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A significant gap exists in knowledge about general practice nurses'(GPNs) patient care activities, despite their now strong presence in Australian general practice. The aim of this paper is to explore the extent of direct general practitioner (GP) involvement in nurse-patient consultations, and to compare consultations where nurse-specific Medicare items were claimable with consultations where they were not. Data from the Practice Nurse Work Survey, a national cross-sectional survey conducted between May 2007 and May 2008, were analysed. Of the total 5253 nurse- patient encounters, 29% did not involve any contact between the patient and a GP, either directly before, during or directly after the nurse consultation. Encounters without GP involvement were more likely to be indirect (e.g. by telephone) and off-site (e.g. home visits), and had higher rates of administrative actions such as documentation and arranging visits. Nurse-specific Medicare item numbers applied in less than half (42%) of nurse-patient encounters. Encounters where no such item applied were more likely to involve medical examinations, blood tests, electrical tracings, physical function tests, removal of sutures, test results, assisting at operations and preparing for procedures. These results confirm that existing data collections do not capture the extent and nature of GPNs' clinical work. [ABSTRACT FROM AUTHOR]

The article reports on several characteristics of working nurses including their backgrounds, environments, tasks and duties in the Australian general practices. The national cross-sectional survey was used in a 104 working nurses. Majority of them had completed one or more short courses and almost half worked in practices or employed as allied health professionals and practice managers.

Background Heart failure ( HF) remains a condition with high morbidity and mortality. We tested a telephone support strategy to reduce major events in rural and remote Australians with HF, who have limited healthcare access. Telephone support comprised an interactive telecommunication software tool (TeleWatch) with follow-up by trained cardiac nurses. Methods Patients with a general practice ( GP) diagnosis of HF were randomized to usual care ( UC) or UC and telephone support intervention ( UC+ I) using a cluster design involving 143 GPs throughout Australia. Patients were followed up for 12 months. The primary endpoint was the Packer clinical composite score. Secondary endpoints included hospitalization for any cause, death or hospitalization, as well as HF hospitalization. Results Four hundred and five patients were randomized to CHAT. Patients were well matched at baseline for key demographic variables. The primary endpoint of the Packer score was not different between the two groups ( P = 0.98), although more patients improved with UC+ I. There were fewer patients hospitalized for any cause (74 vs. 114, adjusted HR 0.67 [95% CI 0.50-0.89], P = 0.006) and who died or were hospitalized (89 vs. 124, adjusted HR 0.70 [95% CI 0.53-0.92], P = 0.011), in the UC+ I vs. UC group. HF hospitalizations were reduced with UC+ I (23 vs. 35, adjusted HR 0.81 [95% CI 0.44-1.38]), although this was not significant ( P = 0.43). There were 16 deaths in the UC group and 17 in the UC+ I group ( P = 0.43). Conclusions Although no difference was observed in the primary endpoint of CHAT (Packer composite score), UC+ I significantly reduced the number of HF patients hospitalized among a rural and remote cohort. These data suggest that telephone support may be an efficacious approach to improve clinical outcomes in rural and remote HF patients. [ABSTRACT FROM AUTHOR]

Objective. To test the association, in patients with a diagnosis of diabetes I and II, between having or not having a care plan, (i.e. General Practice Management Plans (GPMPs),Team Care Arrangements (TCAs)), and having the recommended number of biochemical checks according to the diabetes Annual Cycle of Care guideline. The checks comprised HbA1c, HDL cholesterol and urinary microalbumin. Methods. Chi-square analysis of retrospective group data obtained from the Medicare database (from 'billing' patterns only). Results. The creation of GPMPs was associated with general practitioners (GPs) requesting checks for HbA1c (59.7%), HDL cholesterol (36.9%) and microalbumin (50.8%) for diabetes patients in accordance with guideline recommendations. Although the introduction of multidisciplinary care via a TCA was associated with an increase in the frequency of HbA1c checks (61.3%) in accordance with the guidelines, there was a reduction in the number of HDL cholesterol (23.7%) and microalbumin (36.8%) checks. The group with no care plans had the lowest association with HbA1c (47.8%), HDL cholesterol (19.7%) and microalbumin (29.3%) checks that met guideline requirements for diabetes. Conclusions. The use of GPMPs showed strong association with increased testing of process measures that met guideline requirements for diabetes. Further research is needed to understand the value and benefits of TCAs in promoting adherence to diabetes guidelines. [ABSTRACT FROM AUTHOR]

This paper uses process evaluation to describe the challenges faced in recruiting and retaining general practitioners (GPs) into a smoking cessation Randomised Controlled Trial (RCT) that tested "in-practice" versus "referral to the Quitline" delivery of national smoking cessation guidelines within general practice. GPs expressed interest in participating in the research either through Divisions of General Practice or through a targeted mail-out to localised networks. The project aimed to recruit and retain 60 GPs. Initially 111 GPs expressed interest in the project, with 44 GPs (40% of those expressing interest) taking part. Using localised networks provided a higher rate of interest than using Divisions of General Practice. GPs allocated to the in-practice condition were more likely to withdraw from the project (46% vs. 30%). The main reason GPs cited when withdrawing from the project was that they were "too busy to recruit". Recruiting and retaining GPs to smoking cessation research is an ongoing challenge with multiple recruitment strategies needed and considerable effort required to ensure GPs comply with the requirements of the research. Barriers to recruitment and retention are of concern and can significantly affect the implementation of large-scale research projects. [ABSTRACT FROM AUTHOR]

Abstract Aim: To explore patients’ and general practitioners’ (GPs) attitudes to participation in research in general practice; to identify barriers to participation; to explore GPs and patients views about how research participation affects the doctor–patient relationship. Methods: Patients and GPs who had participated in a trial examining the effectiveness of a psychological treatment in general practice participated in qualitative interviews. Twenty-eight interviews were conducted. The participants included: 14 GPs and nine patients who participated in the original trial, and were either active or passive participants or withdrew from the original study; three patients with depression and two GPs who did not participate in the trial but had similar profiles to those who entered the trial. Results: Generally informants held a positive view of research in general practice. Concerns raised by the GPs as barriers to participation in research included: lack of time; financial remuneration; lack of training in research methods and conduct of research in general practice; and aspects of research protocols. Issues influencing patient participation included privacy, confidentiality, and the nature of the disease under study. Overall participation in research had a positive impact on the doctor–patient relationship. Conclusions: Research in general practice should be promoted. Possible solutions that were identified as barriers to GP participation included: the use of research nurses and the inclusion of research skills training. Patient barriers should also be addressed. 2003 Blackwell Publishing Asia and Wonca. [ABSTRACT FROM AUTHOR]