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Background: Antibiotic resistance is a major global public health threat. Most antibiotic prescriptions for human consumption in primary care are for acute respiratory tract infections (ARTIs). Australia continues to be a high prescriber of antibiotics, compared with other Organisation for Economic Cooperation and Development (OECD) countries. Implementation of evidence-based strategies to reduce antibiotic use in primary care is needed. Delayed prescribing is one evidence-based strategy that is underused., Objective: This article describes delayed prescribing, the evidence for its effectiveness, how it works, how it could be implemented in Australia and what individual general practitioners (GPs) can do., Discussion: Delayed prescribing, also called 'wait-and-see prescribing', is the process whereby a GP makes an antibiotic prescription available during the consultation, but asks the patient to delay its use to see if symptoms will resolve first. Evidence indicates that delayed prescribing is an effective strategy for reducing antibiotic use but requires implementation. Individual GPs can begin to use this strategy as a method of treating patients with ARTIs.

The aphorism, 'If many treatments are used for a disease, all are insufficient' seems self evident. If any treatments were beneficial ('sufficient' in the aphorism), there would be no need to search for new treatments and therefore the presence of many available treatments might be a marker for none of them being effective.

We have been aware for decades - perhaps as a somewhat far-off theoretical problem - that antibiotic resistance is a threat to healthcare worldwide. However, the crisis is now here and very real. Each year in Europe alone, 25 000 deaths are directly attributed to antibiotic resistance. New antibiotics are not being produced fast enough, and resistance means we are running out of antibiotics of last resort.

Background: Articles published in the research section of Australian Family Physician (AFP) are subject to an editorial process comprising several stages., Method: Timelines tracking the movement of each research manuscript submitted to AFP from 2002-2004 through all stages of the editorial process were constructed. Of 179 papers, 130 had sufficiently progressed to be included in this study. Manuscripts were grouped by subject matter into eight categories., Results: Waiting for authors' responses to editorial feedback (with reviewers' reports) was the greatest cause of delay to AFP editorial processes. Peer reviewers took 43 (SD: 102) days to return their report. Authors took 67 (SD: 76) days to resubmit their paper following initial feedback, and a further 48 (SD: 79) days after it had been edited. Mean accumulated time between receipt of a manuscript by AFP and sending it to peer review was 15 days. Once the editorial process was completed, articles were usually published within 3 months. Most research (64%) was on the topic of health services research rather than clinical research (36%). The most common research method was observational (78%) rather than experimental (22%)., Discussion: There is less clinical research submitted to AFP than expected for a clinical discipline. Authors and reviewers cause the most delay in manuscripts' passage through the editorial process.

Background: Survival from early meningococcal disease might be improved if general practitioners followed guidelines by immediately administering parenteral antibiotics (before hospital referral)., Methods: Structured telephone interviews with 20 GPs who had previously treated meningococcal cases., Results: General practitioners knew guideline recommendations for early management of meningococcal disease: early parenteral antibiotics would be given by about half the GPs entertaining a diagnosis of meningococcal infection. Barriers to immediate treatment were: diagnostic uncertainty, regarding the case as nonurgent, and practising close to a hospital., Discussion: Diagnosing meningococcal disease is difficult in general practice. Early antibiotic administration for suspected cases is appropriate even in close proximity to referral hospitals.

Objective: To describe the utility and acceptability to general practitioners and palliative care staff of case conferences in palliative care., Method: Research focussed on case conferences conducted between GPs and staff of three specialist palliative care units (in an inner urban, outer metropolitan and regional setting), at the time of referral of patients to the service. Telephone interviews were conducted with all GPs who participated in a case conference, and focus groups were conducted with palliative care staff., Results: For most GPs, case conferences by teleconference were a time effective and immediate means of information transfer. The best instances for a conference were at time of patient referral, time of discharge to the community, or where the case was complex. General practitioners appreciated access to multiple professionals simultaneously. Workload pressures were a drawback of participation for both GPs and specialists. Palliative care team members thought case conferences gave GPs an appreciation of a team approach, and reduced professional isolation. The usefulness of the case conferences depended on the willingness of the GP to participate. General practitioners would participate again provided they did not have to organise the case conference. Specialist staff were concerned by the financial cost of organising case conferences., Discussion: Case conferences provide useful information exchange between GPs and specialist staff, and are acceptable to both parties. Much depends on the individual GPs attitude toward participation, as well as the timing of the conferences in the course of the patient's illness. Organisation needs to be a task of the specialist units, who would need administrative support to organise them.

Background: Medication adherence is often suboptimal and this leads to poorer health outcomes., Participants: 179 adult patients taking three or more, long term medications in one academic general practice in Brisbane, Queensland., Design: Unblinded, factorial, randomised controlled trial of computer generated consumer product information, computer generated medication timetable, both, or usual care., Main Outcome Measures: We derived adherence to medication by measuring the relative prescription rate for six groups of medications extracted by the Health Insurance Commission. We also measured patients' knowledge of, and satisfaction with, medications, and general practitioners' attitudes to the decision support system., Results: There was no effect on medication adherence. Although GPs were supportive of the system, neither patients' self reported knowledge of medications, nor satisfaction with care, was increased by the intervention., Conclusion: Simply providing patients with medication timetables and computer generated consumer product information does not improve drug adherence in primary care.

Aim: To assess the current levels of computer use in Australian general practice, and identify clinical and administrative tasks for which computers are most commonly used by general practitioners., Methods: A telephone survey of a nationally representative sample of Australian GPs in active practice (n = 1202)., Results: The national response rate was 55.5%, with New South Wales, Tasmania and the Australian Capitol Territory recording lower than national rates, and Queensland, Western Australia and the Northern Territory recording higher rates. Australian general practices were highly computerised (86%). General practitioners practising in capital cities were less likely to be computerised than their rural colleagues (p < .001). There were no significant differences in general computerisation among practices in the Australian states and territories (p > .05). Three task sets for which computers were used were identified: general administrative functions, patient oriented administrative functions and clinical functions. Computers were more likely to be used for administrative than clinical tasks. Use for administrative tasks increased with the size of the practice (p < .001) and with years of computer use (p < .001)., Discussion: The results suggest that within two years 95% of Australian general practices will be computerised. While use of computers for clinical functions is less common than for administrative purposes, electronic script writing packages are widely employed. However, other theoretically valuable functions for improving clinical outcomes for patients, such as patient educational material and decision support systems, are the least commonly used.

Objective: To pilot single patient trials designed to improve decision making about stimulant use for attention deficit hyperactivity disorder (ADHD) in general practice., Method: Patients previously stabilised on dexamphetamine were enrolled from a general practice. Each undertook a six week same patient randomised, double blind, placebo controlled crossover comparison of dexamphetamine with placebo for ADHD. Rating scales were completed weekly by self, parent and teacher., Results: Three of the four patients were clear responders to dexamphetamine (including a noncompleter, as his results still demonstrated a clear response). The results were clinically useful in each case. Management was confirmed for three patients and changed for one (who ceased dexamphetamine)., Discussion: Prescribing stimulant medications only to children with diagnosed ADHD and who are found to respond, limits use of these worrisome drugs to those who will respond, and minimises their use in those who will not benefit.

Background: In single patient (n of 1) trials, a patient acts as his or her own control in a study comparing the effectiveness of a drug with placebo or another drug. The aim of a single patient trial (SPT) is to identify the best treatment for the individual patient, formalising a 'trial of treatment' by using blinding and multiple crossover periods., Objective: We have successfully piloted SPTs for osteoarthritis and attention deficit hyperactivity disorder, and several others are currently being piloted. Barriers encountered include: obtaining identical placebos, ethical approval for individual SPTs, standardising doses, determining length of treatment periods, patient withdrawals and cost of the SPTs., Discussion: Only prescribing medications if an individual has been shown to be a responder can greatly benefit general practitioners, patients and the healthcare system. We have established the infrastructure necessary to offer a single patient trial service to GPs and patients anywhere in Australia. This has the potential to revolutionise prescribing for certain chronic conditions.

A recent analysis of the evidence suggests that, in Western countries the use of antibiotics as initial treatment for children with acute otitis media benefits one out of 20 children by reducing pain in the acute phase. There is no evident benefit for deafness, recurrent attacks or complications. This suggests that we should use antibiotics less readily.

Conventional weight loss methods usually fail in the long term. An approach that focuses on a low fat diet together with moderate increases in physical activity shows promise. Its most attractive feature is that patients do not have to starve themselves. This approach can be used in general practice.

Objective: Skin cancer is common in Australia. It is managed in large portion within general practice, and early excision usually affords cure, therefore, it may form a much greater workload for general practitioners (GPs) than incidence figures would imply. The aim of this study was to describe the skin cancer workload in Australian general practice., Method: Analysis of data recorded by 495 randomly selected GPs relating to 113,468 consultations (98,796 weighted for State size), which were collected as part of a national descriptive study. Medicare and census data were used to calculate rates at which GPs were consulted for different conditions., Results: Skin tumours accounted for 2,083 (1.5%) of all 145,799 problems managed in 98,796 encounters. Annual rates at which GPs were consulted were: 13/1,000 people for 'malignant' tumours of the skin; 23/1,000 for 'naevus/mole; and 13/1,000 for 'other benign' lesions. The rates of diagnoses of 'malignant skin neoplasms' increased with age to a maximum among women and men aged 65 years or more of > 80/1,000 and > 100/1,000, respectively. For 'naevus/mole' the rates of maximum diagnoses were 40/1,000 for women and 351/1,000 for men aged 15-24 years. There was no sex difference for the maximal rate (15/1,000) among the 45-64 age groups for 'other benign skin lesions'. The main form of management was procedural for malignant skin lesions (90% of consultations) and naevi/moles (50%). Referral to specialist services was most common during consultations for malignant disease (22% of consultations), in comparison to naevi/moles (15%) and other benign skin neoplasms (9%). Procedures (cryotherapy, diathermy and excision) and referrals were more common for malignant lesions and naevi/moles., Conclusions: There were important differences in age distribution for rates of management of benign and malignant skin tumours and naevi. Skin tumours usually were managed in conjunction with other problems. Most were managed procedurally. Only a minority were referred. Skin cancer represents a greater workload for Australian GPs than suggested by previous incidence reports.

Objective: To describe the quality of general practitioner (GP) medical records., Subjects and Setting: One hundred and fifty fee-for-service GPs in suburban Brisbane. SETTING OF STANDARDS: Standards were set at meetings with general practitioner educators, and refined after circulating drafts to participants. Criteria were established in the 12 areas of: general ease-of-use (legibility; consciousness; and layout); whether certain patient data could be found (date of birth; past medical history; family history; allergies; alcohol and tobacco use; and immunisation status); and whether information about the most recent consultation could be found, (the reason for the consultation; its assessment; and management)., Main Outcome Measures: Ten randomly selected medical records of consultations from each of the GPs scored blind by medical students., Results: The mean weighted score was 11.4 out of a maximum possible of 18. Most records attained the standard with: consciousness (97%); recording date of birth (94%); and immunisation status (92%). Fewest attained the standard with family history (12%); adequate layout (17%); and recording alcohol and tobacco use (31%). Practice size and membership of the Royal Australian College of General Practitioners were not associated with significant differences in score, although sex, (being female) and date of graduation, (recent), were associated with significantly higher scores., Conclusion: There is considerable room for improvement in the quality of the clinical records of Australian GPs.

Before designing an intervention aimed at improving the quality of after-hour general practice services to the residents of a relatively isolated outer suburb of Brisbane, a survey of 247 residents was conducted to assess the provisions of after-hours care. The results of the survey were presented to the suburb's general practitioners (GPs). Meetings with the GPs led to attempts at improved communication, using patient-held Health Summary Cards and doctor-to-doctor clinical feedback forms. Forty-four per cent of the 27 GPs participated in the co-operative scheme. One year later the community was resurveyed to assess the impact of the changes in medical services. There was a small but insignificant increase in satisfaction with the provision of after-hours care from 45% to 48%.

Incidence rates of six respiratory infections were calculated from sentinel practice data of 33,407 reports coming from 31 general practitioners in Queensland over 34 months in 1986/1988. Upper respiratory tract infection had an annual incidence of 301 per 1000 people, most in children aged under five, and a winter rate twice the summer rate. Sore throat (incidence 112:1000) and Infectious mononucleosis (incidence 2.7:1000) had little seasonal variation and were maximal among those aged 15-19 (in whom there was one case of Infectious mononucleosis for every 14 sore throats). Influenza (incidence 44:1000) underwent a prominent epidemic in the winter of 1988. Measles (incidence 1.9:1000), and pertussis and pertussis-like syndrome (incidence 0.8:1000) were most commonly reported in the under-fives, and rarely among adults. Sentinel practices networks collect useful epidemiological data from which disease incidences can be calculated.

A clinical activities audit is a method of obtaining interesting information about one's general practice. It is likely to generate improvement in practice, thereby fulfilling the most important requirement of quality assurance, even in the absence of nationally accepted standards of general practice. A five-day audit of clinical activities in one practice is detailed, and some of the changes that this prompted in consultation time management, investigation and referral rates, and conditions managed are frankly discussed.

The epidemiology of the common cold is reviewed with the aim of providing helpful advice for patients. Future management will include limiting the spread of the cold virus by attention to the mode of transmission and the development of anti-viral drugs, of which interferon holds the most promise.

Public opinion is increasingly opposed to smoking and more and more smokers wish to stop. This article offers a practical, 10 point strategy for general practitioners to use to identify patients who smoke and to help them overcome their addiction.