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Objective: Concerns have been raised over the appropriateness of dosing of direct-acting oral anticoagulants (DOACs) in clinical practice. We investigated this issue in patients who were initiated on a DOAC in Australian general practices. Methods:This was a retrospective study among patients newly diagnosed with atrial fibrillation (AF) who were prescribed DOACs, using data obtained from 417 general practice sites across Australia over 8 years (2011–2019). Direct-acting oral anticoagulant dosing was compared with published recommendations, in relation to age and kidney function. Results: A total of 11,251 patients (mean age, 72.8 y; 46.8% female) newly diagnosed with AF were prescribed a DOAC. Of these, 2667 patients (23.7%) had a recorded prescription of a potentially inappropriate DOAC dosage, of whom 2304 (86.4%) and 283 (10.6%) were prescribed lower and higher than the recommended dosage, respectively. The remaining 80 patients (3.0%) were initiated on DOACs when contraindicated based on renal function. Overall, the proportion of patients who seemed to be initiated on a potentially inappropriate DOAC dose decreased from 38.3% (95% confidence interval, 26.1%–51.8%) in 2012 to 22.7% (95% confidence interval, 19.8%–26.0%; P < 0.001) in 2019. By 2019, 19.4%, 20.3%, and 9.3% of the patients with a recorded prescription of apixaban, rivaroxaban, and dabigatran, respectively, received a lower-than-guideline-recommended dose. The patients were more likely to be prescribed a potentially inappropriate dosage if they were elderly with multiple comorbidities. Conclusions: Potential inappropriate DOAC dosing is a problem in the prevention of stroke associated with AF. Nearly 1 in 5 patients received a lower-than-guideline-recommended dose, indicating a need for strategies to raise awareness among prescribers.

Background: Guidelines on lipid disorders are constantly evolving. General practitioners regularly face critical decisions about the best treatment strategies for individual patients. Cardiovascular disease (CVD) is common, with most morbidity and mortality due to atherosclerosis. Raised low-density lipoprotein cholesterol (LDL-C) is the most atherogenic component - lowering it lowers the risk of future cardiovascular events. Objective: The aim of this article is to provide an evidence-informed summary of national guidelines and recent research to help clinicians reduce the risk of atherosclerotic CVD and improve health service delivery through improved lipid management strategies. Discussion: Elevated plasma lipids, especially LDL-C, increase the likelihood of a CVD event over time. Knowledge of family and personal histories plus other risk factors for CVD should alert clinicians to the need for treatment. The greater the overall burden of combined risk factors, the greater the lifetime risk. This update provides new information that informs future approaches for improving lipid management in Australian general practice.

Background Chronic kidney disease (CKD) affects drug elimination and patients with CKD require appropriate adjustment of renally cleared medications to ensure safe and effective pharmacotherapy. The main objective of this study was to determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures. Methods Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). All adults (aged ≥18 years) with CKD presenting to general practices across Australia were included in the analysis. Patients were considered to have CKD if they had two or more estimated glomerular filtration rate (eGFR) recorded values 2, and/or two urinary albumin/creatinine ratios ≥3.5 mg/mmol in females (≥2.5 mg/mmol in males) at least 90 days apart. PIP was assessed for 49 commonly prescribed medications using the Cockcroft-Gault (CG) equation/eGFR as per the instructions in the Australian Medicines Handbook. Results A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n = 9926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. Conclusion This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.

Background The benefit of exercise in the prevention and management of type 2 diabetes(T2D) has a strong evidence base, so itis important to ensure exercise is part of every patient’s management plan. Objective This article reviews the evidence for exercise in T2D and the factors affecting a patient’s willingness to commence and sustain enough exercise to gain benefit. The article offers tips about how to safely and effectively prescribe the ‘medicine’ of exercise for all, even the frailest patients; who to stabilise before an exercise program should begin; and how to use the skills of an accredited exercise physiologist (AEP) to deliver the best ‘prescription’ possible. Discussion General practitioners and their teams,along with other healthcare providers such as AEPs, can increase the amount of exercise medicine a patient receives.This is the case for those at risk of developing T2D, those with T2D and those with the many comorbidities associated with T2D. Refereed/Peer-reviewed

ObjectiveTo report (using linked laboratory data) the incidence, prevalence and geographic variation of chronic kidney disease (CKD) across the whole island population of Tasmania, Australia. MethodsA retrospective cohort study (the Tasmanian Chronic Kidney Disease study (CKD.TASlink)) using linked data from five health and two pathology datasets from the island state of Tasmania, Australia between 1/1/2004 and 31/12/2017. We used data on 460,737 Tasmanian adults (aged 18 years and older, representing 86.8% of the state's population) who had a serum creatinine measured during the study period. We defined CKD as per Kidney Disease Outcomes Quality Initiative, requiring two measures of estimated glomerular filtration rate (eGFR) 65% of Tasmanians with eGFR

Despite changes in antiarrhythmic drug (AAD) choice in patients with atrial fibrillation (AF), trends in AAD prescribing remain not investigated. We aimed to examine these changes using a nationwide Australian general practice data from 2009 to 2018. Over the 10 years, AAD prescribing in patients with AF decreased, which was mainly due to a reduction in the use of amiodarone, sotalol and digoxin. In contrast, the use of beta-blockers and flecainide increased.

There is strong evidence that physical activity (PA) counselling from a health professional (HPs) leads to increased PA of their patients. Despite this, there remains a large evidence-practice gap between HP knowledge of the contribution of physical inactivity to chronic disease prevention and management, and routine effective assessment and prescription of PA. This article will present evidence on the effectiveness of HP- PA counselling and suggested behaviour change frameworks that can be used by HP. Four case studies are provided as examples of programs integrated into current HP student and post-graduate training programs.

Aim: To examine the change in stroke risk over time and determine the proportion of patients with atrial fibrillation (AF) who were initiated on an oral anticoagulant (OAC) as their stroke risk increased from low/moderate to high, using the Australian general practice data set, MedicineInsight. Methods: A total of 2296 patients diagnosed with AF between 1 January 2007 and 31 December 2008, aged 18 years or older and not initiated on an OAC before 2009, were included. We assessed the change in stroke risk and the proportion of patients who had a recorded prescription of an OAC, each year from 1 January 2009 to 31 December 2018. Results: At baseline, 23.9%, 22.9% and 53.2% were categorised as being at low (score = 0), moderate (score = 1) and high stroke risk (score ≥ 2), respectively, using the sexless CHA2DS2-VASc (CHA2DS2-VA) score. Overall, the CHA2DS2-VA score increased by a mean of 1.34 (95% confidence interval, 1.29-1.39) points over the study period. Nearly two-thirds of patients (65%, 412/632) whose stroke risk changed from baseline low/moderate to high were subsequently prescribed an OAC. The median (interquartile range) lag time from becoming high stroke risk to having OAC initiation was 2 (5) years. Conclusions: Nearly one-third of patients reclassified as being at high risk of stroke during the study period were not prescribed OAC therapy. Furthermore, the delay in OAC initiation following classification as being at high risk was a median of 2 years, suggesting that more frequent stroke reassessment is needed.

ObjectiveFamilial hypercholesterolaemia (FH) is characterised by elevated low-density lipoprotein (LDL)-cholesterol and increased risk of cardiovascular disease. However, FH remains substantially underdiagnosed and undertreated. We employed a two-stage pragmatic approach to identify and manage patients with FH in primary healthcare.MethodsMedical records for 232 139 patients who attended 15 general practices at least once in the previous 2 years across five Australian States were first screened for potential risk of FH using an electronic tool (TARB-Ex) and confirmed by general practitioner (GP) clinical assessment based on phenotypic Dutch Lipid Clinic Network Criteria (DLCNC) score. Follow-up GP consultation and management was provided for patients with phenotypic FH.ResultsA total of 1843 patients were identified by TARB-Ex as at potential risk of FH (DLCNC score ≥5). After GP medical record review, 900 of these patients (49%) were confirmed with DLCNC score ≥5 and classified as high-risk of FH. From 556 patients subsequently clinically assessed by GPs, 147 (26%) were diagnosed with phenotypic FH (DLCNC score >6). Follow-up GP consultation and management for 77 patients resulted in a significant reduction in LDL-cholesterol (−16%, pConclusionsA pragmatic approach integrating electronic medical record tools and clinical GP follow-up consultation is a feasible method to identify and better manage patients with FH in the primary healthcare setting.Trial registration number12616000630415.

Summary Introduction Familial hypercholesterolaemia (FH) is a common, heritable and preventable cause of premature coronary artery disease, with significant potential for positive impact on public health and healthcare savings. New clinical practice recommendations are presented in an abridged guidance to assist practitioners in enhancing the care of all patients with FH. Main recommendations Core recommendations are made on the detection, diagnosis, assessment and management of adults, children and adolescents with FH. There is a key role for general practitioners (GPs) working in collaboration with specialists with expertise in lipidology. Advice is given on genetic and cholesterol testing and risk notification of biological relatives undergoing cascade testing for FH; all healthcare professionals should develop skills in genomic medicine. Management is under-pinned by the precepts of risk stratification, adherence to healthy lifestyles, treatment of non-cholesterol risk factors, and appropriate use of low-density lipoprotein (LDL)-cholesterol lowering therapies, including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Recommendations on service design are provided in the full guidance. Potential impact on care of FH These recommendations need to be utilised using judicious clinical judgement and shared decision making with patients and families. Models of care need to be adapted to both local and regional needs and resources. In Australia new government funded schemes for genetic testing and use of PCSK9 inhibitors, as well as the National Health Genomics Policy Framework, will enable adoption of these recommendations. A broad implementation science strategy is, however, required to ensure that the guidance translates into benefit for all families with FH.

Background: We investigated factors that influenced oral anticoagulant (OAC) initiation and choice in Australian general practice patients newly diagnosed with AF. Methods: Using an Australian nationally representative general practice dataset, MedicineInsight, we identified patients newly diagnosed with AF between January 2009 and April 2019. Logistic regression analyses were used to examine factors associated with OAC initiation and choice. Results: A total of 63 212 patients with AF (53.7% males, mean age 72.4 years) were identified. Nearly two-thirds of these patients (40 854 [64.6%]) were initiated on an OAC, at a median time of 6 days after the documented diagnosis date. The proportion of patients who were initiated an OAC increased from 44.8% in 2009 to 72.2% in 2019 (P < .001). High risk of stroke (CHA2DS2-VASc, adjusted odds ratio (AOR), 4.39 [95% CI, 3.99-4.83]), low risk of bleeding (ORBIT, AOR, 1.87 [95% CI, 1.72- 2.03]), not having a recorded history of dementia (AOR, 1.81 [95% CI, 1.65-1.98]) and male sex (AOR, 1.29 [95% CI, 1.22-1.35]) were independently associated with OAC initiation. Direct-acting oral anticoagulant (DOAC) use increased from 11.9% in 2011 to 94.0% of all OAC initiations in April 2019 (P Conclusions: The proportion of newly diagnosed patients with AF initiated on OAC increased markedly following the introduction of the DOACs. Of those initiated, 9 in 10 were receiving a DOAC at the end of the study period. There is potential underuse in women and individuals with dementia.

Familial hypercholesterolaemia (FH) is a dominant and highly penetrant monogenic disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL)-cholesterol concentration and, if untreated, leads to premature atherosclerosis and coronary artery disease (CAD). There are approximately 100,000 people with FH in Australia. However, an overwhelming majority of those affected remain undetected and inadequately treated, consistent with FH being a leading challenge for public health genomics. To further address the unmet need, we provide an updated guidance, presented as a series of systematically collated recommendations, on the care of patients and families with FH. These recommendations have been informed by an exponential growth in published works and new evidence over the last 5 years and are compatible with a contemporary global call to action on FH. Recommendations are given on the detection, diagnosis, assessment and management of FH in adults and children. Recommendations are also made on genetic testing and risk notification of biological relatives who should undergo cascade testing for FH. Guidance on management is based on the concepts of risk re-stratification, adherence to heart healthy lifestyles, treatment of non-cholesterol risk factors, and safe and appropriate use of LDL-cholesterol lowering therapies, including statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors and lipoprotein apheresis. Broad recommendations are also provided for the organisation and development of health care services. Recommendations on best practice need to be underpinned by good clinical judgment and shared decision making with patients and families. Models of care for FH need to be adapted to local and regional health care needs and available resources. A comprehensive and realistic implementation strategy, informed by further research, including assessments of cost-benefit, will be required to ensure that this new guidance benefits all Australian families with or at risk of FH.

Background Chronic kidney disease (CKD) is a significant and growing health burden globally. Tasmania has the highest state prevalence for non-Indigenous Australians and it has consistently had the lowest incidence and prevalence of dialysis in Australia. Objective To examine the gap between the high community prevalence of CKD in Tasmania and the low use of dialysis. Methods This is a retrospective cohort study using linked data from 5 health and 2 pathology data sets from the island state of Tasmania, Australia. The study population consists of any person (all ages including children) who had a blood measurement of creatinine with the included pathology providers between January 1, 2004, and December 31, 2017. This study population (N=460,737) includes within it a CKD cohort, which was detected via pathology or documentation of kidney replacement therapy (KRT; dialysis or kidney transplant). Kidney function (estimated glomerular filtration rate [eGFR]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Individuals with 2 measures of eGFR Results The study population consisted of 460,737 people (n=245,573 [53.30%] female, mean age 47.4 years) who were Tasmanian residents aged 18 years and older and were followed for a median of 7.8 years. During the later 5 years of the study period, 86.79% (355,622/409,729) of Tasmanian adults were represented. The CKD cohort consisted of 56,438 people (ie, 12.25% of the study population; 53.87% (30,405/56,438) female, mean age 69.9 years) followed for a median of 10.4 years with 56,039 detected via eGFR and 399 people detected via documentation of KRT. Approximately half (227,433/460,737, 49.36%) of the study population and the majority of the CKD cohort (41,448/56,438, 73.44%) had an admission episode. Of the 55,366 deaths recorded in the study population, 45.10% (24,970/55,366) had CKD. Conclusions Whole-of-population approaches to examine CKD in the community can be achieved by data linkage. Over this 14-year period, CKD affected 12.25% (56,438/460,737) of Tasmanian adult residents and was present in 45.10% (24,970/55,366) of deaths. International Registered Report Identifier (IRRID) DERR1-10.2196/20160

Background: Physical inactivity is a major modifiable contributor to the global burden of cardiovascular disease (CVD) morbidity and mortality. Objective: In this article, a clinical case study is used to provide practical approaches for general practitioners and their teams to individualise exercise prescriptions for patients with hypertension who are at risk of CVD. The case presented describes a sedentary, overweight male with newly diagnosed hypertension – a common scenario in general practice. Discussion: The many benefits of exercise are supported by an expanding body of research. Blood pressure can be safely and effectively reduced through physical activity, leading to a lower CVD risk. Value-based goal setting and the ‘FITT’ framework may be used to facilitate sustainable physical activity among patients. The engagement of allied health professionals such as exercise physiologists may also be beneficial.

Objective: Appropriate use of oral anticoagulants (OACs) reduces the risk of stroke in patients with atrial fibrillation (AF). The study characterized the prescribing of OACs in people with AF in the Australian primary care setting over 10 years.Design: Retrospective population study.Setting and Participants: We performed 10 sequential cross-sectional analyses of patients with a recorded diagnosis of AF between 2009 and 2018 using national general practice data. The proportion of patients with AF who were prescribed an OAC based on their stroke risk was examined.Primary and secondary outcomes: The primary outcome was the proportion of high stroke risk patients who were prescribed an OAC over a decade. The secondary outcome was variation in OAC prescribing among general practices.Results: The sample size of patients with AF ranged from 9,874 in 2009 to 41,751 in 2018. The proportion who were prescribed an OAC increased from 39.5% (95% CI 38.6–40.5%) in 2009 to 52.0% (95% CI 51.5–52.4%) in 2018 (p for trend < 0.001). During this time, the proportion of patients with AF and high stroke risk who were prescribed an OAC rose from 41.7% (95% CI 40.7–42.8%) to 55.2% (95% CI 54.7–55.8%; p for trend < 0.001) with the direct-acting oral anticoagulants accounting for over three-quarters of usage by 2018. There was substantial variation in OAC prescribing between general practices. In 2018, the proportion of moderate to high stroke risk patients who were prescribed an OAC was 38.6% (95% CI 37.2–40.1%) in the lowest practice site quintiles and 65.6% (95% CI 64.5–66.7%) in the highest practice site quintiles.Conclusions: Over the 10 years, OAC prescribing in high stroke risk patients with AF increased by one-third. There was considerable variation in OAC prescribing between general practices.

The COVID-19 pandemic highlights the key role of general practice in Australian health service delivery, especially for our most vulnerable patients.1 While terms such as ‘index case’ (defined as the first identified case in a group of related cases of a particular communicable or heritable disease) and ‘cascade testing’ (the extension of genetic testing to individuals at risk of inheriting a pathogenic variant previously identified in a biological relative) have long been associated with genetic testing for hereditary conditions among families, the recent increased public awareness of and experience with epidemiological concepts such as contact tracing offers new potential to improve detection and management of familial hypercholesterolaemia (FH) in the community. On 1 May 2020, new Medicare Benefits Schedule (MBS) item numbers relating to genetic testing for FH were introduced in Australia,2 offering a timely opportunity for general practice to collaborate with lipid specialists to facilitate improved detection and management. While an infectious disease such as COVID-19 cannot be directly compared with inherited conditions such as FH, lessons learned from the pandemic and developments in remote consulting can be applied to the management of FH.

Background and objective: Kidney Health Australia recommends regular monitoring of patients with chronic kidney disease (CKD) to reduce progression and prevent complications such as cardiovascular disease. The objective of this study was to examine how practice aligns with the recommendations in Kidney Health Australia’s CKD guidelines. Methods: Australian general practice data from the NPS MedicineWise MedicineInsight program (1 January 2013 – 1 June 2016) for 19,712 adults with laboratory evidence of stage 3 CKD were analysed. Complete monitoring in these individuals was defined as having at least one recorded assessment of blood pressure, urine albumin-to-creatinine ratio, estimated glomerular filtration rate and serum lipids over an 18-month period. Results: Complete monitoring was performed for 25% of the cohort; 54.9% among patients with concomitant diabetes and 14.1% among patients without diabetes. Patients with diabetes, hypertension and a documented diagnosis of CKD were more likely to have complete monitoring. Discussion: There is room for improvement in monitoring of patients with stage 3 CKD, particularly for albuminuria, which was monitored in fewer than 50% of these patients.

Background There is international interest in whether improved primary care, in particular for patients with chronic or complex conditions, can lead to decreased use of health resources and whether financial incentives help achieve this goal. This trial (EQuIP-GP) will investigate whether a funding model based upon targeted, continuous quality incentive payments for Australian general practices increases relational continuity of care, and lessens health-service utilisation, for high-risk patients and children. Methods We will use a mixed methods approach incorporating a two-arm pragmatic cluster randomised control trial with nested qualitative case studies. We aim to recruit 36 general practices from Practice-Based Research Networks (PBRN) covering urban and regional areas of Australia, randomised into intervention and control groups. Control practices will provide usual care while intervention practices will be supported to implement a new service model incorporating incentives for relational continuity and timely access to appointments. Patients will comprise three groups: older (over 65 years); 18–65 years with chronic and/or complex conditions; and those aged less than 16 years with increased risk of hospitalisation. The funding model includes financial incentives to general practitioners (GPs) for providing longer consultations, same day access and timely follow-up after hospitalisation to enrolled patients. The payments are proportional to expected health system savings associated with improved quality of GP care. An outreach facilitator will work with practices to help incorporate the incentive model into usual work. The main outcome measure is relational continuity of care (Primary Care Assessment Tool short-form survey), with secondary outcomes including health-related quality of life and health service use (hospitalisations, emergency presentations, GP and specialist services in the community, medicine prescriptions and targeted pathology and imaging ordering). Outcomes will be initially evaluated over a period of 12 months, with ongoing data collection for 5 years. Discussion The trial will provide robust evidence on a novel approach to providing continuous incentives for improving quality of general practice care, which can be compared to block payment incentives awarded at target quality levels of pay-for-performance, both within Australia and also internationally. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000105246. Registered on 23 January 2018.

Background: Co-prescribing medications that can interact with direct-acting oral anticoagulants (DOACs) may decrease their safety and efficacy. The aim of this study was to examine the co-prescribing of such medications with DOACs using the Australian national general practice dataset, MedicineInsight, over a five-year period. Methods: We performed five sequential cross-sectional analyses in patients with atrial fibrillation (AF) and a recorded DOAC prescription. Patients were defined as having a drug interaction if they had a recorded prescription of an interacting medication while they had had a recorded prescription of DOAC in the previous six months. The sample size for the cross-sectional analyses ranged from 5333 in 2014 to 19,196 in 2018. Results: The proportion of patients who had potential drug interactions with a DOAC decreased from 45.9% (95% confidence interval (CI) 44.6%&ndash, 47.4%) in 2014 to 39.9% (95% CI 39.2%&ndash, 40.6%) in 2018, p for trend &lt, 0.001. During this period, the most frequent interacting class of medication recorded as having been prescribed with DOACs was selective serotonin/serotonin and norepinephrine reuptake inhibitor (SSRI/SNRI) antidepressants, followed by non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (CCBs) and amiodarone. Conclusions: Overall, potential drug interactions with DOACs have decreased slightly over the last five years, however, the rate of possible interaction with SSRIs/SNRIs has remained relatively unchanged and warrants awareness-raising amongst prescribers.

Background: Australian patients with chronic kidney disease (CKD) are routinely managed in general practices with multiple medications. However, no nationally representative study has evaluated the quality of prescribing in these patients. The objective of this study was to examine the quality of prescribing in patients with CKD using nationally representative primary care data obtained from the NPS MedicineWise&rsquo, s dataset, MedicineInsight. Methods: A cross-sectional analysis of general practice data for patients aged 18 years or older with CKD was performed from 1 February 2016 to 1 June 2016. The study examined the proportion of patients with CKD who met a set of 16 published indicators in two categories: (1) potentially appropriate prescribing of antihypertensives, renin-angiotensin system (RAS) inhibitors, phosphate binders, and statins, and (2) potentially inappropriate prescribing of nephrotoxic medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), at least two RAS inhibitors, triple therapy (an NSAID, a RAS inhibitor and a diuretic), high-dose digoxin, and metformin. The proportion of patients meeting each quality indicator was stratified using clinical and demographic characteristics. Results: A total of 44,259 patients (24,165 (54.6%) female, 25,562 (57.8%) estimated glomerular filtration (eGFR) 45&ndash, 59 mL/1.73 m2) with CKD stages 3&ndash, 5 were included. Nearly one-third of patients had diabetes and were more likely to have their blood pressure and albumin-to-creatinine ratio monitored than those without diabetes. Potentially appropriate prescribing of antihypertensives was achieved in 79.9% of hypertensive patients with CKD stages 4&ndash, 5. The prescribing indicators for RAS inhibitors in patients with microalbuminuria and diabetes and in patients with macroalbuminuria were achieved in 69.9% and 62.3% of patients, respectively. Only 40.8% of patients with CKD and aged between 50 and 65 years were prescribed statin therapy. The prescribing of a RAS inhibitor plus a diuretic was less commonly achieved, with the indicator met in 20.6% for patients with microalbuminuria and diabetes and 20.4% for patients with macroalbuminuria. Potentially inappropriate prescribing of NSAIDs, metformin, and at least two RAS inhibitors were apparent in 14.3%, 14.1%, and 7.6%, respectively. Potentially inappropriate prescribing tended to be more likely in patients aged &ge, 65 years, living in regional or remote areas, or with socio-economic indexes for areas (SEIFA) score &le, 3. Conclusions: We identified areas for possible improvement in the prescribing of RAS inhibitors and statins, as well as deprescribing of NSAIDs and metformin in Australian general practice patients with CKD.

This paper reports on the design of a program that aims to prototype teaching aged care facilities in Australia. Beginning in two Tasmanian residential aged care facilities, the intent of the program is to support large-scale inter-professional student clinical placements, positively influence students’ attitudes toward working in aged care and drive development of a high-performance culture capable of supporting evidence-based aged care practice. This is important in the context of aged care being perceived as an unattractive career choice for health professionals, reinforced by negative clinical placement experiences. The Teaching Aged Care Facilities Program features six stages configured around an action research/action learning method, with dementia being a key clinical focus.

This article reports on the development and evaluation of an online repository for sharing general practice (GP) educational resources. GP supervisors and medical educators need quality resources to facilitate learning and teaching. Developing or finding resources from scratch is time-consuming and duplicates effort when teachers and learners are geographically dispersed. In response to this challenge, a curated repository, Self-directed Training and Resource System (STARS) was developed in 2009 for sharing educational and clinical resources within the Australian GP learning community. However, a low engagement by users was observed. This research began by an examination of enablers and barriers for resource sharing and the existing online repository: STARS. Data collection methods included questionnaires, semi-structured interviews and focus groups. Findings contributed to the development of a new pilot repository that was embedded in a collaborative online learning space, also known as a ‘digital habitat’. This space focused on engagement with resources and other users. It incorporated Web 2.0 tools and followed recent trends in user-created content and ranking of usefulness. Overall findings revealed that ease of use and effective management are paramount in ensuring ongoing viability and value of an online repository.

Connectivity is intrinsic to all aspects of our life today, be it political, economic, technological, scientific, or personal. Higher education is also transcending the previous paradigm of technology enabled content delivery and e-learning, with a new emphasis on connectivity, enabling participants to exchange knowledge and collaborate to meet educational goals. In this study, a social media technology supported website—digiMe—was developed and evaluated at the School of Medicine of one Australian university. Connectivity to other medical learners and health professionals is intrinsic to digiMe. This paper reports the functionalities of this website, results of a post-intervention evaluative survey, and statistics of website usage generated from Google Analytics. The results revealed more active adoptions and a more positive attitude towards digiMe from Year 4 students compared to Year 5 students. The participants showed a desire for access to a recommended collection of apps, such as those offered through digiMe. However, many participants did not use digiMe beyond initial introduction to it. digiMe demonstrated its potential in raising awareness of web and mobile apps useful for enhancing connectivity, although it needs to be introduced to students in earlier years of their medical education to achieve a higher impact on their learning.

Background: National health surveys indicate that chronic kidney disease (CKD) is an increasingly prevalent condition in Australia, placing a significant burden on the health budget and on the affected individuals themselves. Yet, there are relatively limited data on the prevalence of CKD within Australian general practice patients. In part, this could be due to variation in the terminology used by general practitioners (GPs) to identify and document a diagnosis of CKD. This project sought to investigate the variation in terms used when recording a diagnosis of CKD in general practice. Methods: A search of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices) was conducted to determine the terms used. Manual searches were conducted on coded and on “free-text” or narrative information in the medical history, reason for encounter, and reason for prescription data fields. Results: From this data set, 61 102 patients were potentially diagnosable with CKD on the basis of pathology results, but only 14 172 (23.2%) of these had a term representing CKD in their electronic record. Younger patients with pathology evidence of CKD were more likely to have documented CKD compared with older patients. There were a total of 2090 unique recorded documentation terms used by the GPs for CKD. The most commonly used terms tended to be those included as “pick-list” options within the various general practice software packages’ standard “classifications,” accounting for 84% of use. Conclusions: A diagnosis of CKD was often not documented and, when recorded, it was in a variety of ways. While recording CKD with various terms and in free-text fields may allow GPs to flexibly document disease qualifiers and enter patient specific information, it might inadvertently decrease the quality of data collected from general practice records for clinical audit or research purposes.

Medically and non-medically trained researchers make critical contributions to rigorous primary health care research. Non-medically qualified staff face unique challenges compared with medically qualified counterparts when entering academic primary care. They often encounter challenges in professional identity, building a career within a discipline that is medically focused and, accessing continuing academic appointments or fellowship funding which is often restricted to those with medical qualifications. Navigating opportunities for career advancement can be difficult with few easily identifiable and accessible ‘Champions’ for Primary Health Care Scientists. In the UK, the Society for Academic Primary Care (SAPC) recognised this gap and addressed it by creating PHoCuS – a group within SAPC for Primary Health Care Scientists. The PHoCuS group was established to better understand and address the career development needs of SAPC members from non-medical backgrounds. Establishing a similar group in Australia and New Zealand that understands and can address the needs of nonmedical academics and researchers working in academic primary care is a conversation we need to have. Sitting within an overarching representative body like AAAPC, a Primary Health Care Scientists group will give voice and champion the work of non-medical academics and researchers, and facilitate career support and development for this group. How it is relevant to primary care? Non-medical researchers make up as much as 70% of the primary health care research workforce in Australia (Barton et al. 2015, Oliver-Baxter et al. 2016). They play critical roles leading, informing, supporting and enabling primary care research. They enhance the quality of primary care research through using rigorous methodologies and contribute to building a stronger evidence-base for general practice and primary care. And yet, this diverse group, made up of individuals from a broad range of disciplinary backgrounds (Barton et al. 2015, Yen et al. 2010) lacks a clearly defined professional identity and has little professional representation that can advocate for their unique roles and career development needs. Continuing this situation poses an inevitable threat to the development and maintenance of primary care research capacity in Australia and New Zealand. AAAPC has over the years evolved from its original focus on representation and advocacy for Australian academic GPs to today embracing a broad vision of academic primary care that recognises and celebrates the multidisciplinary make-up of the academic primary care workforce in Australia and New Zealand. Establishing a Primary Health Care Scientists group in AAAPC will further demonstrate commitment to this vision. The impact it would make to patients and communities: A Primary Health Care Scientists group will promote a more stable and engaged research workforce. Retention of researchers and academics with specific disciplinary methodological expertise will improve the quantity and quality of primary health care research evidence in Australia and New Zealand.

Background The past decade has witnessed the increasing adoption of Web 2.0 technologies in medical education. Recently, the notion of digital habitats, Web 2.0 supported learning environments, has also come onto the scene. While there has been initial research on the use of digital habitats for educational purposes, very limited research has examined the adoption of digital habitats by medical students and educators on mobile devices. This paper reports the Stage 1 findings of a two-staged study. The whole study aimed to develop and implement a personal digital habitat, namely digiMe, for medical students and educators at an Australian university. The first stage, however, examined the types of Web 2.0 tools and mobile devices that are being used by potential digiMe users, and reasons for their adoption. Methods In this first stage of research, data were collected through a questionnaire and semi-structured interviews. Questionnaire data collected from 104 participants were analysed using the Predictive Analytics SoftWare (PASW). Frequencies, median and mean values were pursued. Kruskal Wallis tests were then performed to examine variations between views of different participant groups. Notes from the 6 interviews, together with responses to the open-ended section of the questionnaire, were analysed using the constructivist grounded theory approach, to generate key themes relevant to the adoption of Web 2.0 tools and mobile devices. Results The findings reflected the wide use of mobile devices, including both smart phones and computing tablets, by medical students and educators for learning, teaching and professional development purposes. Among the 22 types of Web 2.0 tools investigated, less than half of these tools were frequently used by the participants, this reflects the mismatch between users’ desires and their actual practice. Age and occupation appeared to be the influential factors for their adoption. Easy access to information and improved communication are main purposes. Conclusions This paper highlights the desire of medical students and educators for a more effective use of Web 2.0 technologies and mobile devices, and the observed mismatch between the desire and their actual practice. It also recognises the critical role of medical education institutions in facilitating this practice to respond to the mismatch. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0283-6) contains supplementary material, which is available to authorized users.

Introduction : Australia has a worsening workforce shortage of general practitioners and of doctors entering training in this specialty. This study aimed to explore the current capacity and enablers and barriers to increasing clinical placements for medical learners in the rural Australian state of Tasmania. Methods : A cross-sectional survey of all 559 general practitioners (GPs) and 151 practice managers in Tasmania in 2010 was conducted using online and postal delivery. Survey data were analysed quantitatively. Results : The response rate was 67% (376) for GPs and 40% (61) for practice managers. GP teaching rates within the previous 2 years were 72% for medical students, 19% for junior doctors, 36% for registrars and 23% for international medical graduates (IMGs). GPs agreed that they taught because of previous positive experiences (91%), enjoyment (85%), wanting to inspire learners to work in general practice (84%), because they considered it their professional duty (83%) and because they thought it kept them clinically up-to-date (80%). Only 15% taught because of remuneration. The reasons that GPs had not taught were lack of opportunity (45%), concern about negative impact on patient care (31%) and income (27%) and lack of self-confidence to teach (24%). Practice managers agreed enablers for teaching would be more GPs to teach (77%), better remuneration (71%), more room to house learners (64%), less “red-tape” to take on learners (62%) and more support from learners’ organisations (64%). Sixty-one percent of GPs expressed interest in upskilling as a teacher/clinical supervisor. Conclusions : Tasmanian general practitioners and their practice organisations already deliver a lot of clinical teaching and supervision to medical learners. This is enjoyed by GPs, but increased funding to cover the cost of supervising learners, the provision of GP teacher/supervisor training and more efficient administrative support of GPs and their practices could lead to an increase in capacity to provide more clinical placement weeks than is currently the case.

Vertical integration of teaching is seen as a key response to increasing number of learners in general practice. Central to vertically integrated teaching is the perceived capability and appropriateness of general practice (GP) registrars as teachers. This exploratory study of GP registrar teaching in regional general practices in the state of Tasmania, Australia investigated the nature and extent of teaching, factors that promote and inhibit teaching, and perceptions of prevocational doctors, registrars and supervisors about registrars as teachers. We suggest, based on the findings of the exploratory study, that supporting registrars in a sustainable teaching environment requires a practice-specific, structured approach to encourage registrars as teachers.

Introduction: In the past decade, we have witnessed the rapid growth of Web 2.0 technologies. While Web 2.0 tools have been recognised for their potential to enhance and enrich learning practice, very little research has been done to examine the level of acceptance of these tools among medical educators and learners. The project described in this paper aimed to explore the capacities of Web 2.0 technologies to foster a community of learning in general practice (GP) education, through the piloting of a digital habitat model, which we called “GPaedia”. Methods: The mixed-method study involved 150 participants, representing various general practice roles, from 15 Australian education institutions. Firstly, a questionnaire, semi- structured interviews and focus groups were conducted to investigate the participants’ views and adoption of Web 2.0 tools. These data were used to inform the development of “GPaedia”. A second questionnaire was then used to evaluate this pilot digital habitat. Results: Participants showed a high level of interest in Web 2.0 technologies but a relatively low level of engagement. Age and roles in the learning community were two influential factors on their views and engagement. “GPaedia” was perceived to be effective in its ability to facilitate communication and collaboration, maintain confidentiality and enhance the quality of GP education. Conclusion: The project demonstrated the potential of Web 2.0 technologies and a resource-rich digital habitat in GP education. The integration of Web 2.0 tools and quality resources enhanced “GPaedia’s” ability to support the professional development of GP learners. Relevant training and ongoing moderation were identified as critical factors in its future implementation.

The pressures on general practice training are increasing. As the number of general practice (GP) learners (medical students, prevocational doctors, GP registrars, practice nurses) grows, under current models of GP training, it will be necessary to expand the teaching capacity of practices without over-straining current GP trainers/supervisors. There is a call for better understanding of the ways in which interprofessional learning can address the education needs of learners in general practice (Reeves & Goldman, 2009). Increasing knowledge, acceptance and confidence about interprofessional learning and teaching has potential to assist in expanding teaching capacity in general practice if it is introduced in a relevant, time effective and engaging way (Reeves & Goldman, 2009). Simulation-based learning is one of five interactive learning methods commonly used in interprofessional learning in medicine, other methods being exchange-based (e.g., seminar-based discussions), observation-based (e.g., joint visits to patients/ clients), problem-focused (e.g., problem-based learning) and practice-based (e.g., interprofessional clinical placements) (Barr, Koppel, Reeves, Hammick, & Freeth, 2005). Simulation is already used as part of general practice registrar training, but there is a call to integrate simulation into interprofessional education (Robertson & Bandali, 2008). This paper reports on a pilot project examining interprofessional learning in GP teams during simulated emergency scenarios in general practice settings.