. Similar assistance and advocacy will be needed in general practice. This paper recommends that a series of rigorously evaluated, high-quality pilot sites need to be established to identify and address potential difficulties, and to ensure that this innovative approach yields tangible health benefits for local communities. It also suggests that government support is critical to the future development of health promoting general practices. This will be needed both directly and in relation to the capacity and resourcing of public health in general.
Full Text Available INTRODUCTION: There is evidence that the collection of ethnicity data in New Zealand primary care is variable and that data recording in practices does not always align with the procedures outlined in the Ethnicity Data Protocols for the Health and Disability Sector. In 2010, The Ministry of Health funded the development of a tool to audit the collection of ethnicity data in primary care. The aim of this study was to pilot the Ethnicity Data Audit Tool (EAT in general practice. The goal was to evaluate the tool and identify recommendations for its improvement. METHODS: Eight general practices in the Waitemata District Health Board region participated in the EAT pilot. Feedback about the pilot process was gathered by questionnaires and interviews, to gain an understanding of practices’ experiences in using the tool. Questionnaire and interview data were analysed using a simple analytical framework and a general inductive method. FINDINGS: General practice receptionists, practice managers and general practitioners participated in the pilot. Participants found the pilot process challenging but enlightening. The majority felt that the EAT was a useful quality improvement tool for handling patient ethnicity data. Larger practices were the most positive about the tool. CONCLUSION: The findings suggest that, with minor improvements to the toolkit, the EAT has the potential to lead to significant improvements in the quality of ethnicity data collection and recording in New Zealand general practices. Other system-level factors also need to be addressed.
Bosch, W.J.H.M. van den
The practice guideline 'Anaemia' from the Dutch College of General Practitioners will certainly be a support for the Dutch general practitioner. The inclusion of an algorithm to make a more precise diagnosis is an experiment that needs to be evaluated in the near future. However, many general practi
BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.
Møller Pedersen, Kjeld; Andersen, John Sahl; Søndergaard, Jens
General practice is the corner stone of Danish primary health care. General practitioners (GPs) are similar to family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or E-mail consultation). General practice is characterized...... education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new challenges...... and is expected to accelerate, in part because of the GP age structure, with many GPs retiring and new GPs not wanting to practice alone. This latter workforce trend is pointing toward a new model with employed GPs, particularly in rural areas....
Kovalchuk, L I; Prokopchuk, Y V; Naydyonova, O V
The article presents the experience of postgraduate training of general practitioners--family medicine. Identified current trends, forms and methods of pedagogical innovations that enhance the quality of learning and mastering the practical skills of primary professionals providing care.
Full Text Available Abstract Objective To ascertain the issues all general practice educators need to understand when educating GP registrars to learn about research. Study Design A review of MEDLINE [1996–2007], six websites and key informants produced 302 publications, which reduced to 35 articles, 7 books, and 9 policy documents. Results Key themes that emerged from a thematic analysis of the literature that GP educators need to consider when teaching registrars about research were [i] the need to understand that learning research is influenced by attitudes; [ii] the need to address organisational constraints on learning research; [iii] the need to identify the educational barriers on learning research; [iv] the need to understand there are gaps in GP research content – especially from GP registrars; And [v] the need to understand the value of research on the GP registrar's educational cycle of learning, which develops in a culture that allows research to flourish. Conclusion Australian GP registrars will observe a research culture only if they encounter clinician-researchers paid to practice and conduct research in their general practice.
Essex, B.; Jackson, R. N.
A game has been developed to train people in the financial and administrative skills needed for effective general practice management. These skills cover a wide range of legal, economic, administrative and personnel problems encountered in general practice. Thirty-four trainees and six trainers showed a highly significant improvement in knowledge and problem-solving skills after playing the game. The format and design of the game allow the problem type, complexity and solution to vary and to ...
Kooijman, M.; Swinkels, I.; Veenhof, C.
Purpose: The aim of this study is to describe the patient population and the process of care in patients with subacromial shoulder complaints both in physiotherapy and in general practice. Relevance: Shoulder complaints are common in the daily practice of a general practitioner (GP) and physiotherapist. They often have a recurrent and lengthy clinical course and substantial disability in daily livingmayresult from it, leading to consumption of medical health care and sick leave from work. Abo...
Thomas, S.; Jenkins, R; Burch, T.; Nasir, L.C.; Fisher, B; Giotaki, G.; Gnani, S; Hertel, L; Marks, M.; Mathers, N.; Millington-Sanders, C.; D. Morris; Ruprah-Shah, B.; Stange, K.; Thomas, P
This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity. files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert ‘Think Tank’ convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHIC...
Flavia Fayet-Moore; Suzanne Pearson
Food-based dietary guidelines shift the focus from single nutrients to whole diet. Guideline 3 of the Australian Dietary Guidelines (ADG) recommends “limiting” discretionary foods and beverages (DF)—Those high in saturated fat, added sugars, salt, and/or alcohol. In Australia, DF contribute 35% of total energy intake. Using the ADG supporting documents, the aim of this study was to develop a food‑based educational toolkit to help translate guideline 3 and interpret portion size. The methodolo...
Campbell Michael J
Full Text Available Abstract Background Many medical specialities have reviewed the statistical content of their journals. To our knowledge this has not been done in general practice. Given the main role of a general practitioner as a diagnostician we thought it would be of interest to see whether the statistical methods reported reflect the diagnostic process. Methods Hand search of three UK journals of general practice namely the British Medical Journal (general practice section, British Journal of General Practice and Family Practice over a one-year period (1 January to 31 December 2000. Results A wide variety of statistical techniques were used. The most common methods included t-tests and Chi-squared tests. There were few articles reporting likelihood ratios and other useful diagnostic methods. There was evidence that the journals with the more thorough statistical review process reported a more complex and wider variety of statistical techniques. Conclusions The BMJ had a wider range and greater diversity of statistical methods than the other two journals. However, in all three journals there was a dearth of papers reflecting the diagnostic process. Across all three journals there were relatively few papers describing randomised controlled trials thus recognising the difficulty of implementing this design in general practice.
Burns, Kara; Belton, Suzanne
Medical photography illustrates what people would prefer to keep private, is practiced when people are vulnerable, and has the power to freeze a moment in time. Given it is a sensitive area of health, lawful and ethical practice is paramount. This paper recognises and seeks to clarify the possibility of widespread clinician-taken medical photography in a tertiary hospital in northern Australia, examining the legal and ethical implications of this practice. A framework of Northern Territory law, state Department of Health policy and human rights theory were used to argue the thesis. Clinicians from 13 purposively chosen wards were asked to participate in an anonymous survey and confidential in-depth interviews. Questions were generated from the literature and local knowledge on the topics of 'occurrence', 'image use', 'quality of consent', 'cameras and technology', 'confidentiality', 'data storage and security', 'hospital policy and law' and 'cultural issues'. One hundred and seventy surveys and eights interviews were analysed using descriptive statistics and theme and content analysis, then triangulated for similarity, difference and unique responses. Forty-eight percent of clinicians surveyed take medical photographs, with the majority using hospital-owned cameras. However, one-fifth of clinicians reported photographing with personal mobile phones. Non-compliance with written consent requirements articulated in policy was endemic, with most clinicians surveyed obtaining only verbal consent. Labeling, storage, copyright and cultural issues were generally misunderstood, with a significant number of clinicians risking the security of patient information by storing images on personal devices. If this tertiary hospital does not develop a clinical photography action plan to address staff lack of knowledge, and noncompliance with policy and mobile phone use, patients' data is at risk of being distributed into the public domain where unauthorised publication may cause
BACKGROUND. Research into general practitioners' responses to the changes in the health service has focused on the quantifiable dimensions of workload, stress, job satisfaction and mental health. AIM. This study set out to investigate general practitioners' practice orientations and responses to change. METHOD. The study was undertaken in 1992. 'Young principals' who had attended MSD Foundation regional courses were invited by letter to reflect on recent change in general practice and to give...
Havelock, Christine; Edwards, Robert; Cuzick, Jack; Chamberlain, Jocelyn
Well organized cervical screening in general practice can have considerable clinical and financial rewards. Yet in a randomized survey of general practitioners in the United Kingdom only 43% operated a system for cervical screening which allows previously untested women to be identified and invited for testing.
Lange, Peter; Rasmussen, Finn Vejlø; Borgeskov, Hanne;
We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve adherence...
Vedsted, Peter; Olesen, Frede
BACKGROUND: A lack of social support is associated with increased morbidity and mortality and a decreased effect of prevention. Frequent attenders to primary care are characterised by poorer social conditions than other patients in general practice, but we do not know whether this is due to social...... inequalities in health or whether social factors in themselves determine the use of general practice. AIM: To examine if social factors are associated with frequent attendance in general practice after adjusting for physical and psychological health variables. DESIGN OF STUDY: Population-based cross......-sectional survey. SETTING: Two hundred and twenty GPs in 132 practices in the county of Aarhus, Denmark, and the listed adult population (aged 20-64 years). METHOD: A sample of frequent attenders and infrequent attenders was drawn. The study included only those resident in the county and who had consulted a GP...
Cavanagh, Jillian; Southcombe, Amie; Bartram, Tim
This study examines the role and impact of collaborative learning on training and development practices in Australian Men's Sheds. We use a case study approach, underpinned by Peters and Armstrong's theoretical framework of collaborative learning in adult education, to investigate five Men's Sheds. Semi-structured interviews were…
J.S. de Koning (Johan); N.S. Klazinga (Niek); P.J. Koudstaal (Peter Jan); A. Prins (Ad); G.J.J.M. Borsboom (Gerard); J.P. Mackenbach (Johan)
textabstractOBJECTIVE: To investigate the relationship between elements of practice organization related to stroke prevention in general practice, and suboptimal preventive care preceding the occurrence of stroke. DESIGN: This study was conducted among 69 Dutch general practitioners in the Rotterda
Clerc, Isabelle; Ventelou, Bruno; Guerville, Marc-André; Paraponaris, Alain; Verger, Pierre
General practitioners' (GPs') use of clinical practice guidelines (CPGs) may be influenced by various contextual and attitudinal factors. This study examines general attitudes toward CPGs to establish profiles according to these attitudes and to determine if these profiles are associated with awareness and with use of CPGs in daily practice. The authors conducted a cross-sectional telephone survey of 1,759 French GPs and measured (a) their general attitudes toward CPGs and (b) their awareness and use in daily practice of CPGs for six specific health problems. A bivariate probit model was used with sample selection to analyze the links between GPs' general attitudes and CPG awareness/use. The authors found three GP profiles according to their opinions toward CPGs and a positive association between these profiles and CPG awareness but not use. It is important to build awareness of CPGs before GPs develop negative attitudes toward them. PMID:21536601
Møller Pedersen, Kjeld; Andersen, John Sahl; Søndergård, Jens
education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new challenges......) an after-hours system staffed by GPs on a rota basis; (4) a mixed capitation and fee-for-service system; and (5) GPs are self-employed, working on contract for the public funder based on a national agreement that details not only services and reimbursement but also opening hours and required postgraduate......General practice is the corner stone of Danish primary health care. General practitioners (GPs) are similar to family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or E-mail consultation). General practice is characterized...
van Drenth, B B; Hulscher, M E; van der Wouden, J C; Mokkink, H G; Van Weel, C; Grol, R P
BACKGROUND: Research findings suggest that the level of cardiovascular risk factor recording in general practice is not yet optimal. Several studies indicate a relation between the organization of cardiovascular disease prevention at practice level and cardiovascular risk factor recording. AIM: To explore the relation between the organization of cardiovascular disease prevention and risk factor recording in general practice. METHOD: A cross-sectional study was conducted using data on adherenc...
Types of social media (Web 2.0) usage associated with eight of Australia's major allied health professions (AHPs, n = 935) were examined. Australian AHPs are interacting with Web 2.0 technologies for personal use but are failing to implement such technologies throughout their health professions to deliver health care. Australian AHPs are willing to undertake online educational courses designed to up skill them about how Web 2.0 may be used for practice promotion and health care delivery in the early twenty-first century. Participants in this study indicated that educational courses that were offered online would be the preferred mode of delivery.
Weel, C. van
This article reviews the practice guideline from the Dutch College of General Practitioners on smoking cessation. General practitioners (GP) should strive after smoking cessation when patients consult and ask for support to stop smoking. Moreover, the practitioner should also show such initiative wh
, flexible support from the PN in partnership with the GP and the Quitline could become the preferred model for providing smoking cessation advice in Australian general practice. Trial Registration ACTRN12609001040257
Full Text Available Research findings from psychological science have identified interventions that will benefit human health. However, these findings are not often incorporated into practice-based settings or used to inform policy, in part, due to methodological and contextual limitations. A strategic approach is required if we are to find a way to facilitate the translation of these findings into areas that will offer genuine impact on health. There is an overwhelming focus on conducting more clinical trials, without consideration of how to ensure that findings from such trials make it to the patients or populations for whom they were intended. The aim of this paper is to outline how the Black Dog Institute, an Australian medical research institute, has created a framework designed to facilitate the translation of research findings into practice-based community settings, and how these findings can be used to inform policy. We propose that the core strategies adopted at the Black Dog Institute to prioritise and implement a translational program will be useful to institutes and organisations worldwide to augment the impact of their work. We provide several examples of how our research has been implemented in practice-based settings at a community-level, and how we have used research in psychology as a platform to inform policy change.
Kjaer, Niels Kristian; Kodal, Troels; Qvesel, Dorte
BACKGROUND: In recent years, there has been growing interest in the role of primary care in postgraduate training. Relatively little has been published about benefits of early and sustained postgraduate basic training in general practice, especially for doctors with other ambitions than family...... medicine. AIM: To explore young Danish doctors' views on basic medical training including views on the participation of general practice. METHODS: We conducted a cross-sectional survey of all Danish doctors, who took part in the postgraduate basic training programmes in 2009. The survey consisted of rating...... scale and qualitative questions. We used a phenomenological approach. RESULTS: Almost all of the young Danish doctors responding felt that training in general practice is a necessary part of a postgraduate basic training programme. Early training in primary care not only gives doctors a broad...
Junge, Anne Gram; Kirkegaard, Pia; Thomsen, Janus Laust
with the arranged preventive consultation with focus on facilitators and barriers in the implementation of the consultation. Material & Method: Semi-structured interviews with 10 GPs and nurses in general practice. Results & Conclusions: Economically lucrative services are not an isolated motivation for the GPs....../nurses, but must be accompanied with a basic belief in the effect of preventive consultations in general practice. The better payment of the 0106-service is used to spend more time per consultation and it makes the GPs/nurses feel rewarded for the preventive work they perform. The consultation frames a social...
Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún;
Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known.......Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known....
Green, Philip E.
This paper describes a project in which a voluntary preferred prescribing list (general practice formulary), analogous to those already in use in some hospitals, was created, implemented and monitored. Cooperation between a pharmacist with knowledge of drug information, access to specialist advice and back-up in the form of evaluated information from drug information centres and a group of five general practitioners and their trainees was necessary.
Kousgaard, Marius Brostrøm; Thorsen, Thorkil
The use of facilitators for quality improvement in general practice has accelerated during the past decade. As general practitioners (GPs) or pharmacists have typically been used as facilitators, there is a lack of knowledge of how other professionals function as facilitators. This article explor...... the experiences and assessments of GPs and nurses participating in a project in which a medical specialist (endocrinologist) acted as a facilitator for quality improvement....
Stephen Burgess; John Breen; Regina Quiazon
This article reports on a study involving analysis of the Web sites of 100 accounting practices located in Melbourne, Australia, and subsequent interviews with twenty practices. This article focuses on identifying the level of e-services that they employ. In this regard, Angehrnâ€™s virtual dimensions of Web site spaces were used to classify the various service delivery strategies adopted by the different practices. The results suggest that information technology plays a critical role in the ...
Bolter, R.; Freund, T.; Ledig, T.; Boll, B.; Szecsenyi, J.; Roos, M.
Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibilit
Full Text Available Food-based dietary guidelines shift the focus from single nutrients to whole diet. Guideline 3 of the Australian Dietary Guidelines (ADG recommends “limiting” discretionary foods and beverages (DF—Those high in saturated fat, added sugars, salt, and/or alcohol. In Australia, DF contribute 35% of total energy intake. Using the ADG supporting documents, the aim of this study was to develop a food‑based educational toolkit to help translate guideline 3 and interpret portion size. The methodology used to produce the toolkit is presented here. “Additional energy allowance” is specific to gender, age, height and physical activity level, and can be met from core foods, unsaturated fats/oils/spreads and/or DF. To develop the toolkit, additional energy allowance was converted to serves equaling 600 kJ. Common DF were selected and serves were determined based on nutrient profile. Portion sizes were used to calculate number of DF serves. A consumer brochure consisting of DF, portion sizes and equivalent number of DF serves was developed. A healthcare professional guide outlines the methodology used. The toolkit was designed to assist dietitians and consumers to translate guideline 3 of the ADF and develop a personalized approach to include DF as part of the diet.
Fayet-Moore, Flavia; Pearson, Suzanne
Food-based dietary guidelines shift the focus from single nutrients to whole diet. Guideline 3 of the Australian Dietary Guidelines (ADG) recommends "limiting" discretionary foods and beverages (DF)-Those high in saturated fat, added sugars, salt, and/or alcohol. In Australia, DF contribute 35% of total energy intake. Using the ADG supporting documents, the aim of this study was to develop a food‑based educational toolkit to help translate guideline 3 and interpret portion size. The methodology used to produce the toolkit is presented here. "Additional energy allowance" is specific to gender, age, height and physical activity level, and can be met from core foods, unsaturated fats/oils/spreads and/or DF. To develop the toolkit, additional energy allowance was converted to serves equaling 600 kJ. Common DF were selected and serves were determined based on nutrient profile. Portion sizes were used to calculate number of DF serves. A consumer brochure consisting of DF, portion sizes and equivalent number of DF serves was developed. A healthcare professional guide outlines the methodology used. The toolkit was designed to assist dietitians and consumers to translate guideline 3 of the ADF and develop a personalized approach to include DF as part of the diet. PMID:25803544
Vedsted, Peter; Sokolowski, Ineta; Olesen, Frede
Walk-in open access in general practice may influence the general practitioner's (GP's) work, but very little research has been done on the consequences. In this study from Danish general practice, we compare the prevalence of burnout between GPs with a walk-in open access and those without....... In a questionnaire study (2004), we approached all 458 active GPs in the county of Aarhus, Denmark, and 376 (82.8%) GPs returned the questionnaire. Walk-in open access was defined as at least 30 minutes every weekday where patients could attend practice without an appointment. Burnout was measured by the Maslach...... Burnout Inventory. Analyses using logistic regression were adjusted for gender, age, marital status, job satisfaction, minutes per consultation, practice organisation, working hours, number of listed patients per GP, number of contacts per GP, continuing medical education- (CME-) activities, and clusters...
Aabenhus, Rune; Siersma, Volkert; Hansen, Malene Plejdrup;
general practice relative to the entire primary care sector. METHODS: This was a registry-based study including all patients who redeemed an antibiotic prescription between July 2004 and June 2013 at a Danish community pharmacy. Antibiotic use was expressed as DDDs and treatments/1000 inhabitants...
Tiessen, Ans H.; Smit, Andries J.; Zevenhuizen, Sebes; Spithoven, Edwin M.; Van der Meer, Klaas
Background: Lower social economic status (SES) is related to an elevated cardiovascular (CV) risk. A pro-active primary prevention CV screening approach in general practice (GP) might be effective in a region with a low mean SES. This approach, supported by a regional GP laboratory, was investigated
Verhoeven, AAH; Jong, BMD
Background. As a result of changes in information technology and the rapid growth of publications methods of searching the literature have changed. Systematic searching of the growing literature has become very important. It is not known whether researchers in general practice search systematically,
In the current social context Information and Communication Technologies (ICT) are more and more present and pervasive and the European institutions enter the Digital Competence in the Key Competences for Lifelong Learning. In this focus we are deepened the general problems of Digital Competence and competence-based education and to describe experimental practices concerning highschools.
Cole, F H
This paper reports a new radiopaging service supplied by British Telecom that will eventually cover the whole United Kingdom. The use of this service by a three-man practice is described. The service is considered to be a major development in communications that will be of interest to most general practitioners.
J.H.J.M. Uijen (Hans)
textabstractThe work presented in this thesis covers various aspects of the epidemiology, diagnosis and management of various respiratory symptoms and diseases in children frequently encountered in general practice. These respiratory tract symptoms and diseases can be categorized into symptoms and d
Hardy, Louise L; Hector, Debra; Saleh, Shay; King, Lesley
The home environment is associated with obesity-related behaviours among children, and research in Australia has shown that some of these behaviours are more prevalent among children from particular cultural backgrounds including Middle Eastern. This study presents findings from face-to-face, semi-structured interviews conducted in April 2013 with a convenience sample of Middle Eastern parents of primary school-age children at an Islamic private school in Sydney, Australia. The interviews explored parental perceptions and practices regarding state government health messages addressing children's eating, physical activity and screen time. The purpose of the study was to investigate whether the content of these generic public health messages is relevant and acceptable to Middle Eastern parents of young children, and to identify any enablers and barriers to adopting these healthy practices at home. Thematic analysis identified predominant themes. In total, 21 interviews were conducted (reference children: 12 boys/9 girls, aged 5-12 years). The content of current health messages regarding children's weight-related behaviours was familiar to respondents, and accepted as relevant for guiding their parenting practices. Parents perceived that they typically encouraged healthy behaviours, although they also reported making regular exemptions, in response to various circumstances. Overall, the perceptions and reported practices of the parents were consistent with other studies with Australian parents. There were no apparent culturally specific barriers or enablers to children's weight-related behaviours. There is however scope for health promoters to provide more precise information on health recommendations, health risks and benefits, and to provide more specific ideas for ways in which parents can act on these health messages within the home and family environment, to encourage and support healthy behaviours in their children. PMID:25929280
Direct access referral for radiological investigations from General Practice (GP) provides an indispensable diagnostic tool and avoids the inherently long waiting time that referral through a hospital based specialty would entail. Improving access to hospital based radiology services is one of Health Information and Quality Authority\\'s key recommendations in its report on patient referrals from general practice. This study aimed to review all GP referrals for ultrasound investigations to a tertiary referral teaching hospital over a seven month period with respect to their demographics, waiting times and diagnostic outcomes. 1,090 ultrasounds originating in general practice were carried out during the study period. Positive findings were recorded in 332 (30.46%) examinations. The median waiting time from receipt of referral to the diagnostic investigation was 56 days (range 16 - 91 years). 71 (6.5%) patients had follow-up imaging investigations while recommendation for hospital based specialty referral was made in 35 cases (3.2%). Significant findings included abdominal aortic aneurysms, metastatic disease and lymphoma. Direct access to ultrasound for general practitioners allows the referring physician to make an informed decision with regard to the need for specialist referral. We believe these findings help support the case for national direct access to diagnostic ultrasound for general practitioners.
Barten, D.J.; Swinkels, I.C.; Dorsman, S.A.; Veenhof, C.
Purpose: To describe demographic characteristics and the treatment process of patients with hip osteoarthritis (OA) or knee OA treated in Dutch general practice (GP) and/or physiotherapy practice. Additionally, to investigate whether there are differences in characteristics between referred and non-
Charlton, Karen; Yeatman, Heather; Lucas, Catherine; Axford, Samantha; Gemming, Luke; Houweling, Fiona; Goodfellow, Alison; Ma, Gary
A before-after review was undertaken to assess whether knowledge and practices related to iodine nutrition, supplementation and fortification has improved in Australian women since the introduction of mandatory iodine fortification in 2009. Surveys of pregnant (n = 139) and non-pregnant (n = 75) women in 2007-2008 are compared with surveys of pregnant (n = 147) and lactating women (n = 60) one to two years post-fortification in a regional area of New South Wales, Australia. A self-administered questionnaire was completed and dietary intake of iodine was assessed using a validated food frequency questionnaire. A generally poor knowledge about the role and sources of iodine in the diet remained after fortification. Post-fortification, iodine-containing supplements were being taken by 60% (up from 20% pre-fortification) and 45% of pregnant and lactating women, respectively. Dairy foods were the highest contributors to dietary iodine intake (57%-62%). A low intake of fish and seafood resulted in this food group contributing only 3%-8% of total intake. A low level of public awareness regarding the role of iodine in health supports the need for public health strategies in addition to fortification, such as an accompanying consumer education campaign, increased uptake of supplementation, and on-going monitoring.
Full Text Available A before-after review was undertaken to assess whether knowledge and practices related to iodine nutrition, supplementation and fortification has improved in Australian women since the introduction of mandatory iodine fortification in 2009. Surveys of pregnant (n = 139 and non-pregnant (n = 75 women in 2007–2008 are compared with surveys of pregnant (n = 147 and lactating women (n = 60 one to two years post-fortification in a regional area of New South Wales, Australia. A self-administered questionnaire was completed and dietary intake of iodine was assessed using a validated food frequency questionnaire. A generally poor knowledge about the role and sources of iodine in the diet remained after fortification. Post-fortification, iodine-containing supplements were being taken by 60% (up from 20% pre-fortification and 45% of pregnant and lactating women, respectively. Dairy foods were the highest contributors to dietary iodine intake (57%–62%. A low intake of fish and seafood resulted in this food group contributing only 3%–8% of total intake. A low level of public awareness regarding the role of iodine in health supports the need for public health strategies in addition to fortification, such as an accompanying consumer education campaign, increased uptake of supplementation, and on-going monitoring.
Full Text Available Vivienne SL Mak,1,2 Geoff March,2 Alice Clark,2 Andrew L Gilbert21Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia; 2Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, AustraliaBackground: A key objective of Australia's health care reform is a skilled, flexible, and well-trained workforce. To meet these requirements, the training of health professionals, including pharmacists, needs to be focused on patient care processes, and students must develop competencies in the delivery of patient care. Pharmacy graduates need to be well prepared for new and alternative career pathways through their education and training, to be a part of the future workforce. This study explores Australian intern pharmacists' perceived preparedness for practice, the match between their expectations and experience to meet the requirements of health professionals in Australia's health care reforms, and their future career intentions.Methods: Two questionnaires were sent by post to all 136 intern pharmacists in South Australia; one was sent early in their internship and the second follow-up questionnaire was sent near the completion of their internship.Results: Pharmacy graduates felt prepared for patient care, medicines information, and primary health care roles. A mismatch between expectations and actual experiences was found. By the end of the internship, 45% agree/strongly agree that they wanted to do something else other than being a practicing pharmacist.Conclusion: The current internship model no longer meets the needs and expectations of knowledgeable and skilled pharmacy graduates. An alternative internship model, which considers the expectations of graduates, is required.Keywords: intern pharmacist, preparedness, expectations, experiences, internship, future career
Boero, Ezequiel F
We present a definition of tensor fields which are average of tensors over a manifold, with a straightforward and natural definition of derivative for the averaged fields; which in turn makes a suitable and practical construction for the study of averages of tensor fields that satisfy differential equations. Although we have in mind applications to general relativity, our presentation is applicable to a general n-dimensional manifold. The definition is based on the integration of scalars constructed from a physically motivated basis, making use of the least amount of geometrical structure. We also present definitions of covariant derivative of the averaged tensors and Lie derivative.
Gilchrist, Iain C.
A prospective controlled study of acute low back pain in general practice was carried out. The presence of psychiatric illness was measured by use of the general health questionnaire (GHQ), by clinical assessment, and personality factors by use of the Eysenck personality inventory (EPI). It was found that overall the amount of psychiatric illness did not differ between patients with back pain and their controls at the time of presentation, although there was a higher prevalence of previous psychiatric illness in the back-pain group. The only difference in the personality factors measured was a higher degree of extraversion in the back-pain patients. PMID:6224930
Klinner, Christiane; Carter, Stacy M; Rychetnik, Lucie; Li, Vincy; Daley, Michelle; Zask, Avigdor; Lloyd, Beverly
We examine the perspectives of health promotion practitioners on their approaches to determining health promotion practice, in particular on the role of research and relationships in this process. Using Grounded Theory methods, we analysed 58 semi-structured interviews with 54 health promotion practitioners in New South Wales, Australia. Practitioners differentiated between relationship-based and research-based approaches as two sources of knowledge to guide health promotion practice. We identify several tensions in seeking to combine these approaches in practice and describe the strategies that participants adopted to manage these tensions. The strategies included working in an evidence-informed rather than evidence-based way, creating new evidence about relationship-based processes and outcomes, adopting 'relationship-based' research and evaluation methods, making research and evaluation useful for communities, building research and evaluation skills and improving collaboration between research and evaluation and programme implementation staff. We conclude by highlighting three systemic factors which could further support the integration of research-based and relationship-based health promotion practices: (i) expanding conceptions of health promotion evidence, (ii) developing 'relationship-based' research methods that enable practitioners to measure complex social processes and outcomes and to facilitate community participation and benefit, and (iii) developing organizational capacity.
Buchanan, John; Ljungdahl, Lesley; Maher, Damian
Adjustment to university is challenging for students as they navigate a path through new academic, social and cultural practices. Some may feel on the borders, marginalised by their background. Issues such as adjustment to university life, independence, performance expectations, establishing friendships, technological competence, cultural capital,…
Gordon, Melissa; Schirmer, Jacki; Lockwood, Michael; Vanclay, Frank; Hanson, Dallas
Although community engagement (CE) is widely recognised as an essential element of sustainable management, few studies have evaluated CE at an industry-wide scale, i.e. in terms of the specific CE needs and best practice methods needed when addressing engagement issues that apply across more than on
Klinner, Christiane; Carter, Stacy M; Rychetnik, Lucie; Li, Vincy; Daley, Michelle; Zask, Avigdor; Lloyd, Beverly
We examine the perspectives of health promotion practitioners on their approaches to determining health promotion practice, in particular on the role of research and relationships in this process. Using Grounded Theory methods, we analysed 58 semi-structured interviews with 54 health promotion practitioners in New South Wales, Australia. Practitioners differentiated between relationship-based and research-based approaches as two sources of knowledge to guide health promotion practice. We identify several tensions in seeking to combine these approaches in practice and describe the strategies that participants adopted to manage these tensions. The strategies included working in an evidence-informed rather than evidence-based way, creating new evidence about relationship-based processes and outcomes, adopting 'relationship-based' research and evaluation methods, making research and evaluation useful for communities, building research and evaluation skills and improving collaboration between research and evaluation and programme implementation staff. We conclude by highlighting three systemic factors which could further support the integration of research-based and relationship-based health promotion practices: (i) expanding conceptions of health promotion evidence, (ii) developing 'relationship-based' research methods that enable practitioners to measure complex social processes and outcomes and to facilitate community participation and benefit, and (iii) developing organizational capacity. PMID:24800758
Edward, Karen-leigh; Hercelinskyj, Julie; Warelow, Philip; Munro, Ian
A variety of developments in nursing education in Australia including some innovative and exciting models, educational enterprises between education and industry, and evidence of developing strengths in research and professional alliances on a national level have been discussed recently. This paper presents Simulation to Practice as an example of…
Mathers, N; Rowland, S
The 'modern' view of the world is based on the premise that we can discover the essential truth of the world using scientific method. The assumption is made that knowledge so acquired has been 'uncontaminated' by the mind of the investigator. Post-modern theory, however, is concerned with the process of knowing and how our minds are part of the process, i.e. our perceptions of reality and the relationships between different concepts are important influences on our ways of knowing. The values of post-modern theory are those of uncertainty, many different voices and experiences of reality and multifaceted descriptions of truth. These values are closer to our experience of general practice than the 'modern' values of scientific rationalism and should be reflected in a new curriculum for general practice. PMID:9167325
Lippert, Maria Laura; Reventlow, Susanne; Kousgaard, Marius Brostrøm
Quality standards play an increasingly important role in primary care through their inscription in various technologies for improving professional practice. While ‘hard’ biomedical standards have been the most common and debated, current quality development initiatives increasingly seek to include...... standards for the ‘softer’ aspects of care. This article explores the consequences of both kinds of quality standards for chronic care consultations. The article presents findings from an explorative qualitative field study in Danish general practice where a standardized technology for quality development...... disease consultations. However, at the same time, adherence to those standards was observed to narrow the focus of doctor–patient dialogues and to divert general practitioners’ attention from patients’ personal concerns. Similar consequences of quality standards have previously been framed...
Meeuwesen, L.; Bensing, J.; Brink-Muinen, A. van den
From the viewpoint of quality of care, doctor-patient communication has become more and more important. Gender is an important factor in communication. Besides, cultural norms and values are likely to influence doctor-patient communication as well. This study examined (1) whether or not communication patterns of gender-dyads in general practice consultations differ across and between Western-European countries, and (2) if so, whether these differences continue to exist when controlling for pa...
Janssen, P. G. H.
The presented studies were conducted within the framework of the international ADDITION study (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care), a randomised controlled trial in 3,057 screen-detected type 2 diabetic patients. The aim of ADDITION is to evaluate whether screening for type 2 diabetes in general practice is feasible and subsequent intensified, multifactorial treatment beneficial. Intensified treatment consisted of pharmacolo...
Gear, M. W.; Barnes, R. J.
In an urban general practice serving 7800 patients, all patients presenting over five and a half years with dyspepsia lasting more than two weeks were investigated by fibreoptic endoscopy and cholecystography, and many by barium meal. Of the 393 patients with dyspepsia, 346 completed the investigation: 180 had specific disease of the oesophagus, stomach, duodenum, or gall bladder, including six with carcinoma. Al further 67 had mucosal disease, and only 99 patients had no abnormality. After t...
Khunti, K; Carr, M
There is a large demand for the provision of hearing aids. However, there are lengthy delays involved between referral and fitment of National Health Service (NHS) hearing aids. This report shows that a general practice based audiology clinic can lead to an increase in the number of patients referred and fitted with a hearing aid. The introduction of the clinic also led to reduced waiting times for patients to be fitted with hearing aids.
Williams, Bronwen; Amiel, Cressida
Objectives To determine how many General Practice (GP) Registrars in the London Deanery taught medical students during their final year of training. For those who did teach, to evaluate their experiences and for those who did not, to identify perceived barriers to teaching. Design Cross sectional survey of GP Registrars in the London Deanery completing their training in August 2010. Setting Online survey of GP Registrars sent after completion of training via the London Deanery GP Vocational T...
van den Bosch Wil JHM
Full Text Available Abstract Background To study the relation between the prescription rates of selected cardiovascular drugs (ACE-inhibitors and Angiotensin receptor blockers, beta-blockers, diuretics, and combinations, sociodemographic factors (age, gender and socioeconomic class and concomitant diseases (hypertension, coronary heart disease, cerebrovascular accident, heart valve disease, atrial fibrillation, diabetes mellitus and asthma/COPD among patients with heart failure cared for in general practice. Methods Data from the second Dutch National Survey in General Practice, conducted mainly in 2001. In this study the data of 96 practices with a registered patient population of 374.000 were used. Data included diagnosis made during one year by general practitioners, derived from the electronic medical records, prescriptions for medication and sociodemographic characteristics collected via a postal questionnary (response 76% Results A diagnosis of HF was found with 2771 patients (7.1 in 1000. Their mean age was 77.7 years, 68% was 75 years or older, 55% of the patients were women. Overall prescription rates for RAAS-I, beta-blockers and diuretics were 50%, 32%, 86%, respectively, whereas a combination of these three drugs was prescribed in 18%. Variations in prescription rates were mainly related to age and concomitant diseases. Conclusion Prescription is not influenced by gender, to a small degree influenced by socioeconomic status and to a large degree by age and concomitant diseases.
Full Text Available Abstract Background Good General Practice is essential for an effective health system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence relevant to virtual communities of practice in General Practice training, identify evidence-based principles that might guide their construction and suggest further avenues for research. Methods Major online databases Scopus, Psychlit and Pubmed were searched for the terms “Community of Practice” (CoP AND (Online OR Virtual OR Electronic AND (health OR healthcare OR medicine OR “Allied Health”. Only peer-reviewed journal articles in English were selected. A total of 76 articles were identified, with 23 meeting the inclusion criteria. There were no studies on CoP or VCoP in General Practice training. The review was structured using a framework of six themes for establishing communities of practice, derived from a key study from the business literature. This framework has been used to analyse the literature to determine whether similar themes are present in the health literature and to identify evidence in support of virtual communities of practice for General Practice training. Results The framework developed by Probst is mirrored in the health literature, albeit with some variations. In particular the roles of facilitator or moderator and leader whilst overlapping, are different. VCoPs are usually collaborations between stakeholders
Ruth Reynolds; Monika Vinterek
Globalization and global education implies changes to practices at the classroom level to adapt to new imperatives associated with technology use and awareness, and environmental sustainability. It also implies much more. It implies that teachers apply their classroom pedagogy to take account of students’ new found global understandings of which they, and the school community, is largely unaware. This article addresses and discuses three key consequences of globalization for classrooms worldw...
Bartlett, Maggie; Potts, Jessica; McKinley, Bob
Keele medical students spend 113 days in general practices over our five-year programme. We collect practice data thought to indicate good quality teaching. We explored the relationships between these data and two outcomes for students; Objective Structured Clinical Examination (OSCE) scores and feedback regarding the placements. Though both are surrogate markers of good teaching, they are widely used. We collated practice and outcome data for one academic year. Two separate statistical analyses were carried out: (1) to determine how much of the variation seen in the OSCE scores was due to the effect of the practice and how much to the individual student. (2) to identify practice characteristics with a relationship to student feedback scores. (1) OSCE performance: 268 students in 90 practices: six quality indicators independently influenced the OSCE score, though without linear relationships and not to statistical significance. (2) Student satisfaction: 144 students in 69 practices: student feedback scores are not influenced by practice characteristics. The relationships between the quality indicators we collect for practices and outcomes for students are not clear. It may be that neither the quality indicators nor the outcome measures are reliable enough to inform decisions about practices' suitability for teaching. PMID:27117344
Otter, J.J. den; Knitel, M; Akkermans, R P; C P van Schayck; Folgering, H.T.M.; van Weel, C
Recently, spirometers have become available for use within general practice as an alternative to peak flow meters. This study investigates whether practice assistants, after comprehensive training, can effectively carry out spirometry with patients suffering from asthma and other chronic obstructive pulmonary diseases. A scoring system, consisting of 20 items, was devised to determine the effectiveness of the assistants' instructions and to assess the patient's subsequent use of the spiromete...
As hotels' concern about sustainability and budget-control is growing steadily, energy-saving issues have become one of the important management concerns hospitality industry face. By executing proper energy-saving practices, previous scholars believed that hotel operation costs can decrease dramatically. Moreover, they believed that conducting energy-saving practices may eventually help the hotel to gain other benefits such as an improved reputation and stronger competitive advantage. The energy-saving issue also has become a critical management problem for the hotel industry in China. Previous research has not investigated energy-saving in China's hotel segment. To achieve a better understanding of the importance of energy-saving, this document attempts to present some insights into China's energy-saving practices in the tourist accommodations sector. Results of the study show the Chinese general managers' attitudes toward energy-saving issues and the differences among the diverse hotel managers who responded to the study. Study results indicate that in China, most of the hotels' energy bills decrease due to the implementation of energy-saving equipments. General managers of hotels in operation for a shorter period of time are typically responsible for making decisions about energy-saving issues; older hotels are used to choosing corporate level concerning to this issue. Larger Chinese hotels generally have official energy-saving usage training sessions for employees, but smaller Chinese hotels sometimes overlook the importance of employee training. The study also found that for the Chinese hospitality industry, energy-saving practices related to electricity are the most efficient and common way to save energy, but older hotels also should pay attention to other ways of saving energy such as water conservation or heating/cooling system.
Full Text Available Although significant changes at the social, demographic, technological and workforce levelshave transformed the relationship between family and work, these changes have notbeen reflected in the employment practices of many construction companies. Many of thejob and organisational factors found to be negatively associated with family functioning arepertinent to construction professionals. Staff are expected to work long hours in demandingroles and this, combined with job insecurity and frequent relocation, means that familylife and individual well-being can be compromised. A growing body of research has foundthat the implementation of family-friendly work policies and practices can lead to greaterproductivity, lower attrition rates and higher morale in the workplace. In addition providinga work environment that is supportive of workers' family roles can help to alleviate workrelatedmental health problems.This paper outlines the changing demographic trends and societal attitudes that are makingindividuals and organisations question current work cultures and structures. Optionsfor making the construction industry a more family-friendly work environment are considered.All professionals, regardless of their age, gender and family responsibilities, canbenefit from these initiatives. The paper concludes by discussing the implications of theseissues for construction companies and future research work.
Full Text Available This paper discusses what could be considered the top ten innovations that have occurred in policing in the last thirty years. The intent is to focus attention on how practice could be further inspired by additional innovation. The innovations are discussed here as “Big Bangs” as a way of drawing attention to the significant impact they have had on policing, in the same way that the cosmological Big Bang was an important watershed event in the universe’s existence. These ten policing innovations ushered in, it is argued, a new mindset, pattern or trend, and they affected Australian policing profoundly; although many had their roots in other settings long before Australian policy-makers implemented them.
Ahnfeldt-Mollerup, Peder; dePont Christensen, René; Halling, Anders;
BACKGROUND: Medical engagement is a mutual concept of the active and positive contribution of doctors to maintaining and enhancing the performance of their health care organization, which itself recognizes this commitment in supporting and encouraging high quality care. A Medical Engagement Scale...... (MES) was developed by Applied Research Ltd (2008) on the basis of emerging evidence that medical engagement is critical for implementing radical improvements. OBJECTIVES: To study the importance of medical engagement in general practice and to analyse patterns of association with individual and...... results were analysed in conjunction with the GP register data. RESULTS: Statistically adjusted analyses revealed that the GPs' medical engagement varied substantially. GPs working in collaboration with colleagues were more engaged than GPs from single-handed practices, older GPs were less engaged than...
Bjerrum, Lars; Gonzalez Lopez-Valcarcel, Beatriz; Petersen, Gert
Objective: To identify patient- and practice-related factors associated with potential drug interactions. Methods: A register analysis study in general practices in the county of Funen, Denmark. Prescription data were retrieved from a population-based prescription database (Odense University...... Pharmacoepidemiologic Database, OPED) covering prescriptions to all inhabitants in the county of Funen, Denmark. All individuals exposed to concurrent use of two or more drugs (polypharmacy) were identified. Combinations of drugs with potential interactions were registered and classified as major, moderate, or minor......, depending on the severity of outcome and the quality of documentation. A two-level random coefficient logistic regression model was used to investigate factors related to potential drug interactions. Results: One-third of the population was exposed to polypharmacy, and 6% were exposed to potential drug...
Woof, W R
This paper discusses the future of bereavement care in British general practice by providing an insight into existing practice and then speculating on influences that may shape developments. There have been calls for the specialty to build on this traditional role and expand its bereavement service. Specific suggestions for the content of such a service are summarised. This emphasis reflects the increasing awareness in bereavement by other health organisations. This image of an expanding service needs to be contextualised within a primary care system that is feeling more pressurised due to increasing workload. This will continue to inhibit extensive service development. In addition it is important for the profession to consider the appropriateness of this activity. This complex debate has received little attention and research is required to inform and provide the necessary direction. PMID:9233164
Lorraine E. Bates
Full Text Available To date, there are few regulations and policies relating to climate change in Australia. Uncertainty about the timing, structure, and potential impact of proposed legislation such as a national carbon abatement scheme, is leading to planning delays across the country. To assist with these policy uncertainties, organizations can embed themselves in multilevel governance frameworks that inform, structure, and facilitate strategic development, planning, and action. As part of these networks, organizational representatives also engage in formal and informal forums, a type of interorganizational relationship, which can include industry task forces, policy development committees, interagency groups, and specific climate change committees. Forums constitute an additional level of governance that influences decision making. The patterns of relationships within these multilevel governance frameworks are examined in this paper, with a focus on the forum level of organizational cooperation. Specifically, we investigate the type of forums operating and their role in supporting organizational responses to climate change. A series of interviews and focus groups were conducted in two study areas, the Swan Canning region of Western Australia and the Hunter / Central Coast region of New South Wales. The results indicate that organizations participate in a diverse range of forums. Further, forums appear to play a key role in the everyday business of organizations by enhancing their ability to plan and address a range of issues, including those associated with climate change. In addition the research highlights some of the barriers and drivers for the development and implementation of climate adaptation practices that emerge from forum discussions. For example, a lack of government guidance in interpreting climate change policy was described as a barrier yet access to the knowledge and expertise of participants was highlighted as a potential driver. The paper
Kalankesh, Leila R; Farahbakhsh, Mostafa; Rahimi, Niloofar
Background: efficient communication of data is inevitable requirement for general practice. Any issue in data content and its exchange among GP and other related entities hinders continuity of patient care. Methods: literature search for this review was conducted on three electronic databases including Medline, Scopus and Science Direct. Results: through reviewing papers, we extracted information on the GP data content, use cases of GP information exchange, its participants, tools and methods, incentives and barriers. Conclusion: considering importance of data content and exchange for GP systems, it seems that more research is needed to be conducted toward providing a comprehensive framework for data content and exchange in GP systems. PMID:25648317
Heiligers, P.J.M.; Noordman, J.; Korevaar, J.; Dorsman, S.W.; Hingstman, L.; Dulmen, S. van; Bakker, D. de
Background: In 1999, nurse practitioners were introduced. The main objectives were to improve quality of care for chronic ill and to reduce workload of general practitioners. In ten years the number of practice nurses has grown tremendously. Meanwhile there are new tasks as a result of aging. Practi
Full Text Available Knowledge management (KM could be described as a management system that supports the creation, sharing and retrieving of valued information, expertise and insight within and across communities of people and related organizations using information and communication technologies and hence it is a combination of the effective application of information technlogy and management of human resources. KM is becoming a core competitive factor in construction operations. This paper presents the results of two case studies of KM practices in large AEC (architecture, engineering and construction companies through desk-top study and semi-structured interviews. The results indicate that implementing KM in AEC companies leads to competitive advantages and improved decision-making, problem solving and business performance. The results also indicateed that while technology plays an important role, top management commitment, total employee involvement, performance assessment and the culture of knowledge-learning and sharing must be considered when implementing KM. Therefore it is suggested that the implementation of KM should incorporate the company's vision, work processes, technology and culture, to improve the ability of knowledge creating, capturing, sharing, retrieving and ultimately, to improve the company's competitive advantage, decision making, problem solving and innovation.
Hermens, R P; Hak, E; Hulscher, M E; Mulder, J; Tacken, M A; Braspenning, J C; Grol, R P
OBJECTIVE: To assess the effects of a Dutch national prevention programme, aimed at general practitioners (GPs), on the adherence to organizational guidelines for effective cervical cancer screening in general practice. To identify the characteristics of general practices determining success. DESIGN
Benard, Victoire; Rolland, Benjamin; Messaadi, Nassir; Petit, Aymeric; Cottencin, Olivier; Karila, Laurent
Cannabis use is now more frequent than alcohol drinking or tobacco smoking among young people (15-34years), whereas it may induce numerous medical aftermaths. Identifying and assessing cannabis use in general practice have become a current public health issue. The two steps of screening consist in spotting risky use of cannabis, and then in checking criteria for cannabis use disorder (CUD). Risky use requires a "brief intervention" by the general practitioner (GP). In case of CUD, the new DSM-5 criteria allow measuring the severity of the subsequent disorder, and listing the medical and social consequences. Using these criteria can help the GP to decide when the patient should be referred to an addiction-specialized unit. The GP has also to spot the different physical and psychiatric complications of cannabis use, in order to coordinate care between the different specialists.
Full Text Available General practitioners (GPs and social workers (SWs are professions whose professional autonomy and discretion have changed in the so-called risk and audit society. The aim of this article is to compare GPs’ and SWs’ responses to Evidence-Based and Organizational Risk Reduction Technologies (ERRT and ORRT. It is based on a content analysis of 54 peer-reviewed empirical articles. The results show that both professions held ambivalent positions towards ERRT. The response towards ORRT differed in that GPs were sceptical whilst SWs took a more pragmatic view. Furthermore the results suggest that SWs might experience professional benefits by adopting an adherent approach to the increased dissemination of risk reduction technologies (RRT. GPs, however, did not seem to experience such benefits. Keywords: Profession, risk, social worker, general practitioner, risk reduction technologies, evidence-based practice/medicine
intervention is compared between intervention and control groups after adjusting for baseline differences and clustering at the level of the practice. Discussion This study will provide evidence of the effectiveness of a primary care intervention to reduce the risk of cardiovascular disease and diabetes in general practice patients. It will inform current policies and programs designed to prevent these conditions in Australian primary health care. Trial Registration ACTRN12607000423415
Full Text Available Abstract Background The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. Methods Secondary analysis of data from 239 general practices, collected in practice visits between 2003 to 2006 in the Netherlands using a comprehensive set of measures of practice management. Data were collected by a practice visitor, a trained non-physician observer using patients questionnaires, doctors and staff. For this study we selected five measures of practice performance as outcomes and six measures of GP workload and job stress as predictors. A total of 79 indicators were used out of the 303 available indicators. Random coefficient regression models were applied to examine associations. Results and discussion Workload and job stress are associated with practice performance. Workload: Working more hours as a GP was associated with more positive patient experiences of accessibility and availability (b = 0.16. After list size adjustment, practices with more GP-time per patient scored higher on GP care (b = 0.45. When GPs provided more than 20 hours per week per 1000 patients, patients scored over 80% on the Europep questionnaire for quality of GP care. Job stress: High GP job stress was associated with lower accessibility and availability (b = 0.21 and insufficient practice management (b = 0.25. Higher GP commitment and more satisfaction with the job was associated with more prevention and disease management (b = 0.35. Conclusion Providing more time in the practice, and more time per patient and experiencing less job stress are all associated with perceptions by patients of better care and better practice performance. Workload and job stress should be assessed by using list size adjusted data in order to realise better quality of care. Organisational development using
This study was performed to investigate the clinical usefulness of teleradiology in general dental practice. Two hundred and seventy five cases were submitted for inquiry to the case presentation board of the website of The Korean Academy of Oral and Maxillofacial Radiology for a 5 year periods. The diagnosis results of those cases were analyzed according to the disease classification, the correlation with the patient's chief complaint, the necessity of additional examinations or treatments, the image modalities, and the number of dentists inquiring. Differential diagnoses of normal anatomic structures were the most frequently submitted cases, covering 15.6% of all cases. Among 275 cases, 164 cases required no additional treatments or examinations. Panoramic radiographs were the most frequently submitted images, accounting for 248 inquiries. The 275 cases were submitted by 96 dentists. Fifty-two dentists wrote one inquiry, and 44 inquired 2 or more times. The average inquiry number of the latter group was 5.0 cases. A teleradiology system in general dental practice could be helpful in the differential diagnosis of common lesions and reduce unnecessary costs.
Full Text Available Abstract Background Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters, which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the
McKenzie, Joanne E; French, Simon D; O'Connor, Denise A; Grimshaw, Jeremy M; Mortimer, Duncan; Michie, Susan; Francis, Jill; Spike, Neil; Schattner, Peter; Kent, Peter M; Buchbinder, Rachelle; Green, Sally E
Background Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access
Humphreys John S
Full Text Available Abstract Background Rural and remote areas are characterised by a shortage of medical practitioners. Rural background has been shown to be a significant factor associated with medical graduates' intentions and decisions to practise within a rural area, though most studies have only used simple definitions of rural background and not previously looked at specialists. This paper aims to investigate in detail the nature of the association between rural background and practice location of Australian general practitioners (GPs and specialists Methods Data for 3156 GPs and 2425 specialists were obtained from the Medicine in Australia: Balancing Employment and Life (MABEL study. Data on the number of childhood years resident in a rural location and population size of their rural childhood location were matched against current practice location. Logistic regression modelling was used to calculate adjusted associations between doctors in rural practice and rural background, sex and age. Results GPs with at least 6 years of their childhood spent in a rural area were significantly more likely than those with 0-5 years in a rural area to be practising in a rural location (OR 2.28, 95% CI 1.69-3.08, whilst only specialists with at least 11 years rural background were significantly more likely to be practising in a rural location (OR 2.27, 95% CI 1.77-2.91. However, for doctors with a rural background, the size of the community that they grew up in was not significantly associated with the size of the community in which they currently practise. Both female GPs and female specialists are similarly much less likely to be practising in a rural location compared with males (GPs: OR 0.53, 95% CI 0.45-0.62. Conclusions This study elucidates the association between rural background and rural practice for both GPs and specialists. It follows that increased take-up of rural practice by new graduates requires an increased selection of students with strong rural
Whitford, David L; Griffin, Simon J; Prevost, A. Toby
BACKGROUND: The prevalence of type 2 diabetes is known to vary between countries, districts and general practices. The influence of early detection and screening on the variation of prevalence between general practices has not previously been investigated. AIM: To test the hypothesis that the prevalence of type 2 diabetes is associated with awareness of and screening for diabetes within general practices and to explore other factors that may explain the variation in prevalence between practic...
positions. Basic theoretical features from the philosophy of science explain why and how this is different from positivism. Reflexivity, including theoretical awareness and consistency, demonstrates interpretative assumptions, accounting for situated knowledge. Different types of theoretical commitment...... of the interpretative paradigm. Associations between paradigms, philosophies, methodologies and methods are examined and different strategies for theoretical commitment presented. Finally, I discuss the impact of theory for interpretation and the development of general practice knowledge. Main points: A scientific...... theory is a consistent and soundly based set of assumptions about a specific aspect of the world, predicting or explaining a phenomenon. Qualitative research is situated in an interpretative paradigm where notions about particular human experiences in context are recognized from different subject...
Gadegaard Jensen, Anders; Callesen, T; Hagemo, J S;
Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care...... Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients...... influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1-1.5 mg/kg is preferred. Outside...
Dillen, van S.; Noordman, J.; Dulmen, van S.; Hiddink, G.J.
Objective Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight
Dillen, S.M. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.
OBJECTIVE: Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight
Dillen, S.M.E. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.
Objective: Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight
The conclusions and recommendations of this session can be summarized this way. - Basic goal for the regulator is to protect the public and communication is a must to fully achieve this goal. - Regulator should become the prime source of information to the public and the media, regulator should base its actions upon values of competence, independence, transparency and stringency. - Set up of a Information and Communication Policy will help for consistency and efficiency. Policy will include setting goals, strategies, organisational aspects, procedures, and tools. Practices should be developed in accordance with local culture. - Challenges will consider transparency, public involvement and consultation with the stakeholders. - Practices will include in general: - Interactions with the media like press releases, news conferences, media workshops. Printed materials from plant periodical status reports, to periodical and annual reports and specific reports. Audio-visual materials. Use of radio and TV. Web site and electronic mail. - Method chosen depends on the targeted audience and the relevance of the topic. - Messages should be clearly understandable. Do not dehumanize the message by making it technically unintelligible. - Two excellent examples presented. How local culture and social characteristics were taken into account in designing and implementing plans is key for success. - Municipalities are to be considered as front line stakeholders. - Communicators role is relevant to meet regulatory needs. Good collaboration between communicators and technical staff produces benefits for the nuclear regulator and the public. (authors)
The NKS project FOREST was established to prepare a guide for sampling in forest ecosystems for radionuclide analysis. The aim of this guide is to improve the reliability of datasets generated in future studies by promoting the use of consistent, recommended practices, thorough documentation of field sampling regimes and robust preparation of samples from the forest ecosystem. The guide covers general aims of sampling, the description of major compartments of the forest ecosystem and outlines key factors to consider when planning sampling campaigns for radioecological field studies in forests. Recommended and known sampling methods for various sample types are also compiled and presented. The guide focuses on sampling practices that are applicable in various types of boreal forests, robust descriptions of sampling sites, and documentation of the origin and details of individual samples. The guide is intended for scientists, students, forestry experts and technicians who appreciate the need to use sound sampling procedures in forest radioecological projects. The guide will hopefully encourage readers to participate in field studies and sampling campaigns, using robust techniques, thereby fostering competence in sampling. (au)
Spencer, A J; Lewis, J M
An understanding of the current service-mix in private general practice in Australia and the factors that may influence its distribution is important in the anticipation of the future practice of dentistry. The present study aimed to describe service-mix, to investigate the association of service-mix with characteristics of presenting patients, and to identify and discuss a number of factors which may be influencing change in service-mix. Service-mix was dominated by restorative, diagnostic and preventive services and a limited number of services accounted for most service provision or dentist time. Both the broad areas of service and more frequently provided services were related to age of presenting patients. Service-mix appears to be changing over time. Changing needs and expectations of patients and philosophies and technologies available to dentists are among factors that push or pull service-mix in new directions. However, changing service-mix and practitioner variation require considerably more exploration. PMID:2495788
Aro, Lasse (Finnish Forest Research Inst. (METLA) (Finland)); Plamboeck, Agneta H. (Swedish Defence Research Agency (FOI) (Sweden)); Rantavaara, Aino; Vetikko, Virve (Radiation and Nuclear Safety Authority (STUK) (Finland)); Straalberg, Elisabeth (Inst. Energy Technology (IFE) (Norway))
The NKS project FOREST was established to prepare a guide for sampling in forest ecosystems for radionuclide analysis. The aim of this guide is to improve the reliability of datasets generated in future studies by promoting the use of consistent, recommended practices, thorough documentation of field sampling regimes and robust preparation of samples from the forest ecosystem. The guide covers general aims of sampling, the description of major compartments of the forest ecosystem and outlines key factors to consider when planning sampling campaigns for radioecological field studies in forests. Recommended and known sampling methods for various sample types are also compiled and presented. The guide focuses on sampling practices that are applicable in various types of boreal forests, robust descriptions of sampling sites, and documentation of the origin and details of individual samples. The guide is intended for scientists, students, forestry experts and technicians who appreciate the need to use sound sampling procedures in forest radioecological projects. The guide will hopefully encourage readers to participate in field studies and sampling campaigns, using robust techniques, thereby fostering competence in sampling. (au)
Perceptual motor programs continue to be used in Australian schools despite evidence showing they do not influence academic learning. Brain Gym[R] is one perceptual motor program that is used in schools in Australia and overseas. There is little evidence to support the claims made about the benefits of Brain Gym[R]; its theoretical underpinning…
Ali, Nasreen; Atkin, Karl; Neal, Richard
In this paper, we will examine the importance of culture and ethnicity in the general practice consultation process. Good communication is associated with positive health outcomes. We will, by presenting qualitative material from an empirical study, examine the way in which communication within the context of a general practitioner (GP) consultation may be affected by ethnicity and cultural factors. The aim of the study was to provide a detailed understanding of the ways in which white and South Asian patients communicate with white GPs and to explore any similarities and differences in communication. This paper reports on South Asian and white patients' explanations of recent videotaped consultations with their GP. We specifically focus on the ways in which issues of ethnic identity impacted upon the GP consultation process, by exploring how our sample of predominantly white GPs interacted with their South Asian patients and the extent to which the GP listened to the patients' needs, gave patients information, engaged in social conversation and showed friendliness. We then go on to examine patients' suggestions on improvements (if any) to the consultation. We conclude, by showing how a non-essentialist understanding of culture helps to comprehend the consultation process when the patients are from Great Britain's ethnicised communities. Our findings, however, raise generic issues of relevance to all multi-racial and multi-ethnic societies.
van Wayenburg, CAM; van de Laar, FA; de Waal, MWM; Okkes, IM; van den Akker, M; van der Veen, WJ; Schellevis, FG; van Staveren, WA; van Binsbergen, JJ; van Weel, C
Objective: To explore incidence and prevalence rates of nutritional deficiency in adults in general practice. Methods: Six Dutch general practice research and registration networks supplied incidence and prevalence rates of nutritional deficiency by the International Classification of Primary Care (
Full Text Available Abstract Background Economic implications of chemotherapy-induced febrile neutropenia (FN in European and Australian clinical practice are largely unknown. Methods Data were obtained from a European (97% and Australian (3% observational study of patients with non-Hodgkin’s lymphoma (NHL receiving CHOP (±rituximab chemotherapy. For each patient, each cycle of chemotherapy within the course, and each occurrence of FN within cycles, was identified. Patients developing FN in a given cycle (“FN patients”, starting with the first, were matched to those who did not develop FN in that cycle (“comparison patients”, irrespective of subsequent FN events. FN-related healthcare costs (£2010 were tallied for the initial FN event as well as follow-on care and FN events in subsequent cycles. Results Mean total cost was £5776 (95%CI £4928-£6713 higher for FN patients (n = 295 versus comparison patients, comprising £4051 (£3633-£4485 for the initial event and a difference of £1725 (£978-£2498 in subsequent cycles. Among FN patients requiring inpatient care (76% of all FN patients, mean total cost was higher by £7259 (£6327-£8205, comprising £5281 (£4810-£5774 for the initial hospitalization and a difference of £1978 (£1262-£2801 in subsequent cycles. Conclusions Cost of chemotherapy-induced FN among NHL patients in European and Australian clinical practice is substantial; a sizable percentage is attributable to follow-on care and subsequent FN events.
Gallagher, M; Pearson, P; Drinkwater, C; Guy, J
BACKGROUND: Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. AIM: To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. DESIGN OF STUDY: A qualitative study using participant observation. SETTING: Three general practices on Tyneside; a single-handed practice, a practice comprising three doct...
Reddy, Linda A; Fabiano, Gregory A; Jimerson, Shane R
Progress monitoring is a type of formative assessment. Most work on progress monitoring in elementary school settings has been focused on students. However, teachers also can benefit from frequent evaluations. Research addressing teacher progress monitoring is critically important given the recent national focus on teacher evaluation and effectiveness. This special topic section of School Psychology Quarterly is the first to showcase the current research on measuring Tier 1 instructional and behavioral management practices used by prekindergarten and elementary school teachers in general education settings. The three studies included in the special section describe the development and validation efforts of several teacher observational and self-report measures of instruction and/or behavioral management. These studies provide evidence for the utility of such assessments for documenting the use of classroom practices, and these assessment results may be leveraged in innovative coaching models to promote best practice. These articles also offer insight and ideas for the next generation of teacher practice assessment for the field. Finally, the special topic is capped by a commentary synthesizing the current work and offers "big ideas" for future measurement development, policy, and professional development initiatives.
Prescribing Data in General Practice Demonstration (PDGPD project - a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension
Full Text Available Abstract Background 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. Methods 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. Discussion This paper describes the study protocol for a
Full Text Available BackgroundDoctors undertaking vocational training in general practicein Australia may require assistance, in addition to thenormal training offered as part of their training programme.Issues requiring assistance may go undetected for a periodof time. Delay in the identification of issues leads to delay inthe provision of the assistance. The aim of this study is todetermine the most common reasons registrars requireextra assistance, and how these issues are identified. Thefindings of this study will provide direction for 21 regionallybased training providers (RTPs to develop improved toolsto ensure earlier detection of registrars requiring assistance.MethodThis study is based on qualitative research methods, usingsemi-structured interviews with senior medical educationstaff of four regional general practice training providers inVictoria, Australia.ResultsIssues identified included language and cultural issues,applied knowledge and skills, attitude and professionalism,and health and family issues.The principal method that training providers identifiedissues was via the GP supervisor. This was predominantly byinformal communication, rather than formal evaluationsheets. Other methods included the external clinicalteaching visit and other training formative assessments.These more formalised procedures were more likely toidentify issues later than desired. They were also used as away of clarifying suspected problems. The selection processwas not felt to be helpful, and the examinations providedinformation too late.ConclusionAn increased awareness of the potential issues leading to aregistrar to require assistance enables identification andsubsequent action to occur in a more timely and moreuseful fashion. Informal communication between practicesand training programme staff should be encouraged toenable these issues to be dealt with early in training.
Management guidelines for many rheumatic diseases are published in specialty rheumatology literature but rarely in general medical journals. Musculoskeletal disorders comprise 14% of all consultations in primary care. Formal post-graduate training in rheumatology is limited or absent for many primary care practitioners. Primary care practitioners can be trained to effectively treat complex diseases and have expressed a preference for interactive educational courses. The Rheumatology General Practice (GP) Toolbox is an intensive one day course designed to offer up to date information to primary care practitioners on the latest diagnostic and treatment guidelines for seven common rheumatic diseases. The course structure involves a short lecture on each topic and workshops on arthrocentesis, joint injection and DXA interpretation. Participants evaluated their knowledge and educational experience before, during and after the course. Thirty-two primary care practitioners attended, who had a median of 13 (IQR 6.5, 20) years experience in their specialty. The median number of educational symposia attended in the previous 5 years was 10 (IQR-5, 22.5), with a median of 0 (IQR 0, 1) in rheumatology. All respondents agreed that the course format was appropriate. Numerical improvements were demonstrated in participant\\'s confidence in diagnosing and managing all seven common rheumatologic conditions, with statistically significant improvements (p < 0.05) in 11 of the 14 aspects assessed. The Rheumatology Toolbox is an effective educational method for disseminating current knowledge in rheumatology to primary care physicians and improved participant\\'s self-assessed competence in diagnosis and management of common rheumatic diseases.
Full Text Available Abstract Background Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. Results Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development and education (self-directed adult learning theories and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4 where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of
Usher, Wayne T
This study was concerned with identifying reasons behind patterns of social media (Web 2.0) usage associated with eight of Australia's major health professions. Attention was given to uncovering some of the more significant motivations for the resistance or adoption of Web 2.0 technologies for health care delivery and practice promotion by Australian health professionals. Surveys were developed from a common set of questions with specific variations between professions negotiated with professional health societies. Survey questions were constructed in an attempt to identify Web 2.0 adoption trends. An online survey (www.limesurvey.org) was used to collect data. Initial data preparation involved the development of one integrated SPSS file to incorporate all responses from the eight surveys undertaken. Initial data analysis applied Frequencies and Crosstabs to the identified groups and provided a profile of respondents by key business and demographic characteristics. Of the 935 respondents, 9.5% of participants indicated that they used Web 2.0 for their professional work, 19.1% of them did not use it for work but used it for their personal needs and 71.3% of them did not use Web 2.0 at all. Participants have indicated that the main reason for 'choosing not to adopt' Web 2.0 applications as a way of delivering health care to their patients is due to the health professionals' lack of understanding of Web 2.0 (83.3%), while the main reason for 'choosing to adopt' Web 2.0 applications is the perception of Web 2.0 as a quick and effective method of communication (73.0%). This study has indicated that Australian health professionals 'choose not to adopt' Web 2.0 usage as a way of delivering health care primarily due to 'a lack of understanding as to how social media would be used in health care' (83.3%). This study identifies that Australian health professionals are interacting with Web 2.0 technologies in their private lives but are failing to see how such technologies
Norris, Ray P
The traditional cultures of Aboriginal Australians include a significant astronomical component, perpetuated through oral tradition, ceremony, and art. This astronomical component includes a deep understanding of the motion of objects in the sky, and this knowledge was used for practical purposes, such as constructing calendars. There is also evidence that traditional Aboriginal Australians made careful records and measurements of cyclical phenomena, paid careful attention to unexpected phenomena such as eclipses and meteorite impacts, and could determine the cardinal points to an accuracy of a few degrees.
... practical test: (1) If the aircraft's FAA-approved flight manual requires the pilot flight crew complement be a single pilot, then the applicant must demonstrate single pilot proficiency on the practical test... single pilot, then the applicant must demonstrate single pilot proficiency on the practical test. (3)...
Errichetti, E; Stinco, G
Beside to traditional use, dermoscopy is more and more used in the assessment of other "general" dermatologic conditions, namely scalp and hair disorders (trichoscopy), nails abnormalities (onychoscopy), skin infections and infestations (entomodermoscopy), and cutaneous inflammatory diseases (inflammoscopy). Among the list of new applications of dermoscopy, the study of inflammatory dermatoses is probably the most promising topic in terms of development and usefulness, considering the large number of such disorders and the frequent problems in their differential diagnosis which the dermatologist encounters in own daily clinical practice. In this paper, we report selected relatively common clinical differential diagnosis issues concerning inflammatory dermatoses (and some clinically related noninflammatory conditions), analysing them by a dermoscopic point of view in order to assist their noninvasive resolution according to the available literature data and our personal experience, including papulosquamous dermatoses (guttate psoriasis, pityriasis lichenoides chronica, pityriasis rosea, lichen planus, lymphomatoid papulosis, classic pityriasis rubra pilaris, papulosquamous sarcoidosis, disseminated forms of porokeratosis and papulosquamous chronic GVHD), dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides, subacute cutaneous lupus erythematosus), palmar psoriasis vs. chronic hand eczema, scalp psoriasis vs. seborrheic dermatitis, erythematous-desquamative disorders typically involving the elbows (psoriasis vulgaris, circumscribed juvenile pityriasis rubra pilaris, dermatomyositis/Gottron's sign), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), common facial inflammatory skin diseases (rosacea, seborrheic dermatitis and demodicidosis), lichen sclerosus vs. morphea, urticaria vs. urticarial
Kendrick, T.; Sibbald, B; Addington-Hall, J.; Brenneman, D; Freeling, P.
OBJECTIVE--To describe the nature and distribution of mental health professionals working on site in general practices. DESIGN--Postal questionnaire and telephone interview survey. SETTING--English and Welsh general practices. SUBJECTS--1880 general practitioners, of whom 1542 (82%) responded. MAIN OUTCOME MEASURES--Prevalence, types, and distribution of mental health professionals working on site among general practices. Factors predicting the presence of mental health professionals on site....
Jones, Sandra C; Bennett, Sue; Iverson, Don; Robinson, Laura
Background Professional isolation is an important factor in low rural health workforce retention. Objective The aim of this study was to gain insights to inform the development of an implementation plan for a virtual community of practice (VCoP) for general practice (GP) training in regional Australia. The study also aimed to assess the applicability of the findings of an existing framework in developing this plan. This included ascertaining the main drivers of usage, or usefulness, of the VCoP for users and establishing the different priorities between user groups. Methods A survey study, based on the seven-step health VCoP framework, was conducted with general practice supervisors and registrars—133 usable responses; 40% estimated response rate. Data was analyzed using the t test and the chi-square test for comparisons between groups. Factor analysis and generalized linear regression modeling were used to ascertain factors which may independently predict intention to use the VCoP. Results In establishing a VCoP, facilitation was seen as important. Regarding stakeholders, the GP training provider was an important sponsor. Factor analysis showed a single goal of usefulness. Registrars had a higher intention to use the VCoP (Psupervisors. Usefulness independently predicted intention to actively use the VCoP (Psupervisors to want allied health professional and specialist involvement (Pfeedback about site activity. Regarding technology and community, training can be online, but trust is better built face-to-face. Supervisors were significantly more likely than registrars to perceive that registrars needed help with knowledge (P=.01) and implementation of knowledge (P<.001). Conclusions Important factors for a GP training VCoP include the following: facilitation covering administration and expertise, the perceived usefulness of the community, focusing usefulness around knowledge sharing, and overcoming professional isolation with high-quality content. Knowledge needs
Flexner, Hans; Berrettini, Robert
The perceptions of faculty and administrators regarding the following issues were assessed: the distinction between general and liberal education; the supporting philosophical or conceptual bases of general education; its societal goals and intellectual orientation; the place within general education of interdisciplinarity; and the role of general…
Full Text Available Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB, Italy, to develop general practitioners’ (GPs care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i clinical pathways can result in GPs working in a more efficient and effective fashion; ii they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.
Fleuren, M.; Wijkel, D.; Haan, M. de; Grol, R.; Sips, F.
Objective: to determine the feasiblity in daily practice of guidelines on threatened miscarriage for general practice. The guidelines on threatened miscarriage were issued in 1989 by the Dutch College of General Practitioners. Methods: prospective recording of appointments by 86 general practitioner
Waldorff, Frans Boch; Vogel, Asmus Mejling; Siersma, Volkert Dirk;
OBJECTIVE: Many older patients in general practice have subjective memory complaints (SMC); however, not all share this information with their general practitioner (GP). The association between SMC and future cognitive decline or dementia is not clear, especially in a general practice population...
Full Text Available INTRODUCTION: General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. METHODS: This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. FINDINGS: General practitioners (GPs play a key role in influencing medical students’ attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. CONCLUSION: GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.
澳大利亚其高质量的教育水平、严格的教学质量保障、政府的政策支持、潜在的就业机会等因素受到国际学生的欢迎.本文剖析了澳大利亚国际教育的现状、发展历程、教育政策和实践经验,以期对我国发展国际教育带来启示.%With high education quality, strict teaching quality assurance, government policies support and potential employ-ment opportunities, Australia attracts more and more international students. Through the analysis of the key facts, development history, education policies and practice experience of Australian international education, the article tries to bring enlightenment to China's international education.
Wang, Yun; 王芸
Introduction Though the associations of general parenting styles and smoking-specific parenting practices with adolescent smoking have received much attention in recent years, important questions remain. Most general parenting studies focused on Caucasian parents but much less in the literature is known about Chinese parents. As for smoking-specific parenting practices in the household, anti-smoking practices have been the focus, with pro-smoking practices seldom being studied. The ob...
Rodgers, S.; Avery, A J; Meechan, D; Briant, S; Geraghty, M.; Doran, K; Whynes, D K
BACKGROUND: It has been suggested that the employment of pharmacists in general practice might moderate the growth in prescribing costs. However, empirical evidence for this proposition has been lacking. We report the results of a controlled trial of pharmacist intervention in United Kingdom general practice. AIM: To determine whether intervention practices made savings relative to controls. METHOD: An evaluation of an initiative set up by Doncaster Health Authority. Eight practices agreed to...
Baker, R; Hearnshaw, H; Cooper, A.; Cheater, F; Robertson, N
Objectives--To determine the role of medical audit advisory groups in audit activities in general practice. Design--Postal questionnaire survey. Subjects--All 104 advisory groups in England and Wales in 1994. Main measures--Monitoring audit: the methods used to classify audits, the methods used by the advisory group to collect data on audits from general practices, the proportion of practices undertaking audit. Directing and coordinating audits: topics and number of practices participating in...
Lone Marie Larsen; Loni Ledderer; Dorte Ejg Jarbøl
Background. Because of the increasing prevalence of overweight and obesity in childhood in the Western world, focus on the management in general practice has also increased. Objective. To explore the experiences of general practitioners (GPs) and practice nurses participating in a randomised controlled trial (RCT) comparing two management programmes in general practice for children who are overweight or obese. Methods. Three focus groups with GPs and nurses participating in the RCT. Transcrib...
Huygens, M.W.J.; VERMEULEN, J; Friele, R.; Schayck, O.C.P. van; Jong, J.D. de; de Witte, L.P.
Background: The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients’ actual use and intention toward using. Objective: The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the gen...
Kjaersgaard,Maiken; Vedsted, Peter; Parner, Erik; Bech,Bodil; Vestergaard, Mogens; Flarup,Kaare; Fenger-GrÃ¸n,Morten
Maiken Ina Siegismund Kjaersgaard,1 Peter Vedsted,2 Erik Thorlund Parner,1 Bodil Hammer Bech,3 Mogens Vestergaard,2,4 Kaare Rud Flarup,2 Morten Fenger-Grøn,2 1Section for Biostatistics, 2Research Unit for General Practice, 3Section for Epidemiology, 4Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark Background: The patient list system in Denmark assigns virtually all residents to a general practice. Nevertheless, historical inform...
Background: In the early 1990s, waiting times for some surgical procedures and opinions for such routine problems as groin hernia repair were unacceptably long. General practitioners with a special interest (GPwSIs) in general surgery may improve this, but little evidence exists as to whether such service developments may improve efficiency and effectiveness of care.
Verheij, R.; Ton, C.; Tates, K.
Introduction: The Dutch Council for Public Health and Health Care reported in 2005 that 70% of internet users would want to have the opportunity to consult their own general practitioner by e-mail . Since January 1, 2006, general practitioners in the Netherlands are reimbursed 4.50 euro for e-mai
Liya G. Skorobogatova
The article concerns crucial issues of practice-oriented training in Russia's intermediate vocational education, designates directions of general educational disciplines study in intermediate vocational education.
Nys, S.; Merode, T. van; Bartelds, A.I.M.; Stobberingh, E.E.
Objectives: Urinary tract infections (UTIs) are common bacterial infections encountered in general practice. For the optimal treatment the general practitioner (GP) should rely on the results of diagnostic tests and recent antimicrobial susceptibility of uropathogens. Patients and methods: In total
In all systems of health care there are certain essential levels of care and service. These take the form of self-care within the family unit; primary professional care by general medical nursing or social practitioners within a local neighbourhood; general specialist care in a district and super-specialist care in a region. Each of these has its own special roles and responsibilities and each is considered in this paper.
Stanley, I; al-Shehri, A; Thomas, P
The arrangements under which continuing education for general practice is provided and attendance by general practitioners is rewarded have now been in operation for three years. More recently, reaccreditation has emerged as a significant issue for the profession. For these reasons it appears timely to review the whole basis of ongoing learning by established general practitioners. In this the first of two papers, learning by established professionals is considered in relation to the educatio...
Dick, Marie-Louise B; King, David B; Mitchell, Geoffrey K; Kelly, Glynn D; Buckley, John F; Garside, Susan J
There is increasing demand to provide clinical and teaching experiences in the general practice setting. Vertical integration in teaching and learning, whereby teaching and learning roles are shared across all learner stages, has the potential to decrease time demands and stress on general practitioners, to provide teaching skills and experience to GP registrars, and to improve the learning experience for medical students, and may also help meet the increased demand for teaching in general practice. We consider potential advantages and barriers to vertical integration of teaching in general practice, and provide results of focus group discussions with general practice principals and registrars about vertical integration. We recommend further research into the feasibility of using vertical integration to enhance the capacity to teach medical students in general practice.
American Society for Testing and Materials. Philadelphia
1.1 This practice covers procedures for penetrant examination of materials. Penetrant testing is a nondestructive testing method for detecting discontinuities that are open to the surface such as cracks, seams, laps, cold shuts, shrinkage, laminations, through leaks, or lack of fusion and is applicable to in-process, final, and maintenance testing. It can be effectively used in the examination of nonporous, metallic materials, ferrous and nonferrous metals, and of nonmetallic materials such as nonporous glazed or fully densified ceramics, as well as certain nonporous plastics, and glass. 1.2 This practice also provides a reference: 1.2.1 By which a liquid penetrant examination process recommended or required by individual organizations can be reviewed to ascertain its applicability and completeness. 1.2.2 For use in the preparation of process specifications and procedures dealing with the liquid penetrant testing of parts and materials. Agreement by the customer requesting penetrant inspection is strongly rec...
To estimate the population risk due to dental radiography an investigation was started among 1200 dental practitioners. A questionnaire was set up to inventory commonly applied indications of X-ray examinations, the number of examinations and the organizational actions taken by the dentists to limit radiation doses to the patients. Information was gathered on the type of X-ray machines, the use of aiming devices, protective measurements for patients and dental staff, developing procedures and the type of films. A number of practical tests was applied to obtain a quantitative impression of patient doses in accordance with special circumstances. For the practical tests films and lithium fluoride TLD-100 chips (Harshaw) were used to determine the beam diameter, the exposure of the X-ray machine and the scatter at a set distance of the middle of the beam, developing circumstances as well as entrance and exist skin doses measured on the skin of a patient. The results of 544 dental practices will be discussed. Finally an estimation of the possible extent of reduction in patient exposure in the Netherlands will be made
Full Text Available BACKGROUND AND CONTEXT: In New Zealand, the highest prevalence of gout is in Maori and Pacific people. Counties Manukau District Health Board (CMDHB has the highest Maori and Pacific population of any New Zealand District Health Board. A CMDHB study found that a high proportion of patients with gout were also at increased risk of cardiovascular disease. ASSESSMENT OF PROBLEMS: The primary objective was to examine whether the control of gout had changed over time at one clinic. The secondary objective was to assess the management of cardiovascular risk factors in patients with gout at that clinic. RESULTS: The mean serum uric acid level of patients with gout in the practice had risen in comparison with a similar audit carried out in March 2009. This indicates that the control of gout for patients at the practice has worsened over time. Many patients had not had an annual serum uric acid test. STRATEGIES FOR IMPROVEMENT: A repeat uric acid level was scheduled for all patients with gout in the practice, with follow-up appointments to be arranged if the result was abnormal. LESSONS: Gout is often suboptimally managed. Serum uric acid levels may only be tested when a patient presents with an acute attack of gout. Consideration should be given to a minimum of annual serum uric acid levels. Appropriate management of modifiable cardiovascular risk factors in this particular cohort is important and should be a particular focus of care.
Bunker Jeremy M
quality of life measures, smoking and immunisation status, medications, inhaler technique, and lung function. Outcomes will be assessed by project officers blinded to patients’ randomization groups. Discussion This study will use proven case-finding methods to identify patients with undiagnosed COPD in general practice, where improved care has the potential for substantial benefit in health and healthcare utilization. The study provides the capacity to trial a new model of team-based assessment and management of newly diagnosed COPD in Australian primary care. Trial registration ACTRN12610000592044
Science Teacher, 2005
Massive extinctions of animals and the arrival of the first humans in ancient Australia--which occurred 45,000 to 55,000 years ago--may be linked. Researchers at the Carnegie Institution, University of Colorado, Australian National University, and Bates College believe that massive fires set by the first humans may have altered the ecosystem of…
Meeuwesen, L.; Bensing, J.; Brink-Muinen, A. van den
The aim of this study has been to obtain more insight into the health condition of fatigued patients, their expectations when visiting the general practitioner (GP), the way they communicate, and possible gender differences. Data consisted of 579 patient questionnaires and 440 video-observations of
Gieteling, M.; Wouden, H. van der; Schellevis, F.; Berger, M.
Introduction: Abdominal pain in children is a challenging complaint for general practitioners. After ruling out an acute organic reason for the pain he has to manage the non-specific or non-organic abdominal pain. From research performed in secondary and tertiary care and from cross-sectional surve
Dillen, van S.; Hiddink, G.J.; Woerkum, van C.M.J.
Introduction: Promotion of nutrition and physical activity is important to slow down the increase of overweight. General practitioners (GPs) are in an unique position to communicate with their patients about nutrition and physical activity, because of the high referral score, high perceived expertis
Diploma thesis provides an overview of legal and ethical regulation of advertising, defines the basic concepts in advertising, summarizes the functions and objectives of advertising and characterized various forms of advertising by the communication media. Through the questionnaire survey detects and analyzes the general attitudes towards advertising as specific views on ethically problematic advertisements.
In this thesis several studies are presented with the objective to detect and elucidate the patterns by which new drugs are prescribed by general practitioners (GPs). Furthermore, we studied the influences of medical specialists and community pharmacists as important factors on the GP's decision to
The Chinese authorities plan to gradually rebalance the composition of Chinese economic growth from investment towards household consumption. This article uses the World Input-Output Database (WIOD) to give a general sense of how this rebalancing might affect Australian exports and economic activity. Dollar for dollar, Chinese investment appears to absorb more than twice as much Australian value-added output as Chinese household consumption. This largely reflects the significant role of resou...
Fiona Judd; Grant Blashki; Leon Piterman; 杨辉
The Journal presents the Column of Case Studies of Mental Health in General Practice; with academic support from Australian experts in general practice, psychology and psychiatry from Monash University and the U-niversity of Melbourne. The Column's purpose is to respond to the increasing needs of mental health services in China. Through study and analysis of mental health cases, we hope to improve understanding of mental illnesses in Chinese primary health settings , and to build capacity of community health professional in managing of mental illnesses in general practice. Patient - centred and whole - person approach in general practice is the best way to maintain and improve the physical and mental health of residents. Our hope is that these case studies will lead new wave of general practice and mental health development both in practice and academic research. A number of Australian experts from the disciplines of general practice, mental health and psychiatry will contribute to the Column. You will find A/Professor Blashki, Professor Judd and Professor Piterman are authors of General Practice Psychiatry. The Journal cases are helping to prepare for the translation and publication of a Chinese version of the book in China. We believe Chinese mental health in primary health care will step up to a new level under this international cooperation.
Engels, Y.M.P.; Campbell, S.; Dautzenberg, M.; Hombergh, P. van den; Brinkmann, H.; Szecsenyi, J.; Falcoff, H.; Seuntjens, L.; Kuenzi, B.; Grol, R.P.T.M.
OBJECTIVES: To develop a framework for general practice management made up of quality indicators shared by six European countries. METHODS: Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six n
S.D. Borgsteede; L. Deliens; W.W.A. Zuurmond; F.G. Schellevis; D.L. Willems; G. van der Wal; J.T.M. van Eijk
Purpose To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. Methods In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed pop
Borgsteede, S.D.; Deliens, L.; Zuurmond, W.W.A.; Schellevis, F.; Willems, D.L.; Wal, G. van der; Eijk, J.T.M. van
PURPOSE: To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. METHODS: In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed p
Kooijman, M.; Swinkels, I.; Dijk, C. van; Bakker, D. de; Veenhof, C.
Background: Shoulder complaints are commonly seen in general practice and physiotherapy practice. The only complaints for which general practitioners (GPs) refer more patients to the physiotherapist are back and neck pain. However, a substantial group have persistent symptoms. The first goal of this
Huygens, M.W.J.; Vermeulen, J.; Friele, R.; Schayck, O.C.P. van; Jong, J.D. de; Witte, L.P. de
Background: The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients’ actual us
Schellevis, F.G.; Donker, G.
Aims: To describe time trends in the incidence of respiratory tract infections in general practice in the Netherlands and its relation to sex and age. Design and Methods: Data will be presented from several morbidity surveys conducted in general practices in the Netherlands: the Intermittent Morbidi
Giesen, P H; Slagter-Roukema, T M
The first revision of the Dutch College of General Practitioners' practice guideline about pregnancy and puerperium does not significantly differ from the first edition. The guideline is extensive, is well-worth reading and supports daily practice. There is a greater emphasis on the importance of cooperation and differentiation in primary care (midwifes and general practitioners). During the last decade many general practitioners stopped doing home deliveries and have therefore lost their experience in obstetric care and pathology. The guideline describes the general practitioner's tasks as a preconception counsellor, a professional expert on illnesses during pregnancy and after the delivery, and as the doctor of the newborn baby. It will hopefully stimulate a revived interest of and involvement in pregnancy and post-partum care among general practitioners. PMID:14753124
Marsh, G N; McNay, R A
A survey of the total care provided by a general practitioner and his paramedical team for 3,137 patients in Teesside in 1972 showed that even in this area of high morbidity and mortality the work load was very small. The doctor held an average of 2.3 consultations per patient per year, and the overall average for the team of doctor, nurse, and health visitor was only 3.1. By delegating work to a team of trained paramedical workers, by increasing the proportion of personal medicine, and by engaging the co-operation of his patients, the general practitioner reduced his work load considerably, without any apparent reduction in standard of care.
Rexvid, Devin; Blom, Björn; Evertsson, Lars; Forssén, Annika
General practitioners (GPs) and social workers (SWs) are professions whose professional autonomy and discretion have changed in the so-called risk and audit society. The aim of this article is to compare GPs’ and SWs’ responses to Evidence-Based and Organizational Risk Reduction Technologies (ERRT and ORRT). It is based on a content analysis of 54 peer-reviewed empirical articles. The results show that both professions held ambivalent positions towards ERRT. The response towards ORRT differed...
Devin Rexvid; Björn Blom; Lars Evertsson; Annika Forssén
General practitioners (GPs) and social workers (SWs) are professions whose professional autonomy and discretion have changed in the so-called risk and audit society. The aim of this article is to compare GPs’ and SWs’ responses to Evidence-Based and Organizational Risk Reduction Technologies (ERRT and ORRT). It is based on a content analysis of 54 peer-reviewed empirical articles. The results show that both professions held ambivalent positions towards ERRT. The response towards ORRT differed...
An open-access upper gastrointestinal endoscopy service for general practitioners is described. Between July 1981 and May 1985, 391 endoscopies were performed on 354 patients. In contrast to the results of other studies, demand for endoscopy and the pick-up rate for major lesions has remained steady, and the number of requests for barium meals has fallen by almost a quarter. Major lesions — cancer, gastric and duodenal ulcers and severe oesophagitis — were found in 33% of patients. Oesophagit...
Ford, F M; Ford, J; Dowrick, C.
This paper considers the potential effects of the government's Welfare to Work policy on general practitioner (GP) working patterns, and aims to explore the relationship between unemployment, ill health, and GP sickness certification. Social security and employment policy initiatives are discussed in relation to the literature on the relationship between unemployment and ill health, sociological and psychological perspectives on work and unemployment, medicalisation of unemployment, adjudicat...
MARINESCU Paul; Candea, George
Fault injection, a critical aspect of testing robust systems, is often overlooked in the development of general-purpose software. We believe this is due to the absence of easy-to-use tools and to the extensive manual labor required to perform fault injection tests. This paper introduces LFI (Library Fault Injector), a tool that automates the preparation of fault scenarios and their injection at the boundary between shared libraries and applications. LFI extends prior work by automatically pro...
Bensing, J.; Brink-Muinen, A. van den; Bakker, D.
The differences between female and male general practitioners (GPs) were studied regarding three different factors: 1) Do female GPs see more female patients than their male colleagues in the same practice?; 2) Are female GPs confronted with different types of health problems from their male colleagues?; and 3) Do female GPs provide different services to their patients? Data from the Dutch National Study on Morbidity and Interventions in General Practice were used. All practices in this study...
Introduction and aim It has been suggested that the employment of pharmacists in general practice might moderate the growth in prescribing costs. However, empirical evidence for this proposition has been lacking. The aim of this study was to evaluate a controlled trial of pharmacist-led intervention in general practice to determine whether intervention practices made savings relative to controls and if so, exactly how these savings were made and whether quality of prescribing was maintain...
Eccles Martin P; Goh Teik T; Steen Nick
Abstract Background Quality of care in general practice may be affected by the team climate perceived by its health and non-health professionals. Better team working is thought to lead to higher effectiveness and quality of care. However, there is limited evidence available on what affects team functioning and its relationship with quality of care in general practice. This study aimed to explore individual and practice factors that were associated with team climate, and to explore the relatio...
Humphreys, J S; Rolley, F
Whilst definitions of what constitutes general practice vary according to purpose, the pivotal role of general practitioners as key providers of health and medical services is acknowledged. Recent concerns to address both what general practitioners and their patients want and get from general practice stem from a recognized need to include stakeholder concerns about the adequacy of general practice alongside workforce issues such as recruitment and retention. Nowhere is this need so crucial as in rural areas where the range of health services is limited and major inequities exist in the availability of general practitioners. An extended framework for evaluating what general practitioners and their patients expect and receive from general practice, with particular reference to rural general practice in Australia is presented. Three inter-related dimensions of recruitment, retention and a whole patient/whole family approach to health care are suggested as underpinning this framework. The significance of each dimension to ensuring the provision of quality general practice care in rural communities, and the links between them, are outlined in the proposed framework. PMID:9579746
Kang, Yicheng; Gong, Xiaodong; Gao, Jiti; Qiu, Peihua
Without measurement errors in predictors, discontinuity of a nonparametric regression function at unknown locations could be estimated using a number of existing approaches. However, it becomes a challenging problem when the predictors contain measurement errors. In this paper, an error-in-variables jump point estimator is suggested for a nonparametric generalized error-in-variables regression model. A major feature of our method is that it does not impose any parametric distribution on the m...
Full Text Available As a pedagogical discipline glotoeducology is related to didactics, i. e. teaching theory. Three concepts of didactics are being distinguished: teaching, teaching principles and types of teaching activity. The authors limited themselves in their paper on one of them, namely: teaching principles that determine the usage of teaching regularities in the course of implementation of the objectives of teaching and education. The article also provides analysis of interaction of linguodidactical principles with general didactical principles, the impact thereof to teaching of foreign languages.
Abstract Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes—all core attributes of a medical home. This qualitative study looked at 4 different PHCO models—3 from the United States and 1 from Australia—with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system. PMID:26636485
Wensing, M; Mainz, Jan; Kramme, O;
Randomized trials were performed in Denmark and The Netherlands to determine the effect of mailed reminders on the response rate in surveys among patients in general practice. In both countries, general practitioners handed out questionnaires to 200 adult patients who came to visit them. An inter......) but not in Denmark (87% versus 81%, respectively). Mailed reminders can improve the response rate in surveys related to a general practice, but they are not effective in all situations....
Kjaersgaard, Maiken Ina Siegismund; Vedsted, Peter; Parner, Erik Thorlund;
the performance of an algorithm linking individual patients to their general practice by using information from the Danish National Health Service Register and the Danish Civil Registration System. MATERIALS AND METHODS: The National Health Service Register contains information on all services provided by general...... and general practices. The algorithm performs better in subgroups of patients with high health care needs. The algorithm constitutes a valuable tool for primary health care research....
Thomson, Donald M.
This paper describes and analyses an experimental clinical examination for general practice. Differences in the results obtained by fourth year students, fifth year students and trainee general practitioners highlight some of the dilemmas of medical education. It is concluded that examinations which include clinical tests can increase the credibility of general practice examinations, can be reliably applied to small groups of candidates and therefore have considerable potential for formative ...
Piterman, Leon; Jones, Kay M; Castle, David J
General practitioners are involved in the continuing care and shared care of patients with chronic mental illness, including bipolar disorder. Psychiatrists are particularly reliant on GPs to monitor and treat comorbidities as well as the psychiatric condition itself. Management of chronic mental illness is compromised by a number of factors, including problems with diagnosis, physical comorbidity, erratic attendance and poor compliance with treatment. Diagnosis of bipolar disorder is often delayed, and differential diagnoses to be considered include unipolar depression, anxiety disorder, drug and alcohol dependence, personality disorder, attention deficit hyperactivity disorder, and general medical and central nervous system diseases. New Medicare items have been introduced under the Better Access to Mental Health Care initiative. However, uptake for patients with chronic psychiatric illness, including bipolar disorder, is low. Patients with bipolar disorder may be prone to a range of comorbid psychological, social and physical problems, and GPs need to be vigilant to detect and manage comorbidity and social problems as part of the overall plan. This includes assistance with certification for sickness and unemployment benefits. GPs may become involved during crises affecting patients and this may pose significant problems for GPs who need to provide ongoing care following patient discharge from hospital. Despite these difficulties, opportunities exist for GPs to play a vital and ongoing role in the management of patients with bipolar disorder. PMID:20712554
Mahomed S Patel
Full Text Available BACKGROUND: Although primary health care, and in particular, general practice will be at the frontline in the response to pandemic influenza, there are no frameworks to guide systematic planning for this task or to appraise available plans for their relevance to general practice. We aimed to develop a framework that will facilitate planning for general practice, and used it to appraise pandemic plans from Australia, England, USA, New Zealand and Canada. METHODOLOGY/PRINCIPAL FINDINGS: We adapted the Haddon matrix to develop the framework, populating its cells through a multi-method study that incorporated the peer-reviewed and grey literature, interviews with general practitioners, practice nurses and senior decision-makers, and desktop simulation exercises. We used the framework to analyse 89 publicly-available jurisdictional plans at similar managerial levels in the five countries. The framework identifies four functional domains: clinical care for influenza and other needs, public health responsibilities, the internal environment and the macro-environment of general practice. No plan addressed all four domains. Most plans either ignored or were sketchy about non-influenza clinical needs, and about the contribution of general practice to public health beyond surveillance. Collaborations between general practices were addressed in few plans, and inter-relationships with the broader health system, even less frequently. CONCLUSIONS: This is the first study to provide a framework to guide general practice planning for pandemic influenza. The framework helped identify critical shortcomings in available plans. Engaging general practice effectively in planning is challenging, particularly where governance structures for primary health care are weak. We identify implications for practice and for research.
Truin Gert-Jan; Bronkhorst Ewald M; Wensing Michel; Sonneveld Rutger E; Brands Wolter G
Abstract Background Considering the changes in dental healthcare, such as the increasing assertiveness of patients, the introduction of new dental professionals, and regulated competition, it becomes more important that general dental practitioners (GDPs) take patients' views into account. The aim of the study was to compare patients' views on organizational aspects of general dental practices with those of GDPs and with GDPs' estimation of patients' views. Methods In a survey study, patients...
Jørgensen, Jeanette Therming; Andersen, John Sahl; Tjønneland, Anne;
into the cohort (baseline) in the period between 1993 and 1997. RESULTS: Frequent attenders accounted for 40 % of all face-to-face GP consultations with a mean 12 visits/year. Women were more likely to be frequent attenders, in crude (Odds ratio: 1.95; 95 % Confidence Interval: 1.85-2.06) and fully adjusted (1...... in Danish adult population, by examining lifestyle, socio-demographic, medical and gender-specific factors. METHOD: For 54,849 participants of the Danish Diet, Cancer and Health cohort (50-65 year old) we obtained data on visits to general practitioner (GP) from the Danish National Health Service Register...... at cohort baseline (1993-97), when information on medical conditions and lifestyle, socio-demographic and gender-specific factors was collected by questionnaire. Logistic regression was used to identify determinants of frequent attendance, defined as top 10 % GP users at the year of recruitment...
The focus of the research herein was to examine the main characteristics of a learning organization in a general practice. An ethnographic approach was taken. Blockage instrument, structured interviews and documentary evidence were used to establish the validity and the reliability of the research. Data were collected and analysed systematically. It is shown that the case study practice contains the characteristics of a learning organization and key management and organizational issues, such as policy making, practice management and performance management, are identified. Management strategies are offered and recommendations made both for the case study practice and generally for primary and secondary healthcare services. We hope that our research will guide further strategic planning in the case study practice, and that it will help other general practices and the NHS as a whole in the development of a learning organization.
Beale, N; Baker, N; Straker-Cook, D
This study tests the hypothesis that Council Tax Valuation Banding (CTVB) is a measure both of UK socioeconomic status and of general practice workload. It is a retrospective cohort study based in a UK semi-rural general practice, North Wiltshire. The study group is a randomised selection of UK general practice patients. The outcome measures are socio-demographic and primary care workload parameters versus CTVBs by logistic regression analyses in a sample of 378 patients (90% participation rate). People who pay little or no council tax are significantly less likely to live in owner-occupied homes or to have access to a car than their counterparts. There is also a significant inverse association between CTVB and demand for general practitioner services. CTVB could be an accessible, universal, non-census marker of UK socioeconomic status and of general practice workload that would have validity in the context of primary care resource allocation and is a concept worthy of further investigation.
C. GOURLEY; A. RIDLEY
The Australian farming sector is continuing to intensify, particularly within 300 km of the east and southern coastlines.In the future there will be fewer and larger farms, which will use more fertilizer, support more stock, grow more monoculture crops, and utilise more marginal soils. This is likely to increase the major environmental impacts of soil degradation, salt,nutrient and sediment contamination of waterways, and greenhouse gas emissions. Australian national water policy continues to focus on land, stream and groundwater salinity issues, although there is now a greater recognition of the importance of nitrogen and phosphorus losses from agriculture. The general philosophy of policy for dealing with nonpoint source pollution has been towards a voluntary rather than regulatory approach, with state and national governments supporting a range of programs to encourage sustainable agricultural practices. A catchment (watershed) based approach,through the use of integrated catchment management plans, is the primary way that non-point source pollution is addressed at the farm and local level. At an industry level, cotton, grains, meat, sugarcane and dairy amongst others, as well as the Australian fertilizer industry, have responded to non-point source issues by investing in research and development, and developing codes of practice aimed at abating these environmental impacts. Understanding the economic, social, political and cultural contexts of farming as well as the environmental impacts of agriculture are very important in determining the appropriateness of policy responses for Australian farming systems.
Full Text Available Saravana Kumar, Luke Perraton, Zuzana Machotka.International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, South Australia.Abstract: Evidence-based practice is now considered to be a vital element of health care service delivery. The call to use evidence to inform other areas, such as teaching and learning, is growing. This paper reports on the processes used to integrate best evidence into teaching practices within an undergraduate health science program. An existing course within this program at an Australian tertiary institution was remodeled by a newly appointed course coordinator in response to critical feedback from student cohorts. A systematic, iterative, five-step approach was used in the development of the new course. The process of development was influenced by current research evidence, an audit of the existing course, and critical feedback from students. The new course was evaluated using quantitative and qualitative research methods for five study periods. In 2005, prior to implementing the changes, the overall student satisfaction rating for the course was zero (representing the lowest possible score. In 2006, the overall student satisfaction rating was 62.07, in 2007 it was 65.8, and in 2008 it was 55.7. Qualitative findings also supported these quantitative findings, indicating improvements in the structure and process of the new course. The outcomes from the evaluation of the remodeled course provide evidence of a consistent quality learning experience for students, and support the concept of using research evidence to guide the development of teaching and learning practices in the training of health professionals.Keywords: evidence-based teaching, learning, health care, qualitative, quantitative.
Yilmaz, Tonguc Utku; Gumus, Enes; Salman, Bulent
Objective: Communication between the patient and physician is central to medical care. However communication skills in Turkey haven’t been gained so much concern. This situation effect the national quality of health care. Here, we tried to perform some basic communication skills and to find the problems with the possible solution suggestions. Materials and Methods: The study was conducted for a month in general surgery outpatient department located in the slum part of Ankara with low socio-economic population. Basic communication skills were performed. The age, sex, education levels of the patients were obtained. Total symptom expression and interview time were recorded. Previous medical histories were asked. Interruptions including telephone, door knocking were noted. The questions of the patients at the end of the interview classified as hospital setting, nutrition and treatment. Results: Total 410 interviews were analysed. Mean symptom expression and interview times were 22.9 sec and 7.05 min, respectively. Educated patients, males and young patients expressed symptoms longer than the others (p<0.05). There were 174 interruptions in which total interview time signifantly increased than the non interrupted ones (p<0.05). Final questions about hospital setting were signifantly higher in illiterate patients than the educated ones (p<0.05). Awareness of medical history is higher in educated and young patients. Conclusion: Basic communications skills can be performed whether in rural regions. Much more concern should be given to the education of communication skills. The obstacles in communication in medicine are low education levels, and unorganised health system. PMID:26644767
de Vries Marianne
Full Text Available Abstract Background The use of oral corticosteroids as treatment of COPD exacerbations in primary care is well established and evidence-based. However, the most appropriate dosage regimen has not been determined and remains controversial. Corticosteroid therapy is associated with a number of undesirable side effects, including hyperglycaemias, so differences in prescribing might be relevant. This study examines the differences between GPs in dosage and duration of prednisolone treatment in patients with a COPD exacerbation. It also investigates the number of general practitioners (GPs who adjust their treatment according to the presence of diabetic co-morbidity. Methods Cross-sectional study among 219 GPs and 25 GPs in training, located in the Northern part of the Netherlands. Results The response rate was 69%. Nearly every GP prescribed a continuous dose of prednisolone 30 mg per day. Among GPs there were substantial differences in treatment duration. GPs prescribed courses of five, seven, ten, or fourteen days. A course of seven days was most common. The duration of treatment depended on exacerbation and disease severity. A course of five days was especially prescribed in case of a less severe exacerbation. In a more severe exacerbation duration of seven to fourteen days was more common. Hardly any GP adjusted treatment to the presence of diabetic co-morbidity. Conclusion Under normal conditions GPs prescribe prednisolone quite uniformly, within the range of the current Dutch guidelines. There is insufficient guidance regarding how to adjust corticosteroid treatment to exacerbation severity, disease severity and the presence of diabetic co-morbidity. Under these circumstances, there is a substantial variation in treatment duration.
Kreshnik Hoti; Jeffery Hughes; Bruce Sunderland
Expanded pharmacist prescribing is a new professional practice area for pharmacists. Currently, Australian pharmacists’ prescribing role is limited to over-the-counter medications. This review aims to identify Australian studies involving the area of expanded pharmacist prescribing. Australian studies exploring the issues of pharmacist prescribing were identified and considered in the context of its implementation internationally. Australian studies have mainly focused on the attitudes of com...
Atkins, E M; Duffy, M C; Bain, D J
In response to a climate of constant change and increasing demand for services, general practice in the UK has undergone significant modification over the last 10 years. It has become a multi-disciplinary organisation encouraged by funding bodies to plan for service delivery using a more structured team based approach. In Tayside in 1996, practices were charged with producing formal Practice Development Plans (PDPs) which would focus on priority areas aligned with the Health Boards own strategic plan--those were teamwork, information management and technology, and clinical service delivery. The University of Dundee's Department of General Practice successfully applied for funding to develop ways of facilitating practices so that they could a) identify their own development priorities, and b) plan and implement action and learning to see these priorities through. Using action research methodology, the project attempted to create a climate for change, provide support and training to see the changes implemented, and ensure commitment to the changes from all members of the practice team. The Facilitator adopted a flexible style varying her role between expert, guide and support. Analysis of progress made by different practices, coupled with the Facilitator's in depth knowledge of them, suggested the importance of certain key aspects of practice organisation and culture. A practice characterisation model identified practices which were stable, currently coping, proactive and ready to face the challenge of change as best placed to engage in a full scale development programme. Other profiles suggested a range of alternative interventions as more likely to be acceptable and productive. PMID:11499046
Full Text Available Background: Australia has a growing number of Asian Indian immigrants. Unfortunately, this population has an increased risk for coronary heart disease (CHD. Dietary adherence is an important strategy in reducing risk for CHD. This study aimed to gain greater understanding of the knowledge, attitudes and beliefs relating to food practices in Asian Indian Australians. Methods: Two focus groups with six participants in each were recruited using a convenience sampling technique. Verbatim transcriptions were made and thematic content analysis undertaken. Results: Four main themes that emerged from the data included: migration as a pervasive factor for diet and health; importance of food in maintaining the social fabric; knowledge and understanding of health and diet; and elements of effective interventions. Discussion: Diet is a complex constructed factor in how people express themselves individually, in families and communities. There are many interconnected factors influencing diet choice that goes beyond culture and religion to include migration and acculturation. Conclusions: Food and associated behaviors are an important aspect of the social fabric. Entrenched and inherent knowledge, attitudes, beliefs and traditions frame individuals’ point of reference around food and recommendations for an optimal diet.
de Ville, Paul A.
This paper explores the formative basis of the professional reflective practice of in-service science teachers through their reconstruction of their pre-service interaction with lecturing staff. It reports through the voice of graduates of the Bachelor of Science/Bachelor of Teaching double degree program of Avondale College, NSW who are currently…
Hoffmann, B; Müller, V; Rochon, J;
Background: The measurement of safety culture in healthcare is generally regarded as a first step towards improvement. Based on a self-assessment of safety culture, the Frankfurt Patient Safety Matrix (FraTrix) aims to enable healthcare teams to improve safety culture in their organisations....... In this study we assessed the effects of FraTrix on safety culture in general practice. Methods: We conducted an open randomised controlled trial in 60 general practices. FraTrix was applied over a period of 9 months during three facilitated team sessions in intervention practices. At baseline and after 12...... months, scores were allocated for safety culture as expressed in practice structure and processes (indicators), in safety climate and in patient safety incident reporting. The primary outcome was the indicator error management. Results: During the team sessions, practice teams reflected on their safety...
Maiorova, T.; Stevens, F.; Zee, J. van der; Boode, B.; Scherpbier, A.
Background: Female medical students often prefer primary care specialties, while male students appear to be attracted to hospital specialties. Notwithstanding the steady feminisation of medicine, in many countries there are still difficulties in recruiting trainees for general practice. This seeming
Wensing, M.J.P.; Baker, R.; Szecsenyi, J.; Grol, R.P.T.M.
OBJECTIVE: To examine associations between patient evaluations of general practice and characteristics of national health care systems. METHODS: International comparative study in 17 countries, using international patient survey data (n= 25052) and data-bases for health care system characteristics.
Rhydderch, S.M.; Edwards, A.; Elwyn, G.; Marshall, M.; Engels, Y.M.P.; Hombergh, P. van den; Grol, R.P.T.M.
BACKGROUND: Quality improvement of organizational aspects in general practice is receiving increasing attention. In particular, the impact of effective organization on preventative care has been recognized. Organizational assessments are typically used as part of professionally led accreditation sch
Liya G. Skorobogatova
Full Text Available The article concerns crucial issues of practice-oriented training in Russia's intermediate vocational education, designates directions of general educational disciplines study in intermediate vocational education.
Riis, Allan; Jensen, Cathrine Elgaard; Bro, Flemming;
primary care to secondary care. The primary aim of this project was to reduce secondary care referral within 12 weeks by a multifaceted implementation strategy (MuIS). METHODS: In a cluster randomised design, 189 general practices from the North Denmark Region were invited to participate. Practices were...... randomised (1:1) and stratified by practice size to MuIS (28 practices) or a passive implementation strategy (PaIS; 32 practices). Included were patients with LBP aged 18 to 65 years who were able to complete questionnaires, had no serious underlying pathology, and were not pregnant. We developed a Mu.......31 to 0.81; p = 0.004]). CONCLUSIONS: Using a MuIS changed general practice referral behaviour and was cost effective, but patients in the MuIS group were less satisfied. This study supports the application of a MuIS when implementing guidelines. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01699256....
Morgan, K.; Clarke, D
BACKGROUND: Insomnia is widely reported and widely treated in general practice, yet relatively little research has focused on the natural history of the condition in primary care settings. As a result, there is at present little information to enable clinicians to assess insomnia risk, or anticipate outcomes in older general practice populations. AIM: To estimate, using 8-year longitudinal data, the risk of insomnia onset associated with selected health and lifestyle factors. METHOD: Survivor...
Wearn, A M; Greenfield, S M
Complementary therapy (CT) has become increasingly popular with the general public and interest from the health professions has been rising. There has been no study focusing on the pattern of availability of CT within urban and inner-city general practice. We aimed to describe the prevalence and pattern of access to complementary therapy in this setting, identifying the characteristics of practices offering CT and the perceived barriers to service provision. We sent a postal questionnaire to ...
textabstractKnee trauma is often seen in general practice. The availability of magnetic resonance (MR) imaging has improved the diagnostic possibilities after knee trauma. Nevertheless, little is known about the findings on MR imaging after knee trauma in general practice. Especially, there is little known about bone bruise (a finding seen on MR imaging, but not on conventional radiographs). In this thesis the available knowledge on the natural course of posttraumatic knee lesions and bone br...
Full Text Available Abstract Background Considering the changes in dental healthcare, such as the increasing assertiveness of patients, the introduction of new dental professionals, and regulated competition, it becomes more important that general dental practitioners (GDPs take patients' views into account. The aim of the study was to compare patients' views on organizational aspects of general dental practices with those of GDPs and with GDPs' estimation of patients' views. Methods In a survey study, patients and GDPs provided their views on organizational aspects of a general dental practice. In a second, separate survey, GDPs were invited to estimate patients' views on 22 organizational aspects of a general dental practice. Results For 4 of the 22 aspects, patients and GDPs had the same views, and GDPs estimated patients' views reasonably well: 'Dutch-speaking GDP', 'guarantee on treatment', 'treatment by the same GDP', and 'reminder of routine oral examination'. For 2 aspects ('quality assessment' and 'accessibility for disabled patients' patients and GDPs had the same standards, although the GDPs underestimated the patients' standards. Patients had higher standards than GDPs for 7 aspects and lower standards than GDPs for 8 aspects. Conclusion On most aspects GDPs and patient have different views, except for social desirable aspects. Given the increasing assertiveness of patients, it is startling the GDP's estimated only half of the patients' views correctly. The findings of the study can assist GDPs in adapting their organizational services to better meet the preferences of their patients and to improve the communication towards patients.
Bolden, Aljernon J.; And Others
A study compared the practice patterns of 41 dentists with graduate training in general dentistry with those of 41 dentists without such training, in terms of number and types of procedures performed, patient characteristics, professional and community activities, and practice characteristics. Some differences were found, particularly in patient…
De Croon, Robin; Klerkx, Joris; Duval, Erik
This paper reports on our proof-of-concept interactive visualization dashboard to support general practitioners (GPs) explore patient follow-up in their practice. The dashboard enables GPs to create visual queries in order to filter patients. Using the dashboard, GPs themselves can verify their practice with official quality indicators.
This paper analyzes "empathy" and "sympathy" as situated practices, sequential processes that are coconstructed by the participants in the situation. The data consists of 228 sequences of patients' descriptions of their problematic experiences and professionals' responses to them in videorecorded general practice and homeopathic consultations. One…
Sleddens, E.F.C.; Kremers, S.P.J.; Stafleu, A.; Dagnelie, P.C.; Vries, N.K. de; Thijs, C.
Research on parenting practices has focused on individual behaviors while largely failing to consider the context of their use, i.e., general parenting. We examined the extent to which food parenting practices predict children's dietary behavior (classified as unhealthy: snacking, sugar-sweetened be
Verheij, R.; Jabaaij, L.; Njoo, K.; Hoogen, H. van den; Bakker, D. de
Background: The use of electronic medical records (EMR) in general practice has spread rapidly in the last decade (more than 90% today). Traditionally, these records are primarily used for direct patient care and for administrative purposes by the practice involved. In recent years, further technica
Full Text Available Abstract Background General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP, have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening. Methods Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach. Results Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets. Conclusion The NCSP
The objective of this article is to investigate general contemporary Australian perceptions of the Japanese. I will do this by exploring how Australian contemporary literature (2006- 2007) and Australian contemporary film (1997-2007) depicts Japanese characters. By analysing the representation of the Japanese characters in these areas I will attempt to gather a broad understanding of how Australians represent, perceive and identify the Japanese today.
Lundstrøm, Sanne Lykke; Edwards, Kasper; Reventlow, Susanne;
In this paper we investigate the association between relational coordination among the practice team in general practice and number of consultations performed in a general practice per staff, i.e. a proxy of productivity. We measured relational coordination using the Relational Coordination Survey...... and combined the results with register data. We found that relational coordination was statistically significant associated with number of consultation per staff per year. We later divided consultations in to three types: Face-to-face, Email and phone consultations. We found a statistically...... significant associating between relational coordination and with number of face-to-face consultation per staff per year....
Dierick-van Daele, Angelique; Steuten, Lotte M.G.; Romeijn, Aria; Derckx, Emmy W.C.C.; Vrijhoef, Hubertus J.M.
Background: General practitioners face the challenging task of finding the most efficient and effective mix of professionals in general practice to accommodate future care demands within scarce health care budgets. To enable informed decision-making about skill mix issues, economic information is n
Eitzen-Strassel, J. von; Vrijhoef, H.J.M.; Derckx, E.W.C.C.; Bakker, D.H. de
Background: General practitioners (GPs) have to match patients’ demands with the mix of their practice staff’s competencies. However, apart from some general principles, there is little guidance on recruiting new staff. The purpose of this study was to develop and test a method which would allow GPs
Schiøttz-Christensen, Berit; Nielsen, Gunnar Lauge; Hansen, Vivian Kjær;
OBJECTIVES: We aimed to examine the prognosis of acute low back pain (LBP) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP. METHOD: We conducted a prospective cohort study in general...
Schiøttz-Christensen, Berit; Nielsen, G L; Hansen, V K;
OBJECTIVES: We aimed to examine the prognosis of acute low back pain (LBP) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP. METHOD: We conducted a prospective cohort study in general...
Marquet, R.L.; Bartelds, A.I.M.; Kerkhof, A.J.F.M.; Schellevis, F.G.; Zee, J. van der
BACKGROUND: Many patients attempting or committing suicide consult their general practitioner (GP) in the preceding period, indicating that GPs might play an important role in prevention. The aim of the present study was to analyse the epidemiology of suicidal behaviour in Dutch general practice in
David Alejandro González-Chica; Zandile Mnisi; Jodie Avery; Katherine Duszynski; Jenny Doust; Philip Tideman; Andrew Murphy; Jacquii Burgess; Justin Beilby; Nigel Stocks
Background Appropriate understanding of health information by patients with cardiovascular disease (CVD) is fundamental for better management of risk factors and improved morbidity, which can also benefit their quality of life. Objectives To assess the relationship between health literacy and health-related quality of life (HRQoL) in patients with ischaemic heart disease (IHD), and to investigate the role of sociodemographic and clinical variables as possible confounders. Methods Cross-sectio...
@@ Introduction The Australian Research Council(ARC) is the Australian Government's main agency for allocating research funding to academics and researchers in Australian universities.Its mission is to deliver policy and programs that advance Australian research and innovation globally and benefit the community.
Sivertsen, Børge; Nordhus, Inger H; Bjorvatn, Bjørn; Pallesen, Ståle
The aim of the current national survey of all general practitioners (GPs) practising in Norway was to explore assessment, treatment practice and perceived efficacy of treatment of sleep problems in general practice. A short questionnaire, including self-report measures of the frequency and routines of treatment and assessment of sleep problems, was sent to all 4049 GPs in Norway, of whom 1465 (36.7%) provided valid responses. The prevalence of sleep problems among patients in general practice was estimated to be 11.2%, of which almost two-thirds were believed to be caused by a medical condition. Anamnestic information and blood tests were the most common assessment of sleep problems, whereas GPs rarely referred patients to all-night polysomnographic recording. Sleep hygiene advices were the most commonly used treatment strategy, whereas hypnotics were believed to have the best short-term efficacy. Antidepressives were considered to be the best option for long-term management of sleep problems. About one-third of the patients were prescribed benzodiazepines or 'Z-drugs' for more than 6 months. This study demonstrates that sleep problems are recognized by GPs, but despite evidence that non-pharmacological treatment is superior in the long-term management of insomnia, the current study shows that hypnotics are still considered by GPs to be the most successful treatment. PMID:19732316
Freeman Christopher; Cottrell W; Kyle Greg; Williams Ian; Nissen Lisa
Abstract Background Pharmacists are viewed as highly trained yet underutilised and there is growing support to extend the role of the pharmacist within the primary health care sector. The integration of a pharmacist into a general practice medical centre is not a new concept however is a novel approach in Australia and evidence supporting this role is currently limited. This study aimed to describe the opinions of local stakeholders in South-East Queensland on the integration of a pharmacist ...
Full Text Available Abstract Background In Germany, clinical trials and comparative effectiveness studies in primary care are still very rare, while their usefulness has been recognised in many other countries. A network of researchers from German academic general practice has explored the reasons for this discrepancy. Methods Based on a comprehensive literature review and expert group discussions, problem analyses as well as structural and procedural prerequisites for a better implementation of clinical trials in German primary care are presented. Results In Germany, basic biomedical science and technology is more reputed than clinical or health services research. Clinical trials are funded by industry or a single national programme, which is highly competitive, specialist-dominated, exclusive of pilot studies, and usually favours innovation rather than comparative effectiveness studies. Academic general practice is still not fully implemented, and existing departments are small. Most general practitioners (GPs work in a market-based, competitive setting of small private practices, with a high case load. They have no protected time or funding for research, and mostly no research training or experience. Good Clinical Practice (GCP training is compulsory for participation in clinical trials. The group defined three work packages to be addressed regarding clinical trials in German general practice: (1 problem analysis, and definition of (2 structural prerequisites and (3 procedural prerequisites. Structural prerequisites comprise specific support facilities for general practice-based research networks that could provide practices with a point of contact. Procedural prerequisites consist, for example, of a summary of specific relevant key measures, for example on a web platform. The platform should contain standard operating procedures (SOPs, templates, checklists and other supporting materials for researchers. Conclusion All in all, our problem analyses revealed that
Full Text Available Abstract Background Quality is on the agenda of European general practice (GP. European researchers have, in collaboration, developed tools to assess quality of GPs. In this feasibility study, we tested the European Practice Assessment (EPA in a one-off project in Belgium, where general practice has a low level of GP organisation. Methods A framework for feasibility analysis included describing the recruiting of participants, a brief telephone study survey among non-responders, organisational and logistic problems. Using field notes and focus groups, we studied the participants' opinions. Results In this study, only 36 of 1000 invited practices agreed to participate. Co-ordination, administrative work, practice visits and organisational problems required several days per practice. The researchers further encountered technical problems, for instance when entering the data and uploading to the web-based server. In subsequent qualitative analysis using two focus groups, most participant GPs expressed a positive feeling after the EPA procedure. In the short period of follow-up, only a few GPs reported improvements after the visit. The participant GPs suggested that follow-up and coaching would probably facilitate the implementation of changes. Conclusion This feasibility study shows that prior interest in EPA is low in the GP community. We encountered a number of logistic and organisational problems. It proved attractive to participants, but it can be augmented by coaching of participants in more than a one-off project to identify and achieve targets for quality improvement. In the absence of commitment of the government, a network of universities and one scientific organisation will offer EPA as a service to training practices.
Schellevis François G
Full Text Available Abstract Background In 1996 the guideline 'The Red Eye' was first published by the Dutch College of General Practitioners. The extent to which general practitioners adhere to this guideline is unclear. Recently, data on the management of infectious conjunctivitis by general practitioners became available from the Second Dutch National Survey of General Practice. We measured the age-specific incidence of infectious conjunctivitis, described its management by Dutch general practitioners, and then compared these findings with the recommendations made in the guideline. Methods In 2001, over a 12-month period, data from all patient contacts with 195 general practitioners were taken from electronic medical records. Registration was episode-oriented; all consultations dealing with the same health problem were grouped into disease episodes. Data concerning all episodes of infectious conjunctivitis (ICPC-code F70 and sub codes were analysed. Results Over one year, 5,213 new and recurrent episodes of infectious conjunctivitis were presented to general practitioners from a population of N = 375,899, resulting in an overall incidence rate of 13.9 per 1000 person-years, varying from more than 80/1000 py in children up to one-year old, to less than 12/1000 py in children over the age of 4. Topical ophthalmic ointments were prescribed in 87% of the episodes, of which 80% was antibiotic treatment. Fusidic acid gel was most frequently prescribed (69%. In most episodes general practitioners did not adhere to the guideline. Conclusion In 2001, the management of infectious conjunctivitis by Dutch general practitioners was not in accordance with the recommendations of the consensus-based guideline published five years previously, despite its wide distribution. In 2006 this guideline was revised. Its successful implementation requires more than distribution alone. Probably the most effective way to achieve this is by following a model for systemic implementation.
Hall, J; Hall, N; Fisher, E; Killer, D
The broad range of medical problems seen in general practice means that the assessment of health outcomes shares much with the assessment of health status in the general community. The last two decades have seen considerable progress in health status measurement for this purpose. This paper reports the use of three such measures in a general practice setting. The 'Rand health insurance study battery', the 'sickness impact profile' and the 'general health questionnaire' were tested in two general practices in Sydney, Australia, to determine patient compliance, to assess the range of scores and discriminative ability of the instruments, and to compare the different instruments. There was a high degree of acceptance of the questionnaires, showing that patients visiting their general practitioners are prepared to complete such questionnaires. The range of scores obtained was less skewed for the Rand measures than for the sickness impact profile or the general health questionnaire, suggesting that the Rand measures should be the preferred general health status measure. PMID:3609549
Magin, Parker J; Morgan, Simon; Tapley, Amanda; Davis, Joshua S; McArthur, Lawrie; Henderson, Kim M; Mulquiney, Katie J; Dallas, Anthea; Davey, Andrew R; Scott, John; van Driel, Mieke L
Over-prescription of antibiotics for non-pneumonia respiratory tract infections (RTIs) is a major concern in general practice. Australian general practice registrars (trainees) have inappropriately high rates of prescription of antibiotics for RTIs. The 'apprenticeship' educational model and the trainee-trainer relationship are drivers of this inappropriate prescribing. We aimed to reduce registrars' non-pneumonia RTI antibiotic prescribing via an educational intervention (a 90-min face-to-face workshop supported by online modules), complemented by delivery of the same intervention, separately, to their trainers. We conducted a pre- and post-intervention comparison of the registrars' intention to prescribe antibiotics for common RTIs using McNemar's test. We similarly tested changes in supervisors' intended prescribing. Prescribing intentions were elicited by responses to six written clinical vignettes (upper respiratory tract infection, otitis media, sore throat and three acute bronchitis vignettes). We found that, for registrars, there were statistically significant reductions in antibiotic prescribing for the sore throat (24.0% absolute reduction), otitis media (17.5% absolute reduction) and two of the three acute bronchitis (12.0% and 18.0% absolute reduction) vignettes. There were significant reductions in supervisors' antibiotic prescribing intentions for the same four vignettes. We conclude that our intervention produced a significant change in registrars' intention to prescribe antibiotics for non-pneumonia RTIs. PMID:27005837
Magin, Parker J; Morgan, Simon; Tapley, Amanda; Davis, Joshua S; McArthur, Lawrie; Henderson, Kim M; Mulquiney, Katie J; Dallas, Anthea; Davey, Andrew R; Scott, John; van Driel, Mieke L
Over-prescription of antibiotics for non-pneumonia respiratory tract infections (RTIs) is a major concern in general practice. Australian general practice registrars (trainees) have inappropriately high rates of prescription of antibiotics for RTIs. The 'apprenticeship' educational model and the trainee-trainer relationship are drivers of this inappropriate prescribing. We aimed to reduce registrars' non-pneumonia RTI antibiotic prescribing via an educational intervention (a 90-min face-to-face workshop supported by online modules), complemented by delivery of the same intervention, separately, to their trainers. We conducted a pre- and post-intervention comparison of the registrars' intention to prescribe antibiotics for common RTIs using McNemar's test. We similarly tested changes in supervisors' intended prescribing. Prescribing intentions were elicited by responses to six written clinical vignettes (upper respiratory tract infection, otitis media, sore throat and three acute bronchitis vignettes). We found that, for registrars, there were statistically significant reductions in antibiotic prescribing for the sore throat (24.0% absolute reduction), otitis media (17.5% absolute reduction) and two of the three acute bronchitis (12.0% and 18.0% absolute reduction) vignettes. There were significant reductions in supervisors' antibiotic prescribing intentions for the same four vignettes. We conclude that our intervention produced a significant change in registrars' intention to prescribe antibiotics for non-pneumonia RTIs.
Wearn, A M; Greenfield, S M
Complementary therapy (CT) has become increasingly popular with the general public and interest from the health professions has been rising. There has been no study focusing on the pattern of availability of CT within urban and inner-city general practice. We aimed to describe the prevalence and pattern of access to complementary therapy in this setting, identifying the characteristics of practices offering CT and the perceived barriers to service provision. We sent a postal questionnaire to all 254 general practices on the Birmingham Family Health Services Authority list. Practices were asked whether they offered any access to CTs, how services were organized and which therapies were available and to identify any barriers to provision. 175 practices (68.9%) responded. Half of the practices offered access to CT. Of these, half offered an in-house service, usually provided by the doctor (81.8%). Of GPs practising therapies themselves, 58% began in or after 1990. Seventeen separate therapies were offered, most commonly acupuncture, osteopathy, chiropractic, hypnotherapy and homoeopathy. Practices significantly more likely to offer access to CT were of larger list size and training or teaching practices. They were equally likely to be fundholders or non-fundholders. Practices offering an in-house service tended to be fundholding, training and of larger list size. Finance was perceived as the major barrier. In the area studied, many patients now have some access to CT within primary care, often within their own practice. In the main, therapies offered are the 'medically acceptable face' of complementary medicine.
Clement, T; Brown, J; Morrison, J; Nestel, D
General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings. PMID:26384813
Hølge-Hazelton, Bibi; Tulinius, C.
BACKGROUND: Too many abused and neglected children are being overlooked by GPs and other professionals who are in contact with the families. Some suggestions for a definition of 'a child in need' have been given, but the functionality of these definitions has not been tested in general practice...... the wellbeing of the family or the child. CONCLUSION: Based on this analysis, one suggestion as to why some abused and neglected children are overlooked in general practice is that GPs often have to navigate in difficult indirect consultations, where there is a high risk of losing the overview Udgivelsesdato....... AIM: To describe the problems presented by GPs as cases with children in need during supervision, and from here to suggest an empirically-based definition of a child in need in general practice. DESIGN OF STUDY: A mixed-method evaluation design was used. SETTING: Twenty-one GPs, in Denmark...
Paulsen, Maja Skov; Andersen, Morten; Thomsen, Janus L;
Patients with hypertension are primarily treated in general practice. However, major studies of patients with hypertension are rarely based on populations from primary care. Knowledge of blood pressure (BP) control rates in patients with diabetes and/or cardiovascular diseases (CVDs), who have...... additional comorbidities, is lacking. We aimed to investigate the association of comorbidities with BP control using a large cohort of hypertensive patients from primary care practices....
Whitehouse, A. M.; Cooper, P. J.; Vize, C V; Hill, C.; L. Vogel
The aims of this study were to investigate the prevalence of anorexia nervosa, bulimia nervosa and partial syndromes in women general practice attenders to establish the relative proportions of 'conspicuous' and 'hidden' morbidity. A consecutive series of 540 women patients aged 16-35 years attending their family doctor were screened using a specially devised questionnaire, the weight and dietary practices survey. A total of 115 patients were selected for further assessment and of these 101 p...
Still higher demands have been placed on the job of a general nurse recently. This is why secondary education started to seem insufficient and completion of higher vocational or university education has become necessary for future nurses. To be adequately prepared for their jobs the future graduates of the Nursing course have to obtain adequate practical experience during the practical education. Mutual cooperation between nurses and students is necessary in this context. Lack of such coopera...
The international and national complexities of the situation in Australia over the question of mining of the country's large and rich uranium deposits are explored with especial reference to the pending general election. The present position is ironical since access to low cost uranium would give a welcome boost to the nuclear industry which is enthusiastically supported by the Australian prime minister and his colleagues yet the Australian government is unable to promote mining as rapidly as it would like because of the international commitments it has made to provide a justification for its policy. (U.K.)
Full Text Available The purpose of this paper is to highlight the key motivational factors that lead to the successful implementation of Chronic Diseases Information Systems (CDISs in twenty eight general practices in a case study of a large general practice division network in Australia. The literature identified three major areas of CDIS motivation: patient care gap motivator, internal motivators and external motivators. Patient care emerged as the most important motivation for adopting CDIS, followed by risk management and financial incentives. However, the study also determined that the motivational forces are inter-related and suggests that the decision to adopt CDIS should consider a number of these identified factors.
Ouden, D.J. den; Dirkzwager, A.J.E.; IJzermans, C.J.
Objective: To study the health problems presented to general practitioners by disaster survivors who received specialized ambulatory mental health care. Design: (Longitudinal) case-control study based on general practitioners' electronic medical records. Setting: General practice and a mental health
Lindfors, Erik; Helkimo, Martti; Magnusson, Tomas
The aims of the present study were to investigate patient adherence to treatment with hard acrylic interocclusal appliance in general dentistry in Sweden and to see if some general factors could predict patient adherence or non-adherence. During the period January - May 2009 a postal questionnaire was sent to all adult patients (> or = 20 years of age) that had received a hard acrylic interocclusal appliance from the public dental health service in the County of Uppsala during 2007 (n=388). The same questionnaire was also sent to all adult patients that had received a hard acrylic interocclusal appliance at a specialist clinic during the same year (n=69). The response rate in general dental practice was 71% and at the specialist clinic the response rate was 91%. In general dental practice, 97% of the hard acrylic interocclusal appliances were stabilisation appliances. At the specialist clinic other types of interocclusal appliances was used to a greater extent. A vast majority of patients in both general dental practice and at the specialist clinic experienced that the interocclusal appliance had a positive treatment effect. In general dental practice, 73% of the patients still used their interocclusal appliances 1 1/2-2 years after they had received them. The corresponding figure at the specialist clinic was 54%. The main reasons for not using the interocclusal appliance, besides disappearance/reduction of TMD symptoms, were different kinds of comfort problems. From the results of this study it is concluded that the patient adherence to hard acrylic stabilisation appliances made in general dental practice in Sweden is good. It can also be concluded that a perceived good treatment effect, as well as treatment of more long-term conditions, predicted a better patient adherence to hard acrylic stabilisation appliances. More studies concerning factors affecting patient adherence in TMD therapy are warranted.
MacGregor, Rob; Hyland, Peter; Harvei, Charles; Lee, Boon-Chye; Dalley, Andrew; Ramu, Sangeetha
This paper presents a pilot study of benefits derived from information and communications technology(ICT) adoption and use in medical practices in regional Australia. The study involved 122 regional medical practitioners. The results show that like the more general small business sector, the perception of certain benefits is associated with the size of the practice (in terms of employee levels) and/or the gender of the respondent practitioner. The data also showed that the level of skill of certain software used within the practice was significantly associated with the level of perceived benefit derived from ICT adoption and use. PMID:18195425
Nicholson, Caroline; Jackson, Claire L; Marley, John E; Wells, Robert
Primary health care in Australia has undergone 2 decades of change. Starting with a vision for a national health strategy with general practice at its core, Australia established local meso-level primary health care organizations--Divisions of General Practice--moving from focus on individual practitioners to a professional collective local voice. The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional integration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system. PMID:22403246
Jones, Glenn; Savage, Elizabeth; Hall, Jane
In the Australian Medicare system, general practitioners (GPs) are paid on a fee-for-service basis. A practitioner can choose to bill the government directly (termed bulk billing) and receive 85% of a regulated fee as full payment. Bulk billed consultations are free to the patient. However, GPs are free to charge above the regulated fee. The patient can then claim a rebate from the government but only the equivalent of 85% of the regulated Medicare fee. Such copayments for GP consultations cannot be covered by private health insurance. In the ten years following the introduction of Medicare in 1984, the bulk billing rate for GP consultations steadily increased to 84%. Since then the rate has fallen to below 68%. In April 2003 the Minister for Health announced a reform package under the title A Fairer Medicare which aimed, among other things, to increase the availability of bulk billing for some patients. A key feature of the proposal involved changes to the way that GPs are reimbursed. Following political opposition that would have prevented it passing both houses of the federal parliament, a revised version, MedicarePlus, was released in November 2003. This paper describes the factors influencing a GP's choice to bulk bill and examines the two proposals, in this context.
Jones, Glenn; Savage, Elizabeth; Hall, Jane
In the Australian Medicare system, general practitioners (GPs) are paid on a fee-for-service basis. A practitioner can choose to bill the government directly (termed bulk billing) and receive 85% of a regulated fee as full payment. Bulk billed consultations are free to the patient. However, GPs are free to charge above the regulated fee. The patient can then claim a rebate from the government but only the equivalent of 85% of the regulated Medicare fee. Such copayments for GP consultations cannot be covered by private health insurance. In the ten years following the introduction of Medicare in 1984, the bulk billing rate for GP consultations steadily increased to 84%. Since then the rate has fallen to below 68%. In April 2003 the Minister for Health announced a reform package under the title A Fairer Medicare which aimed, among other things, to increase the availability of bulk billing for some patients. A key feature of the proposal involved changes to the way that GPs are reimbursed. Following political opposition that would have prevented it passing both houses of the federal parliament, a revised version, MedicarePlus, was released in November 2003. This paper describes the factors influencing a GP's choice to bulk bill and examines the two proposals, in this context. PMID:15511328
Mørk, Trine; Andersen, Pernille Tanggaard; Taket, Ann
Thirty-five percent of Danish women experience sexual or physical violence in their lifetime. However, health care professionals are not in the practice of asking about intimate partner violence (IPV) in Denmark. It is currently unknown what hinders general practitioners from asking about partner...... violence and how Danish women would perceive such an inquiry. This aspect has not previously been explored in Denmark. An exploratory study was conducted to examine what hinders general practitioners (GPs) from asking and what Danish women’s views and attitudes are regarding being asked about IPV. Data...... were collected through individual and group interviews with a sample of three GPs and a diverse sample of 13 women, including both survivors of partner violence and those without any history of partner violence. An interpretative analysis was performed with the data. This study provides important...
Back pain is a common problem in general practice, and is of enormous economic importance. A recent report urges general practitioners (GPs) to refer early for manual therapies, such as osteopathy. The key concept to understanding osteopathic principles is somatic dysfunction. This is a disorder of function, rather than pathology, of the musculoskeletal and related systems. Its characteristic features are asymmetry of anatomical landmarks, asymmetry of joint movement, tissue texture changes, ...
Roberts, P J
Women's views on the menopause and hormone replacement therapy were explored using a questionnaire given to women attending one general practice who were having hormone replacement therapy under the supervision of their doctor. Sixty four women (67%) responded. Although only 5% of women had requested hormone replacement therapy from their general practitioner the majority of women indicated that they had been helped by hormone replacement therapy. Eight per cent of women were using hormone re...
Kochen Michael M
Full Text Available Abstract Background Patients' health related quality of life (HRQoL has rarely been systematically monitored in general practice. Electronic tools and practice training might facilitate the routine application of HRQoL questionnaires. Thorough piloting of innovative procedures is strongly recommended before the conduction of large-scale studies. Therefore, we aimed to assess i the feasibility and acceptance of HRQoL assessment using tablet computers in general practice, ii the perceived practical utility of HRQoL results and iii to identify possible barriers hindering wider application of this approach. Methods Two HRQoL questionnaires (St. George's Respiratory Questionnaire SGRQ and EORTC QLQ-C30 were electronically presented on portable tablet computers. Wireless network (WLAN integration into practice computer systems of 14 German general practices with varying infrastructure allowed automatic data exchange and the generation of a printout or a PDF file. General practitioners (GPs and practice assistants were trained in a 1-hour course, after which they could invite patients with chronic diseases to fill in the electronic questionnaire during their waiting time. We surveyed patients, practice assistants and GPs regarding their acceptance of this tool in semi-structured telephone interviews. The number of assessments, HRQoL results and interview responses were analysed using quantitative and qualitative methods. Results Over the course of 1 year, 523 patients filled in the electronic questionnaires (1–5 times; 664 total assessments. On average, results showed specific HRQoL impairments, e.g. with respect to fatigue, pain and sleep disturbances. The number of electronic assessments varied substantially between practices. A total of 280 patients, 27 practice assistants and 17 GPs participated in the telephone interviews. Almost all GPs (16/17 = 94%; 95% CI = 73–99%, most practice assistants (19/27 = 70%; 95% CI = 50–86% and the majority of
A proposal has been prepared for the installation in Australia of a national high performance synchrotron light facility called Boomerang. The Boomerang proposal had its origin in the establishment of the Australian Synchrotron Research Program (ASRP) which was one of the seven Major National Research Facilities announced by the Federal Government in December 1995. The ASRP provides the opportunity and funding for Australian researchers to access international synchrotron facilities, specifically two consortia at the Advanced Photon Source (APS) at the Argonne National Laboratory, USA and continued interaction with the Photon Factory at the KEK Laboratory in Japan. The ASRP was the successor to the Australian National Beamline Facility project (ANBF) which began in 1991 following the ASTEC inquiry titled 'Small Country - Big Science'. The Federal Government also provided funding for a Feasibility Study to determine the value of establishing an Australian-based synchrotron radiation facility. The Feasibility Study was completed in August 1998 and endorsed by the institutional members of the ASRP and the research community in general. The study concluded that, on the data available in Australia, there was a strong case for the installation of an Australian-based facility. The study considered several options for an Australian-based facility and recommended that these options and the data supporting the general conclusions receive further investigation. A mission was arranged to a select group of overseas laboratories to explore these questions in detail. The review team included a mix of scientific and industrial experience and also represented the interests of the ASRP and an Industrial Synchrotron Consortium based in Victoria. Based on the conclusions of the overseas mission and incorporating the advice of all international specialists in the design and use of synchrotron facilities consulted during the mission, the most cost-effective option was an extended
A multiple case study design was used to explore dimensions of organizational values in general practice with respect to developing public involvement. The study was undertaken in an urban district in England with data collected through in-depth individual and focus group interviews with service providers and service users. Four general practice organizations were randomly selected for study after sorting all in the district according to their record of developing involvement activities. The case studies provide evidence of how organizational values can differ markedly in general practice in relation to ideas of public involvement, with consequences for the quantity and quality of activities for involving local people and service users. The differences manifest themselves in the beliefs and attitudes of service providers about the purpose of the organization and the types of relationships that are appropriate with service users and local people. Service users appear to be very perceptive to the underlying ethos and purpose to their practice organization and this affects their responsiveness to initiatives for their involvement. The dimensions of the different values found in the study appear to be essentially the same as a number of established empirical findings of variations in values in general practice: an orientation to a narrow medical role and to general practice as a business are associated with a low valuation of involvement; an orientation to teamwork and to a broader social role appear more congruent with the development of involvement. Power is a critical issue in this setting with evidence in the study of the dominance of the medical practitioners in establishing organizational values and the nature of public involvement activities. PMID:11560732
Halvorsen Dag S
Full Text Available Abstract Background In Alzheimer's disease (AD research patients are usually recruited from clinical practice, memory clinics or nursing homes. Lack of standardised inclusion and diagnostic criteria is a major concern in current AD studies. The aim of the study was to explore whether patient characteristics differ between study samples recruited from general practice and from a population based screening by mail within the same geographic areas in rural Northern Norway. Methods An interventional study in nine municipalities with 70000 inhabitants was designed. Patients were recruited from general practice or by population based screening of cognitive function by mail. We sent a questionnaire to 11807 individuals ≥ 65 years of age of whom 3767 responded. Among these, 438 individuals whose answers raised a suspicion of cognitive impairment were invited to an extended cognitive and clinical examination. Descriptive statistics, chi-square, independent sample t-test and analyses of covariance adjusted for possible confounders were used. Results The final study samples included 100 patients recruited by screening and 87 from general practice. Screening through mail recruited younger and more self-reliant male patients with a higher MMSE sum score, whereas older women with more severe cognitive impairment were recruited from general practice. Adjustment for age did not alter the statistically significant differences of cognitive function, self-reliance and gender distribution between patients recruited by screening and from general practice. Conclusions Different recruitment procedures of individuals with cognitive impairment provided study samples with different demographic characteristics. Initial cognitive screening by mail, preceding extended cognitive testing and clinical examination may be a suitable recruitment strategy in studies of early stage AD. Clinical Registration ClinicalTrial.gov Identifier: NCT00443014
Full Text Available Purpose: The fight against Healthcare-associated infections is a public health priority and a major challenge for the safety and quality of care. The objective was to assess hygiene in general practitioners′ (GPs′ office and identify barriers to and drivers for better practice. Materials and Methods: We performed a cross-sectional study in which a questionnaire was sent to a randomly selected, representative sample of 800 GPs. We used a self-administered questionnaire. The first part assessed current practice and the second part focused on barriers and motivating factors for better practice. We performed a descriptive statistical analysis of the responses to closed questions and a qualitative analysis of the responses to open-ended questions. Results: Only a third of the GPs were aware of the current guidelines. Disposable equipment was used by 31% of the GPs. For the remainder, only 38% complied with the recommended procedures for sterilisation or disinfection. Seventy-two percent of the GPs washed their hands between consultations in the office. A significant minority of physicians disregarded the guidelines by never wearing gloves to perform sutures (11%, treat wounds (10%, fit intrauterine devices (18% or perform injections (18%. The main barriers to good practice were the high cost of modifications and lack of time/space. Two third of the GPs did not intend to change their practices. The drivers for change were pressure from patients (4.8 on a scale of 1 to 7, inspection by the health authorities (4.8 and the fear of legal action (4.4. Conclusions: Our results show that there are significant differences between current practice and laid-down professional guidelines. Policies for improvement of hygiene must take into account barriers and motivating factors.
Hoarea, Karen J; Millsc, Jane; Francis, Karen
Graduate nurses in general practice became a feature of New Zealand's health care system in 2008 following an expansion of the New Entrant to Practice Programme. General practice in New Zealand comprises general practitioner business owners who employ nursing and administration staff. Practice nurses are an ageing workforce in New Zealand, it is imperative therefore to attract younger nurses into general practice. This paper reports a section of the findings from a constructivist grounded theory study which examines the use of information by practice nurses in New Zealand. Initially data were collected using the ethnographic technique of observation and field notations in one general practice. Theoretical sensitivity to the value of role models was heightened by this first phase of data collection. A total of eleven practice nurses were interviewed from six general practices. One practice nurse agreed to a second interview; five of the interviewees were new graduate nurses and the other six were experienced practice nurses. The grounded theory constructed from this research was reciprocal role modelling which comprises the following three categories, becoming willing, realising potential and becoming a better practitioner. Graduate nurses and experienced practice nurses enter into a relationship of reciprocal role modelling. Becoming willing, the first core category of this grounded theory features three sub-categories: building respectful relationships, proving yourself and discerning decision making which are reported in this paper. Findings from this study may address the reported phenomenon of 'transition shock' of newly graduated nurses in the work place.
Hoarea, Karen J; Millsc, Jane; Francis, Karen
Graduate nurses in general practice became a feature of New Zealand's health care system in 2008 following an expansion of the New Entrant to Practice Programme. General practice in New Zealand comprises general practitioner business owners who employ nursing and administration staff. Practice nurses are an ageing workforce in New Zealand, it is imperative therefore to attract younger nurses into general practice. This paper reports a section of the findings from a constructivist grounded theory study which examines the use of information by practice nurses in New Zealand. Initially data were collected using the ethnographic technique of observation and field notations in one general practice. Theoretical sensitivity to the value of role models was heightened by this first phase of data collection. A total of eleven practice nurses were interviewed from six general practices. One practice nurse agreed to a second interview; five of the interviewees were new graduate nurses and the other six were experienced practice nurses. The grounded theory constructed from this research was reciprocal role modelling which comprises the following three categories, becoming willing, realising potential and becoming a better practitioner. Graduate nurses and experienced practice nurses enter into a relationship of reciprocal role modelling. Becoming willing, the first core category of this grounded theory features three sub-categories: building respectful relationships, proving yourself and discerning decision making which are reported in this paper. Findings from this study may address the reported phenomenon of 'transition shock' of newly graduated nurses in the work place. PMID:23898596
Full Text Available Abstract Background With evidence to support early assessment and management of TIAs, the role of the general practitioner (GP needs to be considered in developing a TIA service in Western Adelaide. We thus aimed to determine GP knowledge of TIA assessment and management and identify perceived barriers, in order to tailor subsequent GP education and engage primary care in the co-ordinated care of TIA patients. Findings A self-administered questionnaire was mailed to all GPs (n = 202 in the Adelaide Western General Practice Network. Response frequencies were calculated for all variables, and associations examined by univariate analysis. 32 GPs responded. All respondents correctly identified early risk of stroke following a TIA. Difficulty accessing neurological expertise was identified as a barrier (40.6 %, as was a lack of GP knowledge (18.8 %. Areas for improvement included access to neurologists (36.7 %, relevant guidelines and education (43.3 %. Conclusions Diagnosis of TIA is difficult and this study highlights the need for further education and practical guidelines for GPs. With this training, GPs could be better equipped to assess and manage TIAs effectively in the community in consultation with stroke physicians.
Pearson, D; Rossall, H
The authors report on a self-completed questionnaire study from a North Yorkshire based general practice regarding the information needs of its clinicians. The work was carried out with a particular focus on the practice library, and the findings identified that a new approach to maintaining and developing the library was needed. The literature regarding the information needs of primary care clinicians and the role of practice libraries is considered, and compared to those of the clinicians at the practice. Discussion follows on how a collaborative project was set up between the practice and a librarian based at the local NHS Trust library in order to improve the existing practice library. Difficulties encountered and issues unique to the project are explored, including training implications presented by the implementation of electronic resources. Marketing activities implemented are discussed, how the library will operate in its new capacity, and how ongoing support and maintenance of the library will be carried out. It is concluded that although scepticism still exists regarding librarian involvement in practice libraries, collaboration between clinicians and librarians is an effective approach to the successful development and maintenance of a practice library, and recommendations are therefore made for similar collaborative work. PMID:11791859
Laar, F.A. van de; Bor, H.; Lisdonk, E.H. van de
OBJECTIVE: To explore the prevalence of rare diseases in the Continuous Morbidity Registration (CMR) Nijmegen, and to discuss methodological difficulties in the study of rare diseases in general practice. METHODS: We selected all diseases with a prevalence <0.5/1000 patients/year between 1986 and 20
Holley, Debbie; Santos, Patricia; Cook, John; Kerr, Micky
This paper responds to the Alpine Rendez-Vous "crisis" in technology-enhanced learning. It takes a contested area of policy as well as a rapid change in the National Health Service, and documents the responses to "information overload" by a group of general practitioners practices in the North of England. Located between the…
Lundstrøm, Sanne Lykke; Edwards, Kasper; Bøllingtoft Knudsen, Thomas;
Background. Relational coordination (RC) and organisational social capital (OSC) aremeasures of novel aspects of an organisation’s performance, which have not previously been analysed together, in general practice. Objectives.The aim of this studywas to analyse the associations between RC and OSC...
OBJECTIVE: We aimed to evaluate the effect of a medical audit on AIDS prevention in general practice. METHODS: We conducted a prospective randomized controlled study performed as 'lagged intervention'. At the time of comparison, the intervention group had completed 6 months of audit including...
Maarsingh, O.R.; Dros, J.; Weert, H.C. van; Schellevis, F.G.; Bindels, P.J.; Horst, H.E. van der
BACKGROUND: Dizziness in general practice is very common, especially in elderly patients. The empirical evidence for diagnostic tests in the evaluation of dizziness is scarce. Aim of our study was to determine which set of diagnostic tests should be part of a diagnostic protocol for evaluating dizzi
O.R. Maarsingh (Otto); J. Dros (Jacquelien); H.C. van Weert (Henk); F.G. Schellevis (François); P.J.E. Bindels (Patrick); H.E. van der Horst (Henriette)
textabstractBackground. Dizziness in general practice is very common, especially in elderly patients. The empirical evidence for diagnostic tests in the evaluation of dizziness is scarce. Aim of our study was to determine which set of diagnostic tests should be part of a diagnostic protocol for eval
O.R. Maarsingh; J. Dros; H.C. van Weert; F.G. Schellevis; P.J. Bindels; H.E. van der Horst
ABSTRACT: BACKGROUND: Dizziness in general practice is very common, especially in elderly patients. The empirical evidence for diagnostic tests in the evaluation of dizziness is scarce. Aim of our study was to determine which set of diagnostic tests should be part of a diagnostic protocol for evalua
Maarsingh, O.R.; Dros, J.; Weert, van H.C.P.M.; Schellevis, F.G.; Bindels, P.J.; Horst, van der H.E.
BACKGROUND: Dizziness in general practice is very common, especially in elderly patients. The empirical evidence for diagnostic tests in the evaluation of dizziness is scarce. Aim of our study was to determine which set of diagnostic tests should be part of a diagnostic protocol for evaluating dizzi
Bensing, J.M.; Brink-Muinen, A. van den; Bakker, D.H. de
The differences between female and male general practitioners (GPs) were studied regarding three different factors: 1) Do female GPs see more female patients than their male colleagues in the same practice?; 2) Are female GPs confronted with different types of health problems from their male colleag
Eekhof, J.A.H.; Bock, G.H. de; Laat, J.A.P.M. de; Dap, R.; Schaapveld, K.; Springer, M.P.
Hearling loss is an important health problem in the elderly which sometimes leads to social isolation. In a study with 62 patients, the diagnostic value of four simple tests for screening for hearing loss in general practice was examined. When paying attention to the loudness of the whispering, the
Hermens, R P; Hak, E; Hulscher, M E; Mulder, J; Braspenning, J C; Grol, R P
BACKGROUND: Well-organized cervical screening has been shown to be effective in the reduction of both morbidity and mortality from cancer of the uterine cervix. In The Netherlands, the GP plays an important role in the cervical screening. The question is whether the general practices are able to org
Jeanett Friis Rohde
Full Text Available BACKGROUND: Several studies suggest that men and women are treated differently for similar disease including diabetes and cardiovascular disease. Differences in attitudes and treatment practices towards men and women with obesity are not well recognized. OBJECTIVE: To investigate the attitudes and treatment practices among Danish general practitioners (GPs, in relation to treatment of overweight, while taking gender of both the patients and practitioners into account. DESIGN: Questionnaire inventory covertly examining attitudes and practices among Danish general practitioners towards treatment of overweight. All 3.637 general practitioners from the Danish Medical Association register were invited to participate in the survey. In total 1.136 participated. RESULTS: The GPs found weight loss to be more important for overweight male than overweight female patients. They also treated complications to overweight more rigorously among male than female patients, and recommended lipid lowering medicine more often to male than female overweight patients. In addition, the younger female GPs and older male GPs more often said that they would treat an overweight patient with lipid lowering medicine. CONCLUSION: Among general practitioners in Denmark, treatment for weight loss is more often practiced for overweight male than overweight female patients presenting with same symptoms. In addition, hyperlipidemia among overweight males is also more often treated with lipid lowering medicine than hyperlipidemia among overweight females.
Buetow, Stephen; Docherty, Barbara
To reduce health inequalities and improve quality in health care, health policy initiatives in countries including New Zealand and the United Kingdom are expecting general practice to share responsibilities for a population approach to health care. This is giving increased emphasis to preventative care, including health promotion. Reasoned debate on this policy is overdue, not least in New Zealand, where clinicians within general practice appear to have been seduced by the lack of clarity in health policy into accepting this policy without question. They appear to disregard implications of the policy for redefining the nature and scope of their discipline (and of public health), including their own role as providers of personal care. This paper suggests that a population health approach is inappropriate in general practice when this approach weakens personal care and involves health promotion activity of unknown safety and effectiveness. The example of intentional weight loss to reduce overweight is used to illustrate these issues. We argue for a restricted range of general practice services.
Biermans, M.C.J.; Verheij, R.A.; Bakker, D.H. de; Zielhuis, G.A.; Vries Robbé, P.F. de
Objectives: In this study, we evaluated the internal validity of EPICON, an application for grouping ICPCcoded diagnoses from electronic medical records into episodes of care. These episodes are used to estimate morbidity rates in general practice. Methods: Morbidity rates based on EPICON were compa
Biermans, M.C.J.; Verheij, R.A.; Bakker, D.H. de; Zielhuis, G.A.; Robbe, P.F.
OBJECTIVES: In this study, we evaluated the internal validity of EPICON, an application for grouping ICPC-coded diagnoses from electronic medical records into episodes of care. These episodes are used to estimate morbidity rates in general practice. METHODS: Morbidity rates based on EPICON were comp
Rohde, Jeanett Friis; Hessner, Marie Vik; Lous, Jørgen;
: Among general practitioners in Denmark, treatment for weight loss is more often practiced for overweight male than overweight female patients presenting with same symptoms. In addition, hyperlipidemia among overweight males is also more often treated with lipid lowering medicine than hyperlipidemia...
Franx, Gerdien; Huyser, Jochanan; Koetsenruijter, Jan; van der Feltz-Cornelis, Christina M.; Verhaak, Peter F. M.; Grol, Richard P. T. M.; Wensing, Michel
Background: Internationally, guidelines for depression recommend a stepped care approach, implying that antidepressant medication should not be offered as a first step treatment to patients with sub-threshold or mild depression. In the Netherlands, antidepressant prescribing rates in general practic
Wagemakers, Harry P. A.; Luijsterburg, Pim A. J.; Heintjes, Edith M.; Berger, Marjolein Y.; Verhaar, Jan; Koes, Bart W.; Bierma-Zeinstra, Sita M. A.
Background Knee injuries may lead to pain and to functional limitations in the activities of daily living. Patients with knee injuries are frequently seen in general practice; however, the outcome and management in these patients is not known. Aim To assess the outcome and management of knee injurie
H.P.A. Wagemakers (Harry); P.A.J. Luijsterburg (Pim); E.M. Heintjes (Edith); M.Y. Berger (Marjolein); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita)
textabstractAbstract BACKGROUND: Knee injuries may lead to pain and to functional limitations in the activities of daily living. Patients with knee injuries are frequently seen in general practice; however, the outcome and management in these patients is not known. AIM: To assess the outcome and m
Groenier, KH; Winters, JC; Meyboom-de Jong, B
Objectives: To determine if a classification of shoulder complaints in general practice can be made from variables of medical history and physical examination with nonmetric multidimensional scaling and to investigate the reproducibility of results from an earlier hierarchical cluster analysis. Desi
de Bock, GH; Perk, DC; Oosterwijk, JC; Hageman, GCHA; Kievit, J; Springer, MP
Aims. To ascertain whether women who consulted their GP because they perceived themselves as at increased risk of familial breast cancer were indeed at increased risk, and to evaluate potential strategies for assessing genetic risk of breast cancer in general practice. Methods. Sixty-seven out of 81
Sonneveld, R.E.; Brands, W.G.; Bronkhorst, E.M.; Welie, J.V.M.; Truin, G.J.
OBJECTIVES: To explore which organisational aspects are considered most important by patients when assessing a general dental practice, and which patients' characteristics influence their views on these aspects by a paper questionnaire. PARTICIPANTS: The questionnaire was handed out to a sample of 5
van Bruggen, Rykel; Gorter, Kees; Stolk, Ronald; Klungel, Olaf; Rutten, Guy
Materials and methods. Baseline and follow-up data of a Dutch randomized controlled trial on the implementation of a locally adapted guideline were used. The study involved 30 general practices and 1283 patients. Treatment targets differed between study groups [HbA1c <8.0% and blood pressure (BP) <1
Pal-de Bruin, K.M. van der; Verkleij, H.; Jansen, J.; Bartelds, A.; Kromhout, D.
Aim: To evaluate how the incidence of suspected myocardial infarction has developed from 1978 to 1994 and to study the incidence of confirmed acute myocardial infarction in Dutch general practices during the period 1991-1994. Methods: In three periods (1978, 1983-1985 and 1991-1994) the incidence of
Hansen, Dorte Gilså; Jarbøl, Dorte Ejg; Munck, Anders Peter
recommendations for preparedness for anaphylactic shock in connection with allergy vaccine therapy were not fully implemented. CONCLUSION: General practice is substantially involved in the examination and treatment of patients with allergic diseases. There is room for further involvement of staff members...
Groot, C.M.; Vernooy-Dassen, M.J.F.J.; Crul, B.J.P.; Grol, R.P.T.M.
BACKGROUND: General practitioners (GPs) play a crucial part in palliative care. The quality of care can be improved by investigating and addressing barriers perceived by GPs in daily practice. The aim of this study was to investigate GPs' task perception and barriers involved in palliative care. MET
Mol, A.J.J.; Gorgels, W.J.M.J.; Voshaar, R.C. Oude; Breteler, M.H.M.; Balkom, van A.J.L.M.; Lisdonk, van de E.H.; Kan, C.C.; Zitman, F.G.
BACKGROUND: The aim of this study was to (1) describe the characteristics of patients reporting craving for benzodiazepines (BZs) and (2) to search for associations between BZ craving and other clinical variables in a population of general practice (GP) patients who have made an attempt to discontin
Mol, A.J.J.; Gorgels, W.J.M.J.; Oude Voshaar, R.C.; Breteler, M.H.M.; Balkom, A.J.L.M. van; Lisdonk, E.H. van de; Kan, C.C.; Zitman, F.G.
BACKGROUND: The aim of this study was to (1) describe the characteristics of patients reporting craving for benzodiazepines (BZs) and (2) to search for associations between BZ craving and other clinical variables in a population of general practice (GP) patients who have made an attempt to discontin
Winters, JC; Groenier, KH; Sobel, JS; Arendzen, HH; Meyboom-de Jong, B
Objective: To determine if a classification of shoulder complaints in general practice can be made with a cluster analysis of variables of medical history and physical examination. Method: One hundred one patients with shoulder complaints were examined upon inclusion (week 0) and after 2 weeks. Elev
Full Text Available Abstract Background Guideline recommendations on therapy in urinary tract infections are based on antibiotic resistance rates. Due to a lack of surveillance data, little is known about resistance rates in uncomplicated urinary tract infection (UTI in general practice in Germany. In a prospective observational study, urine cultures of all women presenting with urinary tract infections in general practice were analysed. Resistance rates against antibiotics recommended in German guidelines on UTI are presented. Methods In a prospective, multi-center observational study general practitioner included all female patients ≥ 18 years with clinically suspected urinary tract infection. Only patients receiving an antibiotic therapy within the last two weeks were excluded. Results 40 practices recruited 191 female patients (mean age 52 years; range 18–96 with urinary tract infections. Main causative agent was Escherichia coli (79% followed by Enterococcus faecalis (14% and Klebsiella pneumoniae (7.3%. Susceptibiliy of E.coli as the main causative agent was highest against fosfomycin and nitrofurantoin, with low resistance rates of 4,5%; 2,2%. In 17,5%, E.coli was resistant to trimethoprim and in 8,5% to ciprofloxacin. Conclusions Resistance rates of uropathogens from unselected patients in general practice differ from routinely collected laboratory data. These results can have an impact on antibiotic prescribing and treatment recommendations.
Full Text Available Abstract Background Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. Methods We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. Results A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice, commercial and consumer organisations on the meso-level (institutions, organisations and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community. Existing barriers and possible strategies to overcome these barriers were described. Conclusion In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed.
Versluis, RGJA; Papapoulos, SE; de Bock, GH; Zwinderman, AH; Petri, H; van de Ven, CM; Springer, MP
Background. Case-finding strategies to identify women with high risk for osteoporotic fractures have recently been proposed, but little information about such an approach in general practice known. Aim: To study the validity of the proposed case-finding for osteoporosis. Design of study: Survey usin
Straetmans, J.M.J.A.A.; Schrojenstein Lantman-de Valk, H.M.J. van; Schellevis, F.G.; Dinant, G.J.
This study aimed to analyse the health problems and prescriptions of people with intellectual disabilities registered with GPs. Within the Second Dutch National Survey of General practice evidence was gathered on the differences in health problems between people with intellectual disabilities and co
van Bruggen, Rykel; Gorter, Kees; Stolk, Ronald P.; Zuithoff, Peter; Klungel, Olaf H.; Rutten, Guy E. H. M.
Background and Aims Non-adherence is considered a major barrier to better outcomes of diabetes care. A relationship has been established between polypharmacy and patients' adherence. This study aims to investigate the occurrence of polypharmacy and non-adherence in general practice, their mutual rel
Williams, R.; Rapport, F.; Elwyn, G.; Lloyd, B.; Rance, J.; Belcher, S.
BACKGROUND: Primary prevention of type 2 diabetes is now possible with lifestyle or pharmacological interventions in people who are at risk. Primary care would seem to be the legitimate setting for this to take place. AIM: To explore the views of general practitioners and practice nurses about the d
Sleddens, Ester F C; Kremers, Stef P J; Stafleu, Annette; Dagnelie, Pieter C; De Vries, Nanne K; Thijs, Carel
Research on parenting practices has focused on individual behaviors while largely failing to consider the context of their use, i.e., general parenting. We examined the extent to which food parenting practices predict children's dietary behavior (classified as unhealthy: snacking, sugar-sweetened beverage; and healthy: water and fruit intake). Furthermore, we tested the moderating role of general parenting on this relationship. Within the KOALA Birth Cohort Study, in the Netherlands, questionnaire data were collected at 6 and 8 years (N = 1654). Correlations were computed to assess the association between food parenting practices and general parenting (i.e., nurturance, behavioral control, structure, coercive control, and overprotection). Linear regression models were fitted to assess whether food parenting practices predict dietary behavior. Instrumental and emotional feeding, and pressure to eat were found to have associations with undesirable child dietary behavior (increased unhealthy intake/decreased healthy intake), whereas associations were in the desirable direction for covert control, encouragement and restriction. Moderation analyses were performed by evaluating interactions with general parenting. The associations of encouragement and covert control with desirable child dietary behaviors were found to be stronger for children who were reared in a positive parenting context. Future research should assess the influence of contextual parenting factors moderating the relationships between food parenting and child dietary behavior as the basis for the development of more effective family-based interventions. PMID:24727101
Krasnik Huggenberger, Ivan; Andersen, John Sahl
Introduction: The objective of this study was to investigate the evidence for positive predictive value (PPV) of alarm symptoms and combinations of symptoms for colorectal cancer, breast cancer, prostate cancer and lung cancer in general practice. Methods: This study is based on a literature sear...
Pols, D. H. J.; Wartna, J. B.; Moed, H.; van Alphen, E. I.; Bohnen, A. M.; Bindels, P. J. E.
Objective To examine whether significant differences exist between the self-reported prevalence of atopic disorders in the open population compared with physician diagnosed prevalence of atopic disorders in general practice. Methods Medline (OvidSP), PubMed Publisher, EMBASE, Google Scholar and the Cochrane Controlled Clinical Trials Register databases were systematically reviewed for articles providing data on the prevalence of asthma, allergic rhinitis and eczema in a GP setting. Studies were only included when they had a cross-sectional or cohort design and included more than 100 children (aged 0-18 years) in a general practice setting. All ISAAC studies (i.e. the open population) that geographically matched a study selected from the first search, were also included. A quality assessment was conducted. The primary outcome measures were prevalence of eczema, asthma and allergic rhinitis in children aged 0-18 years. Results The overall quality of the included studies was good. The annual and lifetime prevalences of the atopic disorders varied greatly in both general practice and the open population. On average, the prevalence of atopic disorders was higher in the open population. Conclusion There are significant differences between the self-reported prevalence of atopic disorders in the open population compared with physician diagnosed prevalence of atopic disorders in general practice. Data obtained in the open population cannot simply be extrapolated to the general practice setting. This should be taken into account when considering a research topic or requirements for policy development. GPs should be aware of the possible misclassification of allergic disorders in their practice. Key PointsEpidemiological data on atopic disorders in children can be obtained from various sources, each having its own advantages and limitations.On average, the prevalence of atopic disorders is higher in the open population.GPs should take into account the possible
Dobinson, Toni J.; Buchori, Sylvia
This article aims to highlight the complexity of English language related experiences and interactions of a small group of teachers in an Australian, Early Childhood (EC), mainstream setting with children four to eight years old. It draws on data collected from a qualitative case study which investigated four teachers' perspectives and anxieties…
This document traces Australian training and literacy policy developments from 1974 to 1998. The document begins with a brief discussion of the global political, educational, social, and economic trends that have affected Australia's training and literacy policies. Discussed next are major events of the four policy "epochs" in Australia's…
Wells, Susan; Rafter, Natasha; Eggleton, Kyle; Turner, Catherine; Huang, Ying; Bullen, Chris
INTRODUCTION Run charts are quality improvement tools. AIM To investigate the feasibility and acceptability of run charts displaying weekly cardiovascular disease (CVD) risk assessments in general practice and assess their impact on CVD risk assessments. METHODS A controlled non-randomised observational study in nine practices using run charts and nine control practices. We measured the weekly proportion of eligible patients with completed CVD risk assessments for 19 weeks before and after run charts were introduced into intervention practices. A random coefficients model determined changes in CVD risk assessment rates (slope) from pre- to post- intervention by aggregating and comparing intervention and control practices' mean slopes. We interviewed staff in intervention practices about their use of run charts. RESULTS Seven intervention practices used their run chart; six consistently plotting weekly data for >12 weeks and positioning charts in a highly visible place. Staff reported that charts were easy to use, a visual reminder for ongoing team efforts, and useful for measuring progress. There were no significant differences between study groups: the mean difference in pre- to post-run chart slope in the intervention group was 0.03% more CVD risk assessments per week; for the control group the mean difference was 0.07%. The between group difference was 0.04% per week (95% CI: -0.26 to 0.35, P = 0.77). DISCUSSION Run charts are feasible in everyday general practice and support team processes. There were no differences in CVD risk assessment between the two groups, likely due to national targets driving performance at the time of the study. PMID:27477560
Kramer, A.W.M.; Jansen, J.J.; Zuithoff, P.; Dusman, H.; Tan, L.; Grol, R.P.T.M.; Vleuten, C.P.M. van der
PURPOSE: To examine the validity of a written knowledge test of skills for performance on an OSCE in postgraduate training for general practice. METHODS: A randomly-selected sample of 47 trainees in general practice took a knowledge test of skills, a general knowledge test and an OSCE. The OSCE incl
Armando Henrique Norman
Full Text Available This article explores some effects of the British payment for performance model on general practitioners’ principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually strengthened a scientific-bureaucratic model of medical practice which has had profound effects on the way family medicine is practiced in the UK.
Braden, Abby; Rhee, Kyung; Peterson, Carol B; Rydell, Sarah A; Zucker, Nancy; Boutelle, Kerri
Emotional eating is the tendency to eat in response to negative emotions. Prior research has identified a relationship between parenting style and child emotional eating, but this has not been examined in clinical samples. Furthermore, the relationship between specific parenting practices (e.g., parent feeding practices) and child emotional eating has not yet been investigated. The current study examined relationships between child emotional eating and both general and specific parenting constructs as well as maternal symptoms of depression and binge eating among a treatment-seeking sample of overweight children. Participants included 106 mother-child dyads who attended a baseline assessment for enrollment in a behavioral intervention for overeating. Ages of children ranged from 8 to 12 years old. Mothers completed self-report measures of their child's emotional eating behavior, their own feeding practices, and symptoms of depression and binge eating. Children completed a self-report measure of their mothers' general parenting style. A stepwise regression analysis was conducted to identify the parent variable that was most strongly related to child emotional eating, controlling for child age and gender. Emotional feeding behavior (i.e., a tendency to offer food to soothe a child's negative emotions) was the parent factor most significantly related to child emotional eating. Findings suggest that emotional feeding practices in parents may be related to emotional eating in children. Treatment with overweight children who engage in emotional eating may be improved by targeting parent feeding practices.
Rea, David; Griffiths, Sarah
Over the past 20 years, healthcare has adapted to the 'quality revolution' by moving away from direct provision and hierarchical control mechanisms. In their place, new structures based on contractual relationships are being developed coupled with attempts to create an organisational culture that shares learning and that scrutinises existing practice so that it can be improved. The issue here is that contractual arrangements require surveillance, monitoring, regulation and governance systems that can be perceived as antipathetic to the examination of practice and subsequent learning. Historically, reporting levels from general practice have remained low; little information is shared and consequently lessons are not shared across the general practice community. Given large-scale under-engagement of general practitioners (GPs) in incident reporting systems, significant event analysis is advocated to encourage sharing of information about incidents to inform the patient safety agenda at a local and national level. Previous research has concentrated on the secondary care environment and little is known about the situation in primary care, where the majority of patient contacts with healthcare occur. To explore attitudes to incident reporting, the study adopted a qualitative approach to GPs working in a mixture of urban and rural practices reporting to a Welsh Local Health Board. The study found that GPs used significant event analysis methodology to report incidents within their practice, but acknowledged under-reporting. They were less enthusiastic about reporting externally. A number of barriers exist to reporting, including insufficient time to report, lack of feedback, fear of blame, and damage to reputations and patient confidence in a competitive environment. If incident reporting processes are perceived as supportive and formative, and where protected time is allocated to discuss incidents, then GPs are willing to participate. They also need to know how the
van der Windt Daniëlle AWM
Full Text Available Abstract Background Musculoskeletal complaints are frequent and have large consequences for public health. Information about the prognosis after presentation in general practice is far from complete. Knowledge about determinants of the clinical course of musculoskeletal complaints is essential for management decisions and to inform patients about their prognosis. The purpose of this study is to provide information about the prognosis of musculoskeletal complaints other than low back pain by studying the course of these complaints in general practice and to identify determinants of this course. Methods Patients of 18 years and older, who present in general practice with a new episode of a musculoskeletal complaint of the neck, shoulder, elbow, wrist, hand, arm, hip, knee, ankle or foot, are recruited by their general practitioner (GP. Participants will receive complaint-specific questionnaires by mail at baseline and after 3, 6, 12 and 18 months. The following putative determinants of the course of the complaints will be investigated: sociodemographic characteristics, characteristics of the complaint, psychosocial job characteristics, physical workload, physical activity during leisure time, pain coping, mood, kinesiophobia, social support, optimism. The primary outcomes are perceived recovery, pain, functional status, sick leave and overall quality of life.
Hungin, A P; Rubin, G P; O'Flanagan, H
BACKGROUND: Proton pump inhibitors (PPIs) constitute the largest sector of the National Health Service (NHS) community drugs bill (238 m Pounds; 5.6%). Little is known of the long-term prescribing component of this. AIM: To study the extent, the reasons for, and the cost implications of the long-term prescription of PPIs in general practice. METHOD: Subjects on long-term therapy were identified by searches of computerized and paper records from three practices, comprising 21 GPs with 46,650 p...
Tulinius, Anne-Charlotte; Nielsen, Anni Brit Sternhagen; Hansen, Lars Jørgen;
BACKGROUND: To obtain good quality evidence-based clinical work there needs to be a culture of critical appraisal, and strong bridges between the clinical and the academic worlds in general practice. AIM: The aim was to educate the general practitioner (GP) trainees to obtain critical appraisal...... skills, and through the development and implementation of the mandatory programme to gradually empower the GP community to achieve academic capacity by creating a link between the GP researchers and the GP training community. This was done by developing a faculty, giving teaching skills to GP academics...... of the planning phase. RESULTS: From 2006 to 2009, we built a teaching faculty of 25 teachers among clinical GPs and GP academics; developed the training programme; and delivered the programme to 95 GP trainees. Some of the GP trainees later showed an interest in more substantial research projects, and GP...
Grant, Suzanne; Ring, Adele; Gabbay, Mark; Guthrie, Bruce; McLean, Gary; Mair, Frances S; Watt, Graham; Heaney, David; O'Donnell, Catherine
In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol.
Dr. Kirsty Harris
Full Text Available More than 2500 trained Australian army nurses served overseas during World War I. Many were called upon to act outside their normal nursing practice and one new area was that of anaesthetics. Due to a lack of medical officers in the latter part of the war, a number of Australian theatre sisters trained and worked as nurse anaesthetists in Casualty Clearing Stations in France. The British Army provided three months’ training for Australian, British and New Zealand nurses in the use of chloroform and ether. Australian nurses were enthusiastic volunteers as trained nurses at home had already carved out a small but unofficial place for the profession in this role. In addition, Canadian and American army and civil nurses were already trained and used as nurse anaesthetists. While nurses were successfully used without recorded incident, at the end of the first training course, the Director General of Medical Services, Australian Imperial Force, decreed that the nurses would not be further trained or used. This was out of step with the other countries participating, and this paper examines some possible reasons for the change of heart.
Damen-van Beek, Z; Wiersma, Tj
- The Dutch College of General Practitioners' (NHG) practice guideline 'Urinary incontinence in women' provides guidelines for diagnosis and management of stress, urgency and mixed urinary incontinence in adult women.- General practitioners (GPs) should be alert to signals for urinary incontinence in women and offer active diagnosis and treatment if necessary.- Shared decision making is central in the guideline; the GP and the patient should discuss therapeutic options and decide on treatment policy in mutual consultation.- Women with stress urinary incontinence can choose between pelvic floor exercises or a pessary as initial treatment. Placing a midurethral sling (MUS) will be discussed if initial treatment is insufficiently effective or in the case of serious symptoms.- When bladder training is ineffective in urgency incontinence, the GP will discuss the pros and cons of adding an anticholinergic agent.- Exercise therapy can take place in the GPs practice or under supervision of a pelvic physical therapist. PMID:27484432
Schroll, Henrik; Christensen, René Depont; Thomsen, Janus Laust;
/L and not receiving lipid-lowering treatment. Conclusions. Structured collection of electronic data from general practice and feedback with reports on quality of care for diabetes patient seems to give a significant reduction in proportion of patients with no medical treatment over one year for...... individually for each practice on the basis of the accumulated data and are available online only for the specific practice. Objective. To describe the development of the quality of care concerning drug prescriptions for diabetes patients listed with GPs using the Data Capture module. Methods. In a cohort...... study, among 8320 registered patients with diabetes, we analyzed the change in the proportion of medication for uncontrolled cases of diabetes. Results. From 2009 to 2010, there was an absolute risk reduction of 1.35% (0.89-1.81: P <0.001) in proportion of persons not in antidiabetic medication despite...
Koshy, Paul; Phillimore, John
This paper provides an overview of recent trends in the provision of general infrastructure funding by the Commonwealth for Australian universities (Table A providers) over the period 2004 to 2011. It specifically examines general infrastructure development and excludes funding for research infrastructure through the Australian Research Council or…
Atrophic acne scarring is an unfortunate, permanent complication of acne vulgaris, which may be associated with significant psychological distress. General dermatologists are frequently presented with the challenge of evaluating and providing treatment recommendations to patients with acne scars. This article reviews a practical, step-by-step approach to evaluating the patient with atrophic acne scars. An algorithm for providing treatment options is presented, along with pitfalls to avoid. A ...
Temple-Smith, M J; Mulvey, G; Keogh, L
OBJECTIVE: To examine general practitioners' (GPs') attitudes towards taking a sexual history. METHODS: Questions on sexual history taking were included in a random survey on the STD knowledge, attitudes, and practices of 600 GPs practising in Victoria, Australia. RESULTS: Most GPs commonly asked patients about safe sex (79%), number of sex partners (63%), and injecting drug use (60%) while fewer asked about recent overseas travel (50%) and sex with sex workers (31%). GPs who performed ...
Many depressed patients attend primary health care, and minority-group patients often see general practitioners for depressive symptoms. The diagnosis and classification criteria of depression and guidelines for management are based on symptoms. However,expressions of depression can vary with culture and gender but the diagnostic tools and guidelines are not adapted to gendered or cultural context and have shown to be poorly applicable in clinical practice. The purpose of this thesis was to a...
Walach Harald; Lange Oliver; Güthlin Corina
Abstract Background Despite the increasing demand for acupuncture and homoeopathy in Germany, little is known about the effects of these treatments in routine care. We set up a pragmatic documentation study in general practice funded within the scope of project launched by a German health insurer. Patients were followed-up for up to four years. Methods The aim of the project was to study the effects and benefits of acupuncture and/or homoeopathy, and to assess patient satisfaction within a pr...
Andersen, Merethe K; Christensen, Bo; Søndergaard, Jens
Care for overweight children in general practice involves collaboration with parents. Acknowledging the parents' frames of references is a prerequisite for successful management. We therefore aimed to analyse parental beliefs about the presumed causes and consequences of overweight in children...... and expectations towards the GP. Moreover, we aimed at comparing the beliefs and expectations of parents of non-overweight children (NOWC) and parents of overweight children (OWC)....
Andersen, Merethe K; Christensen, Bo; Søndergaard, Jens
Background Care for overweight children in general practice involves collaboration with parents. Acknowledging the parents’ frames of references is a prerequisite for successful management. We therefore aimed to analyse parental beliefs about the presumed causes and consequences of overweight in children and expectations towards the GP. Moreover, we aimed at comparing the beliefs and expectations of parents of non-overweight children (NOWC) and parents of overweight children (OWC). Methods A ...
Lesmes-Anel, J; Robinson, G; Moody, S.
BACKGROUND: Experienced trainers know that individual registrars react very differently to identical learning experiences generated during the year in practice. This divergence reflects differences in registrars' learning styles. Only one study of United Kingdom (UK) general practitioners' learning styles has been undertaken. Learning style theory predicts that matching learning preference with learning style will enhance learning. This paper researches for the first time the evidence in the ...
Hinnerskov, Mette; Therkildsen, Julie Maria; Cordoba, Gloria;
High consumption of macrolides has been linked to increased macrolide resistance in the common pathogens of respiratory tract infections (RTIs). According to Danish recommendations, penicillin is the first-choice treatment for RTIs and macrolides should only be prescribed when a patient is allergic...... to penicillin or for treatment of mycoplasma pneumonias. The aim of the present study was to explore the prescription of macrolides for different RTIs to patients without penicillin allergy in general practice in Denmark....
Bain, J.; Scott, R.; Snadden, D
Several forces have resulted in the creation in Tayside of the first formally integrated unit of undergraduate and postgraduate education in general practice in the United Kingdom. Forces that helped this integration included the desire for change, national developments in education, financial support through funds set aside to cover the additional cost of teaching, and a management structure which concentrates on shared leadership. Forces that hindered the integration included uneasiness abo...
Escobar Martínez, Francisco Javier; Williamson, Ian; Green, Julie; Waters, Elizabeth
This paper describes the delivery of a Geographic Information System (GIS) product through the Internet for primary health care services provided at general medical practices in the State of Victoria, Australia. The paper details a collaborative research project, the principal aim of which was to develop a methodology for creating a GIS as a decision support system, for more effective use of information about population and health services at a given location. The methodology employed i...
Gillies, John CM; Mercer, Stewart W.; Lyon, Andrew; Scott, Mairi; Watt, Graham CM
Over the past 5 years, general practice in the UK has undergone major change. Starting with the introduction of the new GMS contract in 2004, it has continued apace with the establishment of Postgraduate Medical Education Training Board, a GP training curriculum, and nMRCGP. The NHS is developing very differently in the four countries of the UK. Regulation of the profession is under review, and a system of relicensing, recertification, and revalidation is being introduced. The Essence project...
Van Nuland, Marc; Thijs, Gaby; Van Royen, Paul; Van Den Noortgate, Wim; Goedhuys, Jo
Objective: To explore the views and experiences of general practice (GP) vocational trainees regarding communication skills (CS) and the teaching and learning of these skills. METHODS: A purposive sample of second and third (final) year GP trainees took part in six focus group (FG) discussions. Transcripts were coded and analysed in accordance with a grounded theory approach by two investigators using Alas-ti software. Finally results were triangulated by means of semi-structured telephone in...
Harborow, P; Ogden, J
This audit was based in general practice and examined 49 consecutive referrals to a UK trained traditional Chinese acupuncturist. It aimed to assess the type of patients referred to an acupuncturist, subsequent changes in health status, whether the effectiveness of acupuncture was related to the type of presenting problem and to examine which factors were predictive of the success of acupuncture. The referred patients had a wide variety of conditions which were categorised as to whether or no...
martin, E.; Russell, D; Goodwin, S
Prisoners' perceptions of why they consulted the doctor, how ill they thought they were and what happened during the consultation were studied in Bedford prison using a questionnaire. Patients' perceptions were compared before and after the consultation and with the perception of the doctor. The figures from this study were compared with comparable groups in a similar general practice survey. Prisoners perceived themselves to be more ill than comparable groups living in the community and both...
Goetz Katja; Campbell Stephen M; Steinhaeuser Jost; Broge Bjoern; Willms Sara; Szecsenyi Joachim
Abstract Background Primary care teams' job satisfaction is an important issue in quality of care. The purpose of our study was to evaluate the job satisfaction of general practitioners (GPs) and non-physician staff and to explore the elements that may impact on overall job satisfaction for GPs and non-physician staff separately. Methods The study was based on data from the European Practice Assessment and used an observational design. Job satisfaction was measured with the 10-items Warr-Cook...
Smeeton, N C
The Second National Morbidity Survey, conducted in England and Wales between 1970 and 1976, contains a unique body of information on episodes of mental illness experienced by individuals registered in a representative sample of general practices around the country. This information is used to construct the episode distribution among the individuals surveyed. The Poisson and negative binomial distributions are then used to model the episodes. The Poisson model gives a very poor fit but the neg...
van Dijk Liset
Full Text Available Abstract Background Current health policies assume that prescribing is more efficient and rational when general practitioners (GPs work with a formulary or restricted drugs lists and thus with a limited range of drugs. Therefore we studied determinants of the range of drugs prescribed by general practitioners, distinguishing general GP-characteristics, characteristics of the practice setting, characteristics of the patient population and information sources used by GPs. Methods Secondary analysis was carried out on data from the Second Dutch Survey in General Practice. Data were available for 138 GPs working in 93 practices. ATC-coded prescription data from electronic medical records, census data and data from GP/practice questionnaires were analyzed with multilevel techniques. Results The average GP writes prescriptions for 233 different drugs, i.e. 30% of the available drugs on the market within one year. There is considerable variation between ATC main groups and subgroups and between GPs. GPs with larger patient lists, GPs with higher prescribing volumes and GPs who frequently receive representatives from the pharmaceutical industry have a broader range when controlled for other variables. Conclusion The range of drugs prescribed is a useful instrument for analysing GPs' prescribing behaviour. It shows both variation between GPs and between therapeutic groups. Statistically significant relationships found were in line with the hypotheses formulated, like the one concerning the influence of the industry. Further research should be done into the relationship between the range and quality of prescribing and the reasons why some GPs prescribe a greater number of different drugs than others.
Full Text Available The research presented in this paper was motivated by the thrust in Australia to move to whole of e-government. The aim was to determine the level of readiness towards the implementation of customer relationship management (CRM in Australian Federal Government departments and agencies. As such the research presented in this paper represents an initial phase of research that focusses on CRM implementation in the highest level of government in this country. To address the research objective, data were collected through the distribution of an electronic questionnaire to 23 Australian Federal Government departments and agencies using a previously validated questionnaire. The main finding of the research was that a majority of the departments and agencies are only in the early stages of moving toward implementation of collaborative CRM. This suggests that a concerted effort needs to be made to encourage less developed departments and agencies to make this transition. Until collaborative CRM is accomplished, the ultimate goal of whole of e-government in Australia cannot become a reality. However, a positive aspect of the results is that some departments and agencies are in a position of collaborative CRM. This means that those not so positioned can benefit from the ‘best practice’ processes already adopted in the more CRM advanced Australian Federal government departments and agencies.
Full Text Available As colleges of pharmacy prepare a new generation of practitioners, it is important that during practice experiences students learn the impact of clinical interventions. For over ten years, pharmacy students have been a vital part of the multidisciplinary team at the military treatment facility. The overall impact of the student interventions on patient care has not been evaluated. To evaluate the impact, the students began documenting their clinical interventions in Medkeeper RxInterventions™, an online database. The program is used to document faculty and fourth year pharmacy students’ pharmaceutical interventions.Objective: The objective of this study was to analyze the interventions completed by fourth year pharmacy students during a general medicine advanced pharmacy practice experience at a military treatment facility.Methods: The students completing their general medicine advanced pharmacy practice experience at the military treatment facility are responsible for self reporting all interventions made during clinical rounds into the Medkeeper RxIntervention™ database. The researchers retrospectively collected and analyzed interventions made from June 2008 to June 2009.Results: The total number of interventions recorded by 8 fourth year pharmacy students was 114. Students averaged a number of 14.3 interventions during an eight week practice experience. Students spent an average of 5 minutes per intervention. Ninety- five percent of the interventions were accepted.Conclusion: Fourth year pharmacy students’ recommendations were accepted at a high rate by resident physicians. The high acceptance rate may have the ability to positively impact patient care.
Full Text Available INTRODUCTION: Numerous studies report high levels of stigma and discrimination experienced by obese/overweight women within the health care system and society at large. Despite general practice being the most utilised point of access for health care services, there is very little international or national exploration of the experiences of large-bodied women (LBW accessing these services. The aim of this study was to explore LBW's experiences of accessing general practice services in New Zealand. METHODS: This is a qualitative, descriptive, feminist study. Local advertising for participants resulted in eight self-identified, large-bodied women being interviewed. A post-structural feminist lens was applied to the data during thematic analysis. FINDINGS: The women in this study provided examples of verbal insults, inappropriate humour, negative body language, unmet health care needs and breaches of dignity from health care providers in general practice. Seven themes were identified: early experiences of body perception, confronting social stereotypes, contending with feminine beauty ideals, perceptions of health, pursuing health, respecting the whole person, and feeling safe to access care. CONCLUSION: Pressure for body size vigilance has, in effect, excluded the women in this study from the very locations of health that they are 'encouraged' to attend-including socialising and exercising in public, screening opportunities that require bodily exposure, and accessing first point of care health services.
Full Text Available Aim: To assess the level of adherence to diabetes care processes, and associated clinic and patient factors at general practices in Delhi, India. Methods: We interviewed physicians (n = 23 and patients with diabetes (n = 406, and reviewed patient charts at general practices (government = 5; private = 18. We examined diabetes care processes, specifically measurement of weight, blood pressure (BP, glycated hemoglobin (HbA1c, lipids, electrocardiogram, dilated eye, and a foot examination in the last one year. We analyzed clinic and patient factors associated with a number of care processes achieved using multilevel Poisson regression model. Results: The average number of clinic visits per patient was 8.8/year (standard deviation = 5.7, and physicians had access to patient's previous records in only 19.7% of patients. Dilated eye exam, foot exam, and electrocardiogram were completed in 7.4%, 15.1%, and 29.1% of patients, respectively. An estimated 51.7%, 88.4%, and 28.1% had ≥1 measurement of HbA1c, BP, and lipids, respectively. Private clinics, physician access to patient's previous records, use of nonphysicians, patient education, and the presence of diabetes complication were positively associated with a number of care processes in the multivariable model. Conclusion: Adherence to diabetes care processes was suboptimal. Encouraging implementation of quality improvement strategies like Chronic Care Model elements at general practices may improve diabetes care.
Perneger Thomas V
Full Text Available Abstract Background The aim of this study was to identify factors associated with cancer screening practices and with general attitudes toward cancer screening in a general population. Methods Mailed survey of 30–60 year old residents of Geneva, Switzerland, that included questions about screening for five cancers (breast, cervix uteri, prostate, colon, skin in the past 3 years, attitudes toward screening, health care use, preventive behaviours and socio-demographic characteristics. Cancer screening practice was dichotomised as having done at least one screening test in the past 3 years versus none. Results The survey response rate was 49.3% (2301/4670. More women than men had had at least one cancer screening test in the past 3 years (83.2% vs 34.5%, p Conclusion Attitudes play an important role in cancer screening practices among middle-aged adults in the general population, independent of demographic variables (age and sex that determine in part screening recommendations. Negative attitudes were the most frequent among men and the most socio-economically disadvantaged. The moderate participation rate raises the possibility of selection bias.
van Weel, Chris; Mattsson, Bengt; Freeman, George K; de Meyere, Marc; von Fragstein, Martin
This paper reviews the experience of international exchange of medical students for general practice. The experience is based on the EU Socrates programme 'Primary Health Care' that offers, since 1992, clinical attachments and research electives in primary care. This programme involves 11 university departments of general practice/primary care in eight countries: Austria - Vienna; Belgium - Gent; Germany Düsseldorf; Italy - Monza, Udine; Netherlands Nijmegen; Slovenia - Ljubljana; Sweden - Göteborg; and the UK - Edinburgh, Imperial College London and Nottingham. More than 150 students have taken part in the programme, most in the last four years. For clinical attachment communication to patients is essential, and students should be able to speak the language of the host university. A research elective in primary care is less demanding and requires students' ability to communicate in English. Despite marked differences in health care structure in the countries involved, it is quite possible to provide a valuable teaching environment in general practice, and the experience gained by students in the exchanges more than equals that what they would gain at home. The added value is in experiencing the influence of another health care system and of working in another academic primary care centre. A substantial number of research electives have been published in international peer reviewed scientific journals with the student as first (occasionally second) author and staff members of the student's host and home university as co-authors. A further benefit of the exchange programme lies in the transfer teaching innovations between universities.
Williamson Andrea E
Full Text Available Abstract Background We describe the health of "revolving door" patients in general practice in Scotland, estimate changes in their number over the timescale of the study, and explore reasons for changes, particularly related to NHS and government policy. Methods A mixed methods predominantly qualitative study, using a grounded theory approach, set in Scottish general practice. Semi-structured interviews were conducted with professional key informants, 6 Practitioner Services staff who administer the GP registration system and 6 GPs with managerial or clinical experience of working with “revolving door” patients. Descriptive statistical analysis and qualitative analysis of patient removal episodes linked with routine hospital admissions, outpatient appointments, drug misuse treatment episodes and deaths were carried out with cohorts of “revolving door” patients identified from 1999 to 2005 in Scotland. Results A “revolving door” patient is removed 4 or more times from GP lists in 7 years. Patients had complex health issues including substance misuse, psychiatric and physical health problems and were at high risk of dying. There was a dramatic reduction in the number of “revolving door” patients during the course of the study. Conclusions “Revolving door” patients in general practice had significant health problems. Their numbers have reduced dramatically since 2004 and this probably resulted from improved drug treatment services, pressure from professional bodies to reduce patient removals and the positive ethical regulatory and financial climate of the 2004 GMS GP contract. This is a positive development for the NHS.
Simon D French
Full Text Available INTRODUCTION: This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP in general practice. METHODS: General practices were randomised to either access to a guideline for acute LBP (control or facilitated interactive workshops (intervention. We measured behavioural predictors (e.g. knowledge, attitudes and intentions and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP level: behavioural simulation (clinical decision about vignettes and rates of x-ray and CT-scan (medical administrative data. All those not involved in the delivery of the intervention were blinded to allocation. RESULTS: 47 practices (53 GPs were randomised to the control and 45 practices (59 GPs to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05 and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60. Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10 for x-ray or CT-scan. CONCLUSIONS: The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant
Full Text Available Abstract Introduction The speed of diagnosis impacts on prognosis and survival in all types of cancer. In most cases survival and prognosis are significantly worse in rural and remote Australian populations who have less access to diagnostic and therapeutic services than metropolitan communities in this country. Research suggests that in general delays in diagnosis were a factor of misdiagnosis, the confounding effect of existing conditions and delayed or misleading investigation of symptoms. The aim of this study is to further explore the factors that impact on the speed of diagnosis in rural Western Australia with direct reference to General Practitioners (GPs working in this setting. Methods The methodology consisted of a structured discussion of specific cases. GPs based in two rural locations in Western Australia were asked to identify up to eight clinical cases for discussion. A diversity of cases was requested encompassing those with timely and delayed diagnosis of cancer. Focus groups were held with the practitioners to identify which factors under six headings delayed or facilitated the diagnosis in each case. A structured summary of the discussion was relayed to a wider group of GPs to seek additional views or comments on specific factors that impact on the speed of cancer diagnosis in rural and remote locations in Australia. Results A number of factors affecting the speed of diagnosis were identified: the demographic shift towards a frailer and older population, presenting with multiple and complex diseases, increases the challenge to identify early cancer symptoms; seasonal and demanding work patterns leading to procrastination in presenting for medical care; unhelpful scheduling of specialist appointments; and the varying impact of informal networks and social relationships. Conclusion Within the limitations of this study we have generated a number of hypotheses that require formal evaluation: (1 GPs working within informal
Full Text Available Introduction: Rabies in humans is highly fatal and ends in an extremely painful and tortuous death. Unfortunately we still have highest number of deaths due to rabies, ironically a disease preventable by modern prophylactic measures. The post-exposure prophylaxis is a life saving treatment in a definite rabid animal bite. General Practitioners (GP’s act as first line care-givers for the treatment of dog bite and they are also easily approachable by the victim for the treatment to prevent rabies. Objective: To assess the knowledge, attitude and practices regarding rabies among general practitioners. Methodology: This cross sectional survey was carried out from July – August 2011 in Belgaum city among 100 general practitioners using a pre tested questionnaire. Data was entered and analyzed using SPSS 18 trial version. Frequencies were tabulated for demographic variables and association between variables was tested using Chi-square test. Results: Out of the total 100 general practitioners interviewed, 93 were males and 7 were females. The mean age of GP’s was 42.89 years. The mean duration of practice for MBBS doctors was 19 years and for other doctors (BAMS, BHMS, RMP’s was 11 years. Knowledge about various aspects of rabies was comparatively better among MBBS doctors. The knowledge regarding vaccine was very poor among the general practitioners. Conclusion: The major issue was lack of hands on training or updating the knowledge of general practitioners regarding the newer vaccines and their administration. We recommend continued medical education for general practitioners, both (MBBS and non MBBS on prevention of Rabies.
Full Text Available Abstract Background Intimate partner abuse (IPA is a major public health problem with serious implications for the physical and psychosocial wellbeing of women, particularly women of child-bearing age. It is a common, hidden problem in general practice and has been under-researched in this setting. Opportunities for early intervention and support in primary care need to be investigated given the frequency of contact women have with general practice. Despite the high prevalence and health consequences of abuse, there is insufficient evidence for screening in primary care settings. Furthermore, there is little rigorous evidence to guide general practitioners (GPs in responding to women identified as experiencing partner abuse. This paper describes the design of a trial of a general practice-based intervention consisting of screening for fear of partner with feedback to GPs, training for GPs, brief counselling for women and minimal practice organisational change. It examines the effect on women's quality of life, mental health and safety behaviours. Methods/Design weave is a cluster randomised controlled trial involving 40 general practices in Victoria, Australia. Approximately 500 women (16-50 years seen by the GP in the previous year are mailed a short lifestyle survey containing an item to screen for IPA. Women who indicate that they were afraid of a partner/ex-partner in the last year and provide contact details are invited to participate. Once baseline data are collected, GPs are randomly assigned to either a group involving healthy relationship and responding to IPA training plus inviting women for up to 6 sessions of counselling or to a group involving basic education and usual care for women. Outcomes will be evaluated by postal survey at 6 and 12 months following delivery of the intervention. There will be an economic evaluation, and process evaluation involving interviews with women and GPs, to inform understanding about implementation
Full Text Available Background: Good infection control practices are effective in reducing rates of infection in health care settings. Studies in primary care in developed countries indicate that many general practitioners (GPs do not comply with optimal infection control practices. There are no published studies from developing countries in Southern Africa.Objectives: The aim of this study was to describe infection control practices in private GP surgeries in the Buffalo City and OR Tambo District Municipalities in the Eastern Cape Province, South Africa.Method: A literature review was conducted to appraise current best practice with respect to Standard Infection Control and Transmission Based Precautions. A questionnaire, inquiring into GPs’ actual practices, was posted to each surgery.Results: The valid response rate was 34% (47/140. Methods used to sterilise instruments in 40 practices were: ultraviolet sterilisation (23, chemical disinfection (14, boiling water (7, and steam autoclave (2. Compounds used for chemical disinfection included organotin quaternary, chlorhexidine and benzyl ammonium chloride with a quaternary complex. Twenty-two (47% used a hand rub. Sixteen (35% GPs stated that they had a policy to promptly triage patients who are coughing, and 23 (50% had a policy for airflow movement in the surgery. All practices appropriately disposed of sharps. Thirty-seven (80% expressed interest in a seminar on infection control.Conclusions: Overall, GPs were aware of infection control precautions. Ultraviolet sterilisers and chlorhexidine are not recommended, however, for sterilisation or high level disinfection of medical instruments, and their use should be discontinued. Hand rubs are underutilised. GPs should implement Transmission Based Precautions to prevent airborne and droplet infections.
Schellevis François G; Nielen Markus MJ; Verheij Robert A
Abstract Background Previous studies of inter-practice variation of the prevalence of hypertension and diabetes mellitus showed wide variations between practices. However, in these studies inter-practice variation was calculated without controlling for clustering of patients within practices and without adjusting for patient and practice characteristics. Therefore, in the present study inter-practice variation of diagnosed hypertension and diabetes mellitus prevalence rates was calculated by ...
Agner, E; Christensen, T E; Mahnfeldt, M S; Baastrup, A; Jacobsen, K; Jensen, S E
At present, it appears to be probable that both dietary changes and medicinal treatment can reduce the risk of development of coronary disease in middle-aged men with moderately to severely raised blood cholesterol values. Internationally, the limits for cholesterol intervention are considerably lower than in Denmark. Extensive cholesterol screening is, however, very expensive and the identified persons with high cholesterol values will frequently be found in sex and age groups where the beneficial effect of intervention is probably limited. A model for selective cholesterol screening in high risk groups in general practice is described here. In 20 general practices, all of the men aged 45-59 years belonging to the practice were invited to examination of cholesterol and blood pressure. Plasma cholesterol was measured by means of a Reflotron (results are available within three minutes) and the blood pressure and tobacco consumption were registered. After this, the patient's own general practitioner calculated with each of the persons the risk for development of myocardial infarction within the next ten years and intervention could be commenced immediately. 41% of those invited came for examination. Out of these, 29% had cholesterol values greater than or equal to 7.0 mmol/l (Danish limiting value), 44% greater than or equal to 6.5 mmol/l (limiting value in the remainder of Western Europe), and 5% greater than or equal to 9.0 mmol/l (severe hypercholesterolaemia) while only 18% had completely normal cholesterol less than 5.2 mmol/l. In every practice, two patients on an average were found with severe hypercholesterolaemia greater than or equal to 9.0 mmol/l. 28% of the participants had at least two of the three risk factors investigated. (ABSTRACT TRUNCATED AT 250 WORDS) PMID:2238223
Full Text Available The adverse health impacts of tobacco smoking are adrain on national resources. This study will test anintervention to promote smoking cessation among youngadults aged 18-30years. The intervention will be deliveredwithin two settings in Australian health care; communitypharmacies and general practice. The new study builds onthe pilot data, reported here, which inform the feasibility,recruitment strategy, outcome measure, effect size andattrition rate. The new study is a randomised controlledtrial with 200 clients recruited from general practice andcommunity pharmacies in Western Australia.
Panman, Chantal M. C. R.; Wiegersma, Marian; Talsma, Marrit N.; Kollen, Boudewijn J.; Berger, Marjolein Y.; Lisman-Van Leeuwen, Yvonne; Dekker, Janny H.
Background Pelvic floor symptoms are common and are negatively associated with sexual function which, in turn, is an important aspect of quality of life. The majority of older women with pelvic floor symptoms are treated in general practice but evidence from studies in general practice on the sexual
Schuit Albertine J
Full Text Available Abstract Background Obesity is a main threat to public health in the Western world and is associated with diseases such as diabetes mellitus and coronary heart diseases. Up to now a minority of research studied the relation between obesity and the use of primary health care. In the Netherlands the general practitioner (GP is the main primary health care provider. The objective of this article is to evaluate GP consultation and prescription of drugs in moderate and severely overweight (obese persons in the Netherlands. Methods Data were used from a representative survey of morbidity in Dutch general practice in 2001. Our study sample consisted of 8,944 adult respondents (18+ years who participated in an extensive health interview. Interview data were linked to morbidity and prescription registration data from 95 general practices where respondents were listed. Body mass index (BMI was calculated using self-reported height and weight. Analyses were controlled for clustering within practices as well as for socio-demographic and life style characteristics. Results Obesity (BMI ≥ 30 kg/m2 was observed in 8.9% of men and 12.4% of women; for moderate overweight (BMI 25- Conclusion Obesity increases the workload of Dutch general practitioners and the use of prescribed medication. The current increase in the prevalence of obesity will further increase the use of health care and related costs. Since a large majority of Dutch persons visit their GP over the course of one year, GPs' potential role in effective prevention strategies cannot be denied.
Løkkegaard, Thomas; Pedersen, Tina Heidi; Lind, Bent;
INTRODUCTION: Oral anticoagulation treatment (OACT)with warfarin is common in general practice. Increasingly,international normalised ratio (INR) point of care testing(POCT) is being used to manage patients. The aim of thisstudy was to describe and analyse the quality of OACT withwarfarin...... in general practice in the Capital Region of Denmarkusing INR POCT. METHODS: A total of 20 general practices, ten singlehandedand ten group practices using INR POCT, were randomlyselected to participate in the study. Practice organisationand patient characteristics were recorded. INRmeasurements were...... was notsignificant (4.2 percentage points (pp); 95% confidenceinterval (CI): –0.8-9.2). Short sampling intervals, e.g. 10-20days (–11 pp, 95% CI: –16-–6)) and lack of diagnostic coding(–11.8 pp; 95% CI: –19.9-–3.7) were correlated with a lowTTR. CONCLUSION: In our study most of the general practices usingINR POCT...
Miller, Evonne; Buys, Laurie; Bell, Lorraine
This article documents the rationale and experience of a pilot Australian sustainability education programme, "Living Smart Homes" (LSH) based on a community-based social marketing model. Inspired by the Australian "Land for Wildlife" scheme, LSH is designed to engage homeowners with sustainable practices through face-to-face workshops, an…
This paper surveys current pedagogical practice in the teaching of introductory macroeconomics and microeconomics in Australian universities. Survey results are presented detailing lecturers’ approaches to their teaching over 2001 and other aspects of their teaching environment. A comparison of the content and methodology of the main textbooks used in Australian introductory economic courses is also presented.
Løkkegaard, Thomas; Pedersen, Tina Heidi; Lind, Bent;
INTRODUCTION: Oral anticoagulation treatment (OACT) with warfarin is common in general practice. Increasingly, international normalised ratio (INR) point of care testing (POCT) is being used to manage patients. The aim of this study was to describe and analyse the quality of OACT with warfarin...... in general practice in the Capital Region of Denmark using INR POCT. METHODS: A total of 20 general practices, ten single-handed and ten group practices using INR POCT, were randomly selected to participate in the study. Practice organisation and patient characteristics were recorded. INR measurements were...... collected retrospectively for a period of six months. For each patient, time in therapeutic range (TTR) was calculated and correlated with practice and patient characteristics using multilevel linear regression models. RESULTS: We identified 447 patients in warfarin treatment in the 20 practices using POCT...
Due, Tina Drud; Thorsen, Thorkil; Kousgaard, Marius Brostrøm;
BACKGROUND: The Danish health care sector is reorganising based on disease management programmes designed to secure integrated and high quality chronic care across hospitals, general practitioners and municipalities. The disease management programmes assign a central role to general practice......; and in the Capital Region of Denmark a facilitator-based intervention was undertaken to support the implementation of the programmes in general practice. The purpose of the study was to assess the effectiveness of this semi-tailored facilitator-based intervention. METHOD: The study was a stepped-wedge, randomised......, controlled trial among general practices in the Capital Region of Denmark. The intervention group was offered three one-hour visits by a facilitator. The intervention was semi-tailored to the perceived needs as defined by each general practice, and the practices could choose from a list of possible topics...
Pain, Tilley; Stainkey, Lesley; Chapman, Sue
This paper describes a medical model to provide in-house GP services to residents of aged-care facilities. Access to GP services for aged-care residents is decreasing, partially due to the changing demographic of the Australian GP workforce. The model we have developed is an in-house GP (AgedCare+GP) trialled in a publicly funded residential aged-care facility (RACF). The service model was based on the GP cooperative used in our after-hours general practice (AfterHours+GP). Briefly, the service model involves rostering a core group of GPs to provide weekly sessional clinics at the RACF. Financial contributions from appropriate Medicare Benefits Schedule (MBS) items for aged-care planning (including chronic conditions) provided adequate funds to operate the clinic for RACF residents. Evaluation of the service model used the number of resident transfers to the local emergency department as the primary outcome measure. There were 37 transfers of residents in the 3 months before the commencement of the AgedCare+GP and 11 transfers over a 3-month period at the end of the first year of operation; a reduction of almost 70%. This project demonstrates that AgedCare+GP is a successful model for GP service provision to RACF residents, and it also reduces the number of emergency department transfers. PMID:24134857
Pina, Patricia M; Douglass, Joanna
This study aimed to evaluate the opinions and practices of general dentists in Connecticut regarding dental care during pregnancy. A survey was mailed to Connecticut general dentists to acquire data regarding age, gender, training, type of practice, years in practice, payment types accepted, procedures provided for pregnant women according to trimester, provider comfort level with treating pregnant patients, reasons for not treating pregnant patients, and provider opinions about dental care during pregnancy. The response rate was 42%, yielding a sample of 116 dentists. The majority of respondents (97%) reported treating pregnant patients; however, only 45% felt "very comfortable" treating these patients. All dentists in the sample agreed that physicians need to include an oral health evaluation and appropriate referral for patients' prenatal care. However, 70% of respondents had never received a dental referral for a pregnant patient. The majority of dentists favored providing dental treatment during the second trimester of pregnancy. Most dentists (77%) would take a radiograph for a patient 10 weeks into the pregnancy seeking treatment for dental pain, but only 2% would take routine radiographs regardless of the pregnancy trimester. There was a lack of consensus about medications dentists reported acceptable to prescribe for pregnant patients, and female dentists were significantly less likely than males to prescribe ibuprofen (P dental school and continued education course curricula.
Fleming, D M
The fourth morbidity survey in England and Wales is based on a population of 473,000 persons registered in 60 practices and cared for by 241 general practitioners. This presentation traces the evolution of morbidity surveys in England and Wales. That evolution has taken place against a background of advancing computer technology and the drift towards a paperless record. It is motivated by an increasing recognition of the need for data from primary health care an a realisation that a structured record is capable of servicing information needs without intermediary data sheets and coding procedures. The primary objectives of the study include assessment of disease prevalence by region, age-sex and social group; and to study trends over time. Morbidity and social data are collected in the practices and all relevant information stored on practice computers. At the end of the recording year, the computerised record for each patient is copied on to disks in an anonymized but uniquely identified form and transferred to the national Office of Population Censuses & Surveys for analysis. During the year, weekly extracts are taken of new episodes of illness in age and sex groupings which provide the basis of the Weekly Returns Service of the Royal College of General Practitioners.
Carlisle, R; Groom, L. M.; Avery, A J; Boot, D; Earwicker, S.
OBJECTIVES: To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department. DESIGN: Six month longitudinal study. SETTING: Six general practices and the sole accident and emergency department in Nottingham. SUBJECTS: 4745 out of hours contacts generated by 45,182 patients from 23 electoral wards registered with six practices. MAIN OUTCOME MEASURES: Rates of out of hours cont...
Götz, Katja; Berger, Sarah; Gavartina, Amina; Zaroti, Stavria; Szecsenyi, Joachim
Background: Well-being at work is an important aspect of a workforce strategy. The aim of the study was to explore and evaluate psychosocial factors and health and work-related outcomes of practices assistants depending on their employment status in general medical practices. Methods: This observational study was based on a questionnaire survey to evaluate psychosocial aspects at work in general medical practices. A standardized questionnaire was used, the Copenhagen Psychosocial Questionna...
Full Text Available Abstract Background Most comprehensive geriatric assessment (CGA programs refer to hospital-based settings. However the body of geriatric healthcare is provided by general practitioners in their office. Structured geriatric problem detection by means of assessment instruments is crucial for efficient geriatric care giving in the community. Methods We developed and pilot tested a German language geriatric assessment instrument adapted for general practice. Nine general practices in a rural region of Austria participated in this cross-sectional study and consecutively enrolled 115 persons aged over 75 years. The prevalence of specific geriatric problems was assessed, as well as the frequency of initiated procedures following positive and negative tests. Whether findings were new to the physician was studied exemplarily for the items visual and hearing impairment and depression. The acceptability was recorded by means of self-administered questionnaires. Results On average, each patient reported 6.4 of 14 possible geriatric problems and further consequences resulted in 43.7% (27.5% to 59.8% of each problem. The items with either the highest prevalence and/or the highest number of initiated actions by the GPs were osteoporosis risk, urinary incontinence, decreased hearing acuity, missing pneumococcal vaccination and fall risk. Visual impairment was newly detected in only 18% whereas hearing impairment and depression was new to the physician in 74.1% and 76.5%, respectively. A substantial number of interventions were initiated not only following positive tests (43.7% per item; 95% CI 27.5% to 59.8%, but also as a consequence of negative test results (11.3% per item; 95% CI 1.7% to 20.9%. The mean time expenditure to accomplish the assessment was 31 minutes (SD 10 min. Patients (89% and all physicians confirmed the CGA to provide new information in general on the patient's health status. All physicians judged the CGA to be feasible in everyday
Nielen, M.M.J.; Schellevis, F.G.; Verheij, R.A.
BACKGROUND: Previous studies of inter-practice variation of the prevalence of hypertension and diabetes mellitus showed wide variations between practices. However, in these studies inter-practice variation was calculated without controlling for clustering of patients within practices and without adj
Nielen, M.M.J.; Schellevis, F.G.; Verheij, R.A.
BACKGROUND: Previous studies of inter-practice variation of the prevalence of hypertension and diabetes mellitus showed wide variations between practices. However, in these studies inter-practice variation was calculated without controlling for clustering of patients within practices and without adj
Full Text Available Background and objectives: Anxiety and Depressive disorders represent an important public health problem, which involves not only the mental health services, but the General Practice as well. This paper examines models of Collaboration between General Practice and Community Mental Health Services developed in Italy. Methods: Different Consultation -Liaison activities are presented. For every Collaboration model advantages and disadvantage are discussed. Results: The structured Consultation Liaison Service is based on supplying diagnostic consultation and therapeutic interventions in support of General Practitioners (GPs. The service could be based in either a Community Mental Health Centre (CMHC or externally. Diagnostic evaluation can be followed by brief and focal therapeutic interventions, in support of the GP's therapeutic plan. The spontaneous collaboration in small centres are frequent in rural areas where the contained dimensions of the services and the direct acquaintance between psychiatrists and GPs encourage the personalization of the collaboration. The model of Liaison and Group-Training focuses on direct contact between consultant and GPs. In the course of regular meetings, the consultant gives the GPs supervision and education, and they can discuss the therapeutic plans for patients requiring specialist intervention. Conclusion: The empiric classification presented should be considered an attempt to represent a complex reality. Every service, in fact, carries out activities that are necessarily wider than abstract typologies and that overlap with other models' activities.
Kroger, Andrew T; Atkinson, William L; Marcuse, Edgar K; Pickering, Larry K
This report is a revision of General Recommendations on Immunization and updates the 2002 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices and the American Academy of Family Physicians. MMWR 2002;51[No. RR-2]). This report is intended to serve as a general reference on vaccines and immunization. The principal changes include 1) expansion of the discussion of vaccination spacing and timing; 2) an increased emphasis on the importance of injection technique/age/body mass in determining appropriate needle length; 3) expansion of the discussion of storage and handling of vaccines, with a table defining the appropriate storage temperature range for inactivated and live vaccines; 4) expansion of the discussion of altered immunocompetence, including new recommendations about use of live-attenuated vaccines with therapeutic monoclonal antibodies; and 5) minor changes to the recommendations about vaccination during pregnancy and vaccination of internationally adopted children, in accordance with new ACIP vaccine-specific recommendations for use of inactivated influenza vaccine and hepatitis B vaccine. The most recent ACIP recommendations for each specific vaccine should be consulted for comprehensive discussion. This report, ACIP recommendations for each vaccine, and other information about vaccination can be accessed at CDC's National Center for Immunization and Respiratory Diseases (proposed) (formerly known as the National Immunization Program) website at http//:www.cdc.gov/nip.
Attard, Melanie; McArthur, Alexa; Riitano, Dagmara; Aromataris, Edoardo; Bollen, Chris; Pearson, Alan
Quality service provision and patient safety and satisfaction in encounters with health-care professionals relies on effective communication between the practitioner and patient. This study aimed to identify effective practices for improving communication between clinical staff in general practice and patients with limited English proficiency, and to promote their implementation in general practice. Effective interventions and strategies were identified from a review of international research. Experiences with their use in practice were explored via focus group discussions with general practitioners and practice nurses. The results suggest that, wherever possible, communication in the patient's primary language is preferable; use of a qualified medical interpreter should be promoted, and practices should have a standardised and documented procedure for accessing interpreter services. General practice staff must increase their awareness about services that are available to facilitate communication with patients with limited English proficiency, and also develop attitudes, both individual and organisational, that will maximise the effectiveness of these strategies. These findings were used to develop brief, evidence-based practice guidelines that were disseminated to focus group participants for evaluation of utility and general feedback. This evidence-based guidance is now available to assist clinical and administrative general practice staff across regional and metropolitan South Australia.
Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial
Background Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed. Methods/design The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following
Waal, de, M.; Terwee, C. B.; Windt - Mens, van der, D.A.W.M.; Bouter, L M; Dekker, J
BACKGROUND: Information about quality of life of patients with chronic hip or knee complaints in general practice is scarce. This study describes the health-related and overall quality of life (HRQL) of these complaints. METHODS: Data were obtained from a cohort study in general practice. HRQL at three months follow-up was analysed. HRQL was measured as: symptoms, physical, psychological and social functioning, and general health perceptions, using the Western Ontario and McMaster Universitie...
Full Text Available Background Maternal thyroid disease in pregnancy is associated with adverse impact on both mother and fetus. Both the American thyroid association and the endocrine society have recently published guidelines for the management of thyroid disease in pregnancy. Objectives The objective of this survey was to assess and compare the current practices of various East-Asian physicians in the screening and management of thyroid disease in pregnancy. Materials and Methods Completed survey questionnaires were collected from 112 physicians of six East-Asian countries. The survey was based on clinical case scenarios, asking questions about the clinical practices related to diagnosis and management of thyroid disease during pregnancy. Reponses from 76 endocrinologists and 33 internists and general practitioners (generalists were analyzed. Results There were minor differences in treatment preferences for Graves’ disease in pregnancy and tests to monitor antithyroid drugs between endocrinologists and generalists; the major difference being targeted free thyroxin, and also thyroxin, depicted in the upper end of normal range, by the majority of endocrinologist and within the normal range, by generalists. Compared to generalists, endocrinologists perform more targeted screening and are more familiar with its risk factors. Predominantly, endocrinologists increase levothyroxine dose in hypothyroid women, upon confirmation of pregnancy and also indicate full dose in a pregnant woman, diagnosed with overt hypothyroidism, and treat thyroid peroxidase antibody positive or negative pregnant women with thyroid stimulating hormone (2.5 - 5 mU/L, as compared to generalists. Conclusions There is wide variation in the clinical practices of screening and management of thyroid disorders during pregnancy in East-Asia, with many clinicians, in particular general practitioners, not adhering to clinical practice guidelines, unfortunately.
Full Text Available Abstract Background General practitioners (GPs are involved in the management of most melanocytic skin lesions in Australia. A high quality biopsy technique is a crucial first step in management, as it is recognized that poor techniques can mislead, delay, or miss a diagnosis of melanoma. There has been little published on the biopsy decisions and techniques of GPs. This study aims to describe the current management choices made by GPs for suspicious melanocytic skin lesions and to compare their choices with the best practice guidelines. Methods An anonymous survey of GPs presented with three clinical scenarios with increasing complexity of melanoma in which a referral or biopsy decision was specified. Results 391 mailed surveys with a 76.3% response rate. Mean biopsy experience was 4.14 biopsies per GP per month. The rates of choosing to refer among the three scenarios were 31%, 52% and 81% respectively, with referral to surgery being the most common choice (81%. Most biopsy techniques (55% were chosen according to best practice guidelines, although non-guideline biopsy techniques chosen included shave (n = 10, punch biopsy (n = 57, wide excisions (n = 65, and flaps (n = 10. The few GPs (n = 5 who identified themselves as skin specialist GPs were no more likely to adhere to guidelines than their colleagues. Conclusion A majority of referrals and biopsies were chosen by GPs according to best practice guidelines, but concern remains for the high proportion of GPs making non-guideline based choices. How GPs choose to biopsy or refer needs further training, audit, and research if Australia is to improve the outcome of melanoma management in general practice.
Harborow, Patrick W; Ogden, Jane
This audit was based in general practice and examined 49 consecutive referrals to a UK trained traditional Chinese acupuncturist. It aimed to assess the type of patients referred to an acupuncturist, subsequent changes in health status, whether the effectiveness of acupuncture was related to the type of presenting problem and to examine which factors were predictive of the success of acupuncture. The referred patients had a wide variety of conditions which were categorised as to whether or not there was empirical evidence from trials of responsiveness to acupuncture (evidence based vs non evidence based). Patients completed measures of their health status prior to treatment and at two and six month follow ups. In addition, the referring GP's beliefs about the prognosis of the problem and the therapist's and patient's expectations of success were measured at baseline. The results showed that referred patients reported poorer health status than a historical sample of general practice patients and that they showed significant improvements in all aspects of health status following acupuncture. In particular, patients showed improved energy, pain, emotional reactions, sleep and reduced social isolation at two months which were maintained at six months. Physical mobility was improved at six months. In addition, the results indicated that the best predictors of effectiveness were the therapist's and patient's expectations of success at baseline. Effectiveness was not related to the category of condition (evidence based or not) nor to the GP's expectations about the prognosis of the condition. The results are discussed in terms of implications for the role of acupuncture in General Practice and selectively targeting patients who would be responsive to such an approach. PMID:15628779
Full Text Available Abstract Background Non-adherence to clinical guidelines has been identified as a consistent finding in general practice. The purpose of this study was to develop theory-informed, computer-delivered interventions to promote the implementation of guidelines in general practice. Specifically, our aim was to develop computer-delivered prompts to promote guideline adherence for antibiotic prescribing in respiratory tract infections (RTIs, and adherence to recommendations for secondary stroke prevention. Methods A qualitative design was used involving 33 face-to-face interviews with general practitioners (GPs. The prompts used in the interventions were initially developed using aspects of social cognitive theory, drawing on nationally recommended standards for clinical content. The prompts were then presented to GPs during interviews, and iteratively modified and refined based on interview feedback. Inductive thematic analysis was employed to identify responses to the prompts and factors involved in the decision to use them. Results GPs reported being more likely to use the prompts if they were perceived as offering support and choice, but less likely to use them if they were perceived as being a method of enforcement. Attitudes towards using the prompts were also related to anticipated patient outcomes, individual prescriber differences, accessibility and presentation of prompts and acceptability of guidelines. Comments on the prompts were largely positive after modifying them based on participant feedback. Conclusions Acceptability and satisfaction with computer-delivered prompts to follow guidelines may be increased by working with practitioners to ensure that the prompts will be perceived as valuable tools that can support GPs' practice.