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Background: To date there has been no detailed analysis of the profile of home visit patients, and the extent of any changes over time in Australian general practitioner home visiting patterns., Aims: The article aims to provide a profile of current provision of home visits by Australian GPs, investigate whether there has been a decline in such services over time, and surmise about causes of changes in service provision and their impact., Methods: We analysed home visit claims over the past decade. Data were extracted from Medicare Benefits Schedule statistics on services claimed and benefits paid for home visit items, for 1997-2007, stratified by item category and patient demographics., Results: The rate of home visits decreased 51% in a decade, from 15.8 per 100 persons in 1997 to 7.7 in 2007. The majority of patients (60%) receiving home visits were aged 65 years and over in 2007, including 22% aged 85 years and over., Discussion: There has been a clear decline in GP home visits over the past decade. This is problematic in the context of a large and growing population of older Australians. Strategies are needed to better support this function in general practice, and/or ensure that alternative providers are meeting the need for these services.

Background: General practitioners undertake ongoing education in many areas. A train-the-trainer (TTT) approach may be an option for facilitation of continuing professional development (CPD) activities., Methods: With the aim of training GPs to facilitate peer CPD activities, Monash University's Department of General Practice undertook a national TTT program on men's sexual and reproductive health. Over a 3 year period, 40 'GP trainers' were trained to facilitate education sessions on the topics of androgen deficiency, erectile dysfunction, prostate cancer and male infertility for 568 GPs from 33 Australian divisions of general practice., Results: Evaluation of this program showed that GP trainers were a valuable resource for conducting training programs for GPs, being experienced role models who could provide relevant and practical training to their colleagues., Discussion: While resource intensive, the TTT model provided an effective means of improving GP knowledge and clinical practice on men's sexual and reproductive health.

Background: This program examined the impact of clinical guidelines and a 3 year self audit process on general practitioners' diagnosis and management of gastro-oesophageal reflux disease., Methods: Nine hundred and sixty-six Australian GPs participated in a retrospective five step clinical audit reporting on data for 28,622 patients., Results: General practitioners demonstrated significant improvements in their diagnosis and management of gastro-oesophageal reflux disease across the audit period, including: a significant 3% decrease in use of endoscopy; improved GP assessment and identification fo risk factors and exacerbants; significant increase in GP recommendations for patient weight loss and dietary changes (7 and 10% respectively); a significant 4% reduction in patient use of medications that may exacerbate reflux symptoms., Discussion: The findings provide a snapshot of current diagnostic and management practices in Australian general practice, and highlight the benefits of clinical audit as a tool for eliciting evidence based, guideline driven practice change.

Background: Despite the links between aging and sexual dysfunction, the majority of adults continue to be sexually active well into their later years. Conditions such as erectile dysfunction however, present one of many obstacles to maintaining a healthy sex life. Given the sensitive nature of sexual difficulties, many men are reluctant to seek medical advice. It is therefore essential that general practitioners are equipped to discuss and provide unbiased advice and treatment for men of all ages., Objective: This article reviews current knowledge regarding GP approaches to sexuality and the older man., Discussion: Findings suggest that broader cultural beliefs about age appropriate sexuality are evident in general practice. Asking about sexual health remains a low priority for many GPs, particularly when it comes to older patients. Further education is needed to raise professional awareness about the importance of healthy sexuality in aging.

Background: Chronic heart failure (CHF) is a significant cause of mortality and morbidity in developed countries where it predominantly affects elderly persons with a range of other comorbid conditions requiring polypharmacy. In Australia, over 300 000 people are affected by CHF. Quality general practice forms the cornerstone for early diagnosis and evidence based integrated care., Objective: This article examines the epidemiology of CHF, its clinical diagnosis, contemporary management and future treatment possibilities, as well as current barriers to optimal care., Discussion: The global prevalence of CHF is rising. Optimal treatment requires a coordinated interdisciplinary approach using a biopsychosocial model of care in order to maximise compliance with therapy. Pharmacological treatment is essential and should include an angiotensin converting enzyme inhibitor and beta blocker where possible. Device based treatment and cardiac surgery may benefit selected cases.

Background: Gastro-oesophageal reflux disease (GORD) is defined as recurring symptoms or mucosal damage resulting from exposure of the distal oesophagus to reflux of gastric contents. In the past, GORD has been managed with a 'step up' approach beginning with antacids and progressing to H2 antagonists or proton pump inhibitors (PPI) as required., Objective: This article presents a systematic approach to the management of GORD., Discussion: Diagnosis of GORD is made on the basis of symptoms and the decision to treat is based on the symptom pattern. Endoscopy is reserved for cases where there are alarm symptoms, diagnostic uncertainty, poor response to treatment or clinical suspicion of a complication such as Barrett's oesophagus or stricture. A 'step down' approach to treatment involves treating with a PPI for 4-8 weeks. Aggressive therapy is then reduced to maintenance doses, intermittent therapy or in some cases, withdrawn. However, relapse occurs in about 70% of all patients within 6 months. A step down approach ensures more rapid resolution of symptoms, improved quality of life, reduced risk of complications, and overall lower cost.

Background: Interpersonal counselling (IPC) derives from interpersonal psycho-therapy (IPT) but is briefer in the number and duration of sessions and is particularly suited to the primary care setting. While depression and other psychological symptoms are not necessarily 'caused' by interpersonal problems, they do occur in a social and interpersonal context. Problem areas commonly associated with the onset of depression are unresolved grief, interpersonal disputes, role transition and interpersonal deficits such as social isolation., Objective: This article discusses IPC and how it can be used in the general practice setting., Discussion: The structure of IPC is of a brief treatment of six sessions, each with an explicit focus: assessment, education about the interaction between interpersonal relationships and psychological symptoms, identifying current stress areas and helping the patient deal with these more positively and termination of the IPC relationship. Interpersonal counselling can be utilised general practice to reduce psychological symptoms, restore morale, improve self esteem and the quality of the patient's social adjustment and interpersonal relationships.

Background: Increasingly, reforms to health care systems appear to interfere with the traditional (healer) role of the general practitioner, and are perceived to disrupt patient care and the therapeutic relationship., Objective: To outline measures for the survival and future development of the discipline of general practice in Australia., Discussion: In order to preserve longitudinal relationship centred care and high level primary care clinical expertise, health bureaucracies and general practice itself, must re-focus care on the individual and community, integrating new developments rather than allowing 'new ideas and system pressures' to continually distort functional general practice.

Background: Despite evidence that men believe the general practitioner is an appropriate person to assist with sexual health issues, few men actually access medical practitioners for such assistance. Raising community awareness of male sexual and reproductive health issues is expected to generate a clinical demand for men's health services., Objective: The aim of this study was to determine GP perceptions of their own education needs and those of the community in the area of men's health., Discussion: A total of 27 GPs from four Victorian divisions of general practice (three metropolitan and one rural) participated in three focus groups. Key themes from the data were identified after analysis of the data by three researchers. General practitioners indicated that a clinical demand for men's health services needed to be generated in order for GPs to be interested in professional development. They suggested community education providing general information to men about sexual and reproductive health issues and emphasising the importance of accessing their GP for health checks. However, due to a lack of information for GPs about some areas of male sexual and reproductive health, e.g., androgen deficiency and male infertility, a case based practical approach to GP education was recommended. General practitioners also requested concrete information, current specialist recommendations and details of locally available services working in men's health.

Background: The General Practice Psychiatry Program is a collaborative initiative between two universities and two professional colleges. Since 1998 it has offered general practitioners a one year part time Graduate Certificate, and a two year Master of General Practice Psychiatry. The learning is by distance education and multimode, including text packages sent out, tapes, teleconferences and two annual residential weekends with role plays and didactic teaching., Objective: To describe the development of a Graduate Certificate and Master in General Practice Psychiatry., Discussion: The program has been well supported with 141 general practitioners enrolling in the Graduate Certificate and 48 in the Masters during 1998-2001. General practitioners have been enrolling from around Australia, with rural, female and more experienced GPs predominating.

Objective: To describe the self reported level of osteoporosis knowledge, attitudes and preventive activities, including dietary calcium intake of Asian and Caucasian women., Method: Self administered questionnaires in English and Chinese including a food frequency survey were posted to potential respondents that were recruited via general practices, community newsletters and notices., Results: Asian women had less osteoporosis knowledge and lower calcium intake (mean 793 +/- 49 mg/day standard error of the mean) than Caucasian women (1298 +/- 56 mg/day). Postmenopausal Asian women were at greater risk of being below the recommended daily intake (73%) than Caucasian women (31%)., Conclusion: Osteoporosis knowledge and preventive activities among Asian and Caucasian women could be better. Higher dietary or supplementary calcium intake should be considered.