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Background: Patients with hypertension and at high absolute cardiovascular disease risk are a priority group for improved blood pressure control. This study examined the impact of an intervention, primarily delivered by the general practice nurse, to identify, recall and manage patients with uncontrolled hypertension who are at high risk of cardiovascular disease., Methods: A before-and-after pilot study with a six-month follow-up period was conducted in eight general practices in Sydney, Australia., Results: From 507 patients identified, 82 (16.2%) attended an assessment visit, were eligible and provided baseline data. Of these, 55 (67.1%) completed the six-month follow-up. The mean decrease in blood pressure was 14.5 mmHg systolic and 7 mmHg diastolic. Significant decreases were also found in mean weight (1.3 kg), body mass index (0.5 kg/m">22) and waist circumference (1.9 cm). Adherence to blood pressure treatment, as measured by the Hill-Bone scale, significantly improved (P = 0.01) DISCUSSION: The results of this study justify further investigation in a randomised trial. If effective, the approach could alter the way hypertension care is organised and delivered in Australian general practice.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of disability, hospital admission and premature mortality, but is often undiagnosed. This study assessed the effectiveness, feasibility and acceptability of COPD case finding by practice nurses performing spirometry on patients identified as being at risk of developing COPD., Methods: Practice nurses were trained in spirometry. From four general practices, 1010 patients were identified who were aged 40-80 years and current or ex-smokers. Four hundred were randomised to receive a written invitation to attend a case finding appointment with the practice nurse, including spirometry., Results: Seventy-nine patients attended, 16 (20.3% of attendees) had COPD diagnosed on spirometry; practice nurses correctly identified 10 of the 16, but also incorrectly identified a further six patients as having COPD. One patient in the usual care group was diagnosed with COPD, but this was not confirmed on spirometry., Discussion: This study confirmed that COPD is underdiagnosed, with 20% of those at risk and attending for screening having COPD. The search strategy successfully identified patients at risk. Further training in spirometry would be required for practice nurses to increase the accuracy of the diagnoses. The opportunity cost would require consideration. The acceptability to patients is also an issue, this may be related to the recruitment method or the intervention. This study also does not answer whether earlier diagnosis in these patients leads to any change in outcomes.

Background: The authors have previously found that multidisciplinary care plans are associated with improved processes and outcomes of care for diabetic patients. This article examines whether care plans are more likely to be implemented and have greater benefit for patients with poor metabolic control., Methods: Retrospective before and after medical record audit of 230 type 2 diabetic patients with care plans., Results: There was more multidisciplinary care provided and a significant decrease in mean post-care plan glycated haemoglobin (HbA1c) in patients who had a pre-care plan HbA1c level of more than 7%, but no significant change in those patients with HbA1c of 7% or less., Discussion: Care plans are beneficial and more often implemented for patients with poor metabolic control. If this positive impact is due to the implementation of multidisciplinary care, questions are raised about the relative effectiveness of general practitioner management plans and team care arrangements, as the former do not necessarily involve other health professionals.

Background: The Enhanced Primary Care package, introduced in 1999, included an item number for multidisciplinary care plans. There has been little research into what is contained in care plans. This study investigated what general practitioners documented in care plans for their diabetic patients., Methods: A retrospective audit of care plans was conducted as part of a larger audit that evaluated the impact of multidisciplinary care plans on the care of patients with type 2 diabetes. The subjects were GPs and their diabetic patients with care plans., Results: The care plans of 230 patients, identified by 26 GPs, were audited. Most GPs used a template to document care plans and the nature of the template influenced the content. There was limited information documented in care plans., Discussion: Simplification and consistency of care plan templates would assist the care planning process and encourage better documentation. Appropriate GP education is required to support this.

Background: Since the introduction of the Enhanced Primary Care package, care plans have become part of Australian general practice. Previous research has focused on barriers to the uptake of care plans. This study examined the effect of multidisciplinary care plans on provision and outcome of care for patients with type 2 diabetes., Methods: A retrospective before/after medical record audit design was chosen. Subjects of the study were general practitioners practising in Southwest Sydney (New South Wales) and their diabetic patients who had written care plans. Outcome measures were frequency and results of glycosylated haemoglobin, blood pressure, foot, serum lipids, weight, and microalbumin checks., Results: The medical records of 230 patients were audited. Following the care plan, adherence to diabetes guidelines increased. Metabolic control and cardiovascular risk factors improved for patients who had multidisciplinary care implemented., Discussion: Whether the improved diabetes care shown here is attributed to improved teamwork and/or coordination of care needs further research.