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AbstractThis study piloted a dynamic patient outcome cardiovascular disease risk factor audit to measure changes in patient outcomes related to general practitioner management of patients with/or 'at risk' of cardiovascular disease (CVD). Thirty-nine general practitioners (GPs) audited 594 patient records for six CVD risk factors over the preceding 2 years. GPs were given a guideline to the management of CVD risk factors produced by the National Heart Foundation (NHF). A second audit was performed six months later. The audit consisted of earliest recorded assessment of each risk, any subsequent intervention (drug, lifestyle or referral), and most recent follow-up. Outcomes measured were the percentage of patients meeting NHF guideline goals. Data were analysed both excluding blank entries and including such omissions assuming 'not in goal' status. A Pearsons Chi-Square test was performed comparing percentage of patients in goal for risk factors. More patients were in goal for diastolic BP than systolic BP despite evidence that the latter is prognostically more important. Goal status was modest for lipids and smoking but poor for diabetes, BMI, and physical activity. There was little difference in status between primary and secondary prevention. Significant changes between first and second audit in primary prevention patients were more reaching physical activity goals and ceasing smoking but fewer reaching diastolic BP goals. There were no significant changes in secondary prevention despite the greater absolute risk. When omissions were excluded more reached goal systolic and diastolic BPs. There were no statistically significant changes in those with known hypertension, diabetes or hyperlipidaemia. CVSenior research fellow Department of General Practice, Monash University. Doctoral scholar Department of Eppidemiology and Preventive Medicine, Monash University. Victorian regional medical co-ordinator Second Australian National Blood Pressure Study, Baker Medical Research Institute. PAPER: 0102
AbstractThis analysis sought to determine the extent to which 'current guidelines' for the management of hypertension are reflected in the prescribing of antihypertensive drugs in Australia over the period 1994-1998. It further examined the cost implications of actual and recommended prescribing patterns to Federal government prescribing schemes and hence the taxpayer. As general practitioners manage 90% of hypertension in the Australian community this is particularly pertinent to us. Federal government and consumer cost estimates modeled on prescribing patterns and guideline recommendations suggest that the increasing cost of antihypertension drugs are driven by the use of newer more expensive antihypertensive agents whose additional benefit have yet to be demonstrated in clinical outcome trials. The implementation of 'current guidelines' for uncomplicated hypertensive patients on monotherapy alone could have reduced government drug costs by $45-108 million in 1998. Current prescribing patterns indicate that clinical practice has pre-empted the results from clinical trials of newer more expensive agents and that clinicians' prescribing patterns do not closely reflect current recommendations. More recent evidence suggests that newer agents have no advantage over older agents either in burden of side effects or important patient outcomes such as all cause mortality and adverse significant cardiac events such as acute myocardial infarction or stroke. CVSenior research fellow Department of General Practice, Monash University. Doctoral scholar Department of Epidemiology and Preventive Medicine, Monash University. Victorian regional medical co-ordinator Second Australian National Blood Pressure Study, Baker Medical Research Institute. PAPER: 0103
AbstractASPREN (The Australian Sentinel Practices Research Network) has been in existence for over 10 years. A dedicated group of recorders have been collecting information on disease prevalence. Each year the results are published in an annual report. The data provide an interesting insight to Australian general practice. The programs strengtht and weaknesses will be outlined and the results of the reporting in 2000 will be reported. Conditions include influenza, atrial fibrillation and spider bites. As part of the process of the meeting suggestion for inclusion in the conditions being recorded will be sought. CVIan Wilson MB BS; D Obst (RCOG); FRACGP Senior Lecturer, Department of General Practice and Medical Education Unit, Adelaide University PAPER: 0104
AbstractThe Western Australian Divisions of General Practice and the Health Department of Western Australia began a collaborative project to collect routine general practice data from practice computers in 1997. The project entered a pilot phase in October 2000. Three general practitioners, using three different software systems collected data for three months as part of routine consultations. The principal data collected were reason for encounter, prescriptions, billing and patient problem lists. The issues of confidentiality, data quality and uses of the data are examined. The technical aspects of data extraction from three software systems will be presented earlier at the College’s computer conference. A system for protection of patient privacy draws on those employed by United Kingdom’s general practice databases. Billing records may serve as a measure of encounter data completeness. Software system shortcomings mitigate against comprehensive encounter recording. Coding systems for problem and encounter description assist analysis, if good quality and transparent. Prescriptions require substantial processing before analysis is possible. Results of analysis include comparison with BEACH data where possible, age-sex-specific rates of prescribing and problem prevalence, and application of evidence based medicine to assess prescribing for a limited number of problems. CVClinical senior lecturer at the University of Western Australia’s department of General Practice and general practitioner at Lockridge General Practice. Has worked on infrastructure development to record and analyse general practitioners’ prescribing and test ordering and is writing a PhD in this area. Together with Dr Alison Ward, is involved in the design and evaluation of the Western Australian Sentinel Practice project.
AbstractBackground: Health Connect was a telephone triage service staffed by registered nurses, which aimed to refer consumers to the most appropriate care available for their needs, and to provide simple health care advice when appropriate. It operated as part of the Central Sydney/ Broken Hill After Hours Primary Medical Care Trial, funded by the Commonwealth Department of Health and Aged Care. Aims: This paper aims to describe the broad categories of calls and advice given, and to consider health outcomes and patient satisfaction. Methods: Data was collected from 11,742 individual telephone encounters. A random sample of five hundred callers were followed-up by interview to measure satisfaction with the service, and compare Health Connect advice with actual care sought. Results: Results consider the reasons for encounter for Health Connect consultations, and what callers were advised by Health Connect. Advice was compared with what patients would have done if the service was not available, and the care they actually sought. Initial results suggest that Health Connect successfully directed patients to an appropriate level of care for their needs by referring patients to less urgent care than they would have sought if they had not called Health Connect, while still recognising when more urgent care was required. In total, 61% of Health Connect patients were referred to a general practitioner. Of those callers who participated in a follow-up interview, 49% did see a GP within 3 days of calling Health Connect. 85% were satisfied with the service provided by Health Connect. CVSarah Ball is a project officer with the Discipline of General Practice at the University of Newcastle. She has worked on a number of research projects since graduating with a Bachelor of Science Degree, majoring in biology and psychology. Sarah has been involved in General Practice research since 1999. PAPER: 0106
AbstractSince the beginning of 1998, more than 400 gay and other homosexually-active men (GHAM) have been enrolled into the South Australian Primary and Extended Care and Prevention Programme. The Programme provides integrated multidisciplinary care and clinical health promotion in a general practice setting. 38% of GHAM participants are HIV positive. Scores on the Short Form 36 general health questionnaire (sf36) for the first 273 GHAM participants to undergo a second comprehensive health assessment were analysed in paired fashion before and after an average of 18 months participation in the Programme. Significant improvement was seen in seven of the eight sf36 domains. As an example, mean General Health scores increased from 70.2 (/100) to 75.9 (P < 0.0001). For HIV positive men, significant improvement was also seen in 8 out of 9 domains of the Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS. In the HIV negative men reviewed, the immunity rate for Hepatitis B had risen from 66% to 87% of eligible men (P = 0.002) while the rate of Hepatitis A immunity had risen from 38% to 53% (P = 0.024). Rates of Major Depression and Dysthymia fell significantly in paired analysis between enrolment and review. 21% of GHAM reported unsafe sex with a casual partner in the six months prior to enrolment compared with 17% in the six months prior to follow up assessment (P = 0.075). Participants recorded high levels of satisfaction with the Programme. CVDr Rogers graduated in Medicine from the University of Adelaide in 1983 and holds the Masters of General Practice Psychiatry from Monash University. He is a Clinical Lecturer and PhD candidate in the Department of General Practice at Adelaide Univeristy, and Director of the South Australian Primary and Extended HIV and Related Diseases Care and Prevention Programme. His professional interests are HIV medicine, health in human diversity, the biopsychosocial model and medical education.
AbstractSince the beginning of 1998, more than 400 gay and other homosexually-active men (GHAM) have been enrolled into the South Australian Primary and Extended Care and Prevention Programme. The Programme provides integrated multidisciplinary care and clinical health promotion in a general practice setting. 38% of GHAM participants are HIV positive. Scores on the Short Form 36 general health questionnaire (sf36) for the first 273 GHAM participants to undergo a second comprehensive health assessment were analysed in paired fashion before and after an average of 18 months participation in the Programme. Significant improvement was seen in seven of the eight sf36 domains. As an example, mean General Health scores increased from 70.2 (/100) to 75.9 (P < 0.0001). For HIV positive men, significant improvement was also seen in 8 out of 9 domains of the Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS. In the HIV negative men reviewed, the immunity rate for Hepatitis B had risen from 66% to 87% of eligible men (P = 0.002) while the rate of Hepatitis A immunity had risen from 38% to 53% (P = 0.024). Rates of Major Depression and Dysthymia fell significantly in paired analysis between enrolment and review. 21% of GHAM reported unsafe sex with a casual partner in the six months prior to enrolment compared with 17% in the six months prior to follow up assessment (P = 0.075). Participants recorded high levels of satisfaction with the Programme. CVDr Rogers graduated in Medicine from the University of Adelaide in 1983 and holds the Masters of General Practice Psychiatry from Monash University. He is a Clinical Lecturer and PhD candidate in the Department of General Practice at Adelaide Univeristy, and Director of the South Australian Primary and Extended HIV and Related Diseases Care and Prevention Programme. His professional interests are HIV medicine, health in human diversity, the biopsychosocial model and medical education.
AbstractResearch Objectives This collaborative and multi-method study sought to map the areas of interest and levels of research experience in Victorian divisions of general practice. Study Design Key informants in each division of general practice in Victoria were interviewed using a common template of questions. A focus group of urban general practitioners identified important research concerns for general practitioners. In rural Victoria, consumers were consulted via a population-based survey and several focus groups. Principal Findings In urban divisions, there was marked variability with respect to research experience and its perceived importance. For GPs to participate in research, they need (a) proper compensation for lost time, (b) mental stimulation, (c) to perceive a value for their patients, (d) to acquire research skills, (e) a collegial atmosphere, (f) to be passionate about the issue experiences and (g) personal acknowledgement in the publication outcomes of their research activity. Rural divisions emphasised the limitations and pressures imposed by the rural medical workforce shortage. Research on (a) what happens in general practice, (b) the role of the GP and (c) the support of best practice were recommended by rural divisions. Consumers welcomed GP involvement in research and believed that it would be beneficial for GPs and consumers alike. However, many consumers were unclear about what constitutes research, their own GP involvement in research and what a division of general practice is and does. Conclusion In Victoria, divisions, general practitioners and consumers affirmed the need to promote research in general practice, but revealed variable capacity and perspectives on how this has been achieved and how it should proceed in the future.
CVBarry McGrath Senior Lecturer Department of General Practice, The University of Melbourne L Bourke, P Markey, N Sulaiman, H Threlfall, R Guibert, D Simmons, L Piterman, D Young PAPER: 0109 Title: Mapping contemporary models of integration in the Australian primary health care setting Presenter: J Sims
Address for correspondence: Department of General Practice, 200 Berkeley Street, Carlton, Vic 3053 Phone: 03 8344 4547 Email: j.sims@unimelb.edu.auCVDr Sims is a Senior Lecturer in Primary Care in the Department of General Practice at the University of Melbourne. She represents a multi-disciplinary, cross-institutional team who have experience of working together to address aspects of primary care integration from both a national and international perspective. PAPER: 0110 Evaluation of Effectiveness of Pediatric Asthma Guidelines in GP Setting: a Pilot Study Presenter N Sulaiman
Research Objective To examine the effectiveness of asthma guidelines only or guidelines plus an educational package on the management of asthma in children in the general practice setting. Study Design The study is a RCT where 30 general practices are randomly allocated to one of three groups:
Each practice will recruit 17 children aged 2-14 years with GP-diagnosed asthma. Outcome measures are:
The education package is two sessions of three-hour duration small group discussion, case presentation and practical demonstration of inhalation modalities and lung function tests. The materials are based on the National Asthma Campaign "Six-Step Asthma Management Plan’, the 3+ plan, the Royal Children’s Hospital Guidelines and the Australian Pediatric Review Training Program. The guidelines and the education package are developed/ adapted by local GPs representing the two participating divisions of GP and the research team to ensure relevance and ownership. Results Results of the pilot study will be presented for discussion and feedback PAPER: 0111 Falls prevention in the elderly – a data model and terminology Presenter T Liaw
Address Department of General Practice, The University of Melbourne,
Background In Australia we have a National Health Information model and a GP Data Model. The Coding Jury has recommended SNOMED CT as the reference terminology (also called "coding system") of choice. HL7 is the recommended standard for health care messages. The GEHR architecture is being developed and evaluated for applicability as the basis for a national EHR. Aim To develop a data model and terminology for falls prevention in the elderly. Method The GP Data Model and ICD10AM will be used as the starting point to develop a conceptual framework, data model and a term set for use in an integrated health care context. Drawing on national and International literature, the conceptual framework will incorporate single and multiple morbidities and provide the context for the logical data model to comprehensively describe the entities, processes and relationships in the clinical area of falls prevention in the elderly. The professional, clinical, and population health perspectives will be represented. Following that, a prototype falls prevention knowledge base will be created along with a link to a desktop software to provide decision support. The model and terminology will be tested, on paper and electronically, by health care professionals in an Integrated Care Centre and GPs in the catchment. Expected outcome Models and prototype of evidenced-based electronic decision support system for the early identification, grading of risk of falls and production of patient-tailored action plan. Progress report We will report on the methods and progress of work to date and discuss issues raised. PAPER: 0112 Rural, remote, Indigenous & tropical health at the James Cook University School of Medicine Sen Gupta TK, MBBS, FRACGP, FACRRM. Associate Professor Alberts VF, Indigenous Student Support Officer Grant M, BHlthSc, MPH&TM. Senior Lecturer Hays RB, MBBS, PhD, FRACGP, FACRRM. Dean McKenzie AJ, BSc, MBChB, FRNZCGP, FRACGP, FACRRM. Senior Lecturer James Cook University School of Medicine, Townsville Qld 4811 Telephone 07 4781 6222, Facsimile 07 47815870, Email Tarun.Sengupta@jcu.edu.au The mission of the James Cook University (JCU) School of Medicine is to train doctors to meet the health needs of Northern Australia with an emphasis on rural, remote, Indigenous and tropical health. This paper describes the development and implementation of these strands throughout the course, which had its first intake in 2000. With major campuses in Townsville and Cairns, the University had established a regional and rural focus. Medical education was well developed locally through the North Queensland Clinical School; the Anton Breinl Centre; and the North Queensland Rural Health Training Unit. These organisations and others involved in rural, remote, Indigenous and tropical health contributed to development of the curriculum. Many of the teaching staff had a background in one or more of these areas and clinical cases were often set in these contexts. These issues were highlighted from week 1, with students exposed to appropriate resources and role models. A multi-disciplinary rural students club and an Indigenous students club were formed. Year I students participated in a two day cross-cultural course. A subject entitled Rural, Remote, Indigenous and Tropical Health was developed for year II which built on earlier material to provide a foundation for these strands throughout the rest of the course. An advisory committee oversaw development of the course and provided advice and access to community resources. Teaching material was integrated across other subjects and years. Early evaluation suggests students are developing a sound understanding of rural, remote, Indigenous and tropical health, with many considering careers in these fields. Through the strategies outlined the School has undertaken the task of achieving its mission statement. Long term evaluations will be needed to measure the success of this approach.
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