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The TAPS study found that errors in the process of providing health care were reported by general practitioners more than twice as often as deficiencies in a clinician's knowledge or skills. Approximately 20% of these process error events concerned investigations. In addition, some reported events that related to investigations included filing system and recall errors, which accounted for a further 10% of reported error events.

The Threats to Australian Patient Safety (TAPS) Study collected 648 anonymous reports about threats to patient safety from a representative random sample of Australian general practitioners. These contained any events the GPs felt should not have happened and would not want to happen again, regardless of who was at fault or the outcome of the event. This series of articles presents clinical lessons resulting from the TAPS study.

In 2004, 6.5% of Australians over 65 years of age were estimated to have dementia and the prevalence of dementia is rising as a result of our aging population. There is evidence to show that carer wellbeing is important for the wellbeing of the patient. Increasing burden of care may lead to depression, anxiety, and more frequent physical illness in the carer, and earlier institutionalisation of patients. The general practitioner's role includes recognising early dementia, undertaking assessments to confirm the diagnosis, managing the disease, health promotion and support for both patient and carer, and follow up. We initiated a project to explore the extent to which GPs currently fulfill this role for patients with dementia still living in the community (rather than in hostels or nursing homes).

Background: Little research has been undertaken into the factors affecting recruitment by Australian general practitioners of patients for clinical trials. Understanding the differences between recruiters and non-recruiters will assist researchers in better supporting general practitioners involved in such research., Method: A survey of general practitioners involved in recruiting patients for clinical trials for the RACGP Research Program was undertaken., Results: Recruiters were more likely to be interested in learning more about research, to perceive involvement as worthwhile, to desire a good relationship with Research Program staff and to feel the doctor-patient relationship assists recruitment., Discussion: Recruiters in general are average general practitioners, male, middle-aged and work in group practices. Most felt some discomfort in recruiting patients, but believed the strong doctor-patient relationship assisted in the process., Conclusion: The Research Program needs to recruit general practitioners interested in research, choose topics of interest, keep recruitment protocols simple and stay in contact.

Immunisation is the sixth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice.

The aims of this study were to describe asthma management and morbidity in patients attending general practitioners in Australia, and to assess the relationship between patient reports and those of their general practitioner (GP). The sample comprised consecutive patients attending 46 general practitioners chosen at random in five regions of New South Wales, Australia. A total of 4538 patients were screened, 607 (13.4%) reported ever having diagnosed asthma, and the 501 who reported asthma in the previous 12 months completed a detailed questionnaire. Three hundred and thirty-four patients also had information about their asthma management recorded by their GP. The patient questionnaire asked about asthma symptoms, therapy, lung function measurement, and asthma-related morbidity. The GP questionnaire asked the doctor to record similar information about the patients. Two-thirds of the patients used regular inhaled beta 2-agonist medication, and one-half reported using preventive therapy. Only 24% owned a peak flow meter and 9% had a written plan of action for asthma attacks. Although preventive therapy and airway function assessment were more common in those with frequent symptoms (> 2-3 times per week), this group were still sub-optimally managed. In the matched sample (n = 334), doctors reported prescribing bronchodilator and preventive medication, measuring airway function and recommending peak flow meter use more often than suggested by patient-reported data. The study concludes that many patients do not attend for regular review, and that management remains sub-optimal, particularly in young adults. Data from patient surveys may underestimate clinical practice, as assessed from doctors' records. This should lead to patient-derived estimates of management being interpreted with caution in epidemiological studies. Further attention to patient understanding and compliance with prescribed asthma management advice is needed in order to better manage asthma in the community.

The most cost-effective method to measure the morbidity managed and treatments provided in general practice is from records of a cluster of consultations (encounters) from each general practitioner (GP) in a random sample. A cluster sampling method is proposed for future surveys for analysis of encounter-based general practice data. The sample sizes needed to measure the most common problems managed and drugs prescribed were estimated using ratio-estimator models for cluster sample surveys. Morbidity and treatment rates were estimated from the Australian Morbidity and Treatment Survey in General Practice 1990-1991 (AMTS). The 20 most common problems in the AMTS were managed at estimated rates of 1.5 to 9.5 per 100 encounters. The 20 most common drugs were prescribed at estimated rates of 0.7 to 3.6 per 100 problems. These rates were used to determine precision as a percentage of each true value for future surveys, that is, as relative precision. If we want to be 95 per cent confident that these rates will be within 5 per cent of each true rate, sample sizes of 552 to 5675 GPs are needed. If we fix the sample size at 1000 GPs, relative precision lies within 12 per cent of these rates. If the sample size is increased to 1500 GPs, relative precision improves only marginally. The differences in sample size for each of the most frequent morbidity and treatment data are largely due to their variable distributions and relatively infrequent occurrence in general practice. A sample size of 1000 GPs will enable measurement of the most common morbidity and treatments at 95 per cent confidence.

Asthma is the third most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice.

Sprains and strains were the eighth most commonly managed problem in general practice in Australia. This paper provides an overview of their management in general practice.

Acute bronchitis is the fifth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice and compares the results with those of an earlier study.

There have been recent campaigns in many countries to address the increasing morbidity and mortality of asthma by promoting better management. This study aimed to evaluate the National Asthma Campaign (NAC), in Australia, and to assess the extent of its impact on reported asthma management. It was a cross-sectional, before and after study using the same self-administered questionnaire in postal surveys involving 472 general practitioners (GPs) before the campaign and 540 GPs 6 months after the start of the campaign. Both samples were random samples of GPs in active practice. The campaign was effective in making GPs more aware of the principles of good asthma management. Most (74%) GPs in the post-campaign survey were aware of a current asthma education programme compared with 53% in the pre-campaign survey, although only 23% cited the NAC. After the campaign there were significant improvements reported in airway function measurement practices, the use of preventive therapy and the use of written action plans.

The Royal Australian College of General Practitioners has been a leader in quality assurance in Australia, requiring members to participate in its Quality Assurance Programme since 1987. This paper presents the underlying philosophy and requirements of the programme, the results of the first 1987-89 triennium, and the likely future development based on an evaluation of the problems and successes of the first triennium.

More detailed analysis of this data will continue. It will be combined with other more specific studies to provide a more focused view of some aspects of general practice. Requests for individual analyses of selected data will be accepted by the Family Medicine Research Unit. Contact Helena Britt on (02) 745 2633. The Unit has provided Australian Family Physician with 500 copies of the full report for distribution to interested practitioners. Such copies can be obtained by contacting Mrs Judy Brook, Secretary, Australian Family Physician, 2nd Floor, 70 Jolimont Street, Jolimont 3002. Fax: (03) 289 1211. Telephone: (03) 654 3000.

A postal survey of selected general practitioners from Brisbane, Melbourne, Sydney and rural New South Wales was conducted to compare general practitioners' self-reported asthma management practices with the Asthma Management Plan (1989) of the Thoracic Society of Australia and New Zealand. The results suggest that most general practitioners know and practise appropriate asthma management. Room for improvement, however, was detected in the following areas: 1. appropriate understanding of the use of theophyllines, 2. the use of preventive medications such as inhaled steroid and sodium cromoglycate, 3. use of crisis planning for severe asthma attacks, 4. lung function measurement.

To determine the feasibility of serological testing for measles immunity in children attending general practitioners and to assess the validity of establishing immune status by reported immunisation history compared with serology, a cross-sectional descriptive study was conducted in general practices in the Illawarra area south of Sydney, New South Wales. Participants were 234 children under 15 years attending general practitioners. 87 per cent of children were reported to have been immunised against measles, but 46 per cent of these children were seronegative for measles antibody using an ELISA test on finger-prick blood. This could not be explained by inaccurate reporting of immunisation. No causes other than failure to seroconvert or inadequate specificity of the test on the blood samples were evident. Failure to seroconvert as a result of inadequate adherence to cold chain requirements is a possibility that needs further investigation. The results further question whether a single vaccination is adequate to achieve the public health aims of measles immunisation programs.

The epidemiology of measles in Australia has changed in the last decade due to control of the disease by increased immunization rates. Elimination of endemic measles is possible, but has still to be attempted. A partially immunized population results in disease in an older population, with the possibility of contracting measles in the childbearing years. For elimination of measles to occur, a second dose of measles-mumps-rubella vaccine should be introduced. Changes in the immunization protocol would need to be monitored with reliable population-based data on seroconversion rates and disease incidence. Reliable documentation of immunization is a prerequisite for any legislative initiative in the field of immunization. In order to maximize the impact of immunization programmes, the social and cultural contexts within which immunization occurs should receive greater consideration.

Respiratory infections are the most common group of diseases experienced in the community and treated by doctors. Tonsillitis and pharyngitis, sometimes referred to together as acute sore throat, are among the most common of the individual respiratory infections.

The use of a morbidity and therapeutic index in general practice is described. The system can monitor practice activities, morbidity, prescribing and patient characteristics for individual practices or surgeys. A triplicate prescription form is used for data collection, with minimum inconvenience to the doctor. Complete patient confidentially is maintained. Some problems of classification and coding are discussed.

Information about psychotropic drug prescribing in one general practice was compared with overall information about such prescribing in Australia. Over the period 1978-81 there was a significant reduction in the number of prescriptions issued for psychotropic drugs. Prescriptions for hypnotics, sedatives and minor tranquilizers were more common than those for antidepressants or major tranquilizers. The indications for prescribing were distributed equally among three groups of conditions: psychological disorders, sleep problems and physical diseases. Patients for whom psychotropic drugs were prescribed had a greater overall morbidity and used medical care services more than other patients. Only 9% of patients in 1981 were issued with a prescription for one of the four most commonly prescribed psychotropic drugs. A relatively small proportion of patients, most of them elderly women, received the largest proportion of the prescriptions.

In 1983-1984, 9.8 million prescriptions were written for the 12 most common psychotropic drugs that are available under the Pharmaceutical Benefits Scheme. Our analysis shows that, of these prescriptions, 59% (374 per 1000 persons) were for the four most commonly prescribed benzodiazepine agents; 34% (216 per 1000 persons) were for the five main antidepressant agents; and 7% (41 per 1000 persons) were for the three main phenothiazine agents. In the period from 1977-1978 to 1983-1984, prescription volumes were relatively stable for antidepressant and phenothiazine drugs. Fluctuations in the prescribing of individual benzodiazepine agents are discussed. Older patients and women of all ages receive the majority of the psychotropic drug prescriptions that are written by Australian general practitioners.

A comprehensive survey of the number of general practitioners in the Western Metropolitan Health Region of Sydney identified 753 general practitioners with one or more practice locations in the region; this was the equivalent of 711 full-time general practitioners, and represented a general practitioner-population ratio of 1:1533.

From 1984 to 1986 a prospective study was conducted of 104 general practice patients who started treatment with a benzodiazepine or an antidepressant drug. The duration of reported use of the drugs was two months for 45% of patients, four months for 17% of patients, and six months for 15%. Type of drug, age, and level of education were found to be predictive of continuing use. General practitioners have a significant effect on their patients' use of drugs and, with careful selection and review when prescribing, may help to prevent dependence on psychotropic drugs.