Search

Objectives: While general practice involves supporting patients to modify their behaviour, General Practitioners (GPs) vary in their approach to behaviour change during consultations. We aimed to identify mechanisms supporting GPs to undertake successful behaviour change in consultations for people with T2DM by exploring (a) the role of GPs in behaviour change, (b) what happens in GP consultations that supports or impedes behaviour change and (c) how context moderates the behaviour change consultation. Methods: Semi-structured interviews with academic clinicians (n = 13), GPs (n = 7) and patients with T2DM (n = 16) across Australia. Data were analysed thematically using a realist evaluation approach. Results: Perspectives about the role of GPs were highly variable, ranging from the provision of test results and information to a relational approach towards shared goals. A GP–patient relationship that includes collaboration, continuity and patient-driven care may contribute to a sense of successful change. Different patient and GP characteristics were perceived to moderate the effectiveness and experience of behaviour change consultations. Discussion: When patient factors are recognised in consultations, a relational approach becomes possible and priorities around behaviour change, that might be missed in a transactional approach, can be identified. Therefore, GP skills for engaging patients are linked to a person-centred approach. [ABSTRACT FROM AUTHOR]

The author discusses the importance for SNAPSHOT technology in providing better patient care to heart patients in Australia and New Zealand. Topics discussed include poor and unequal cardiac care to patients in Australia and New Zealand, SNAPSHOT ignoring variations in clinicians' prescribing practices for individual patients and health services for secondary prevention including cardiac rehabilitation and clinic-based counseling.

Background: The mechanisms contributing to the success of cardiac rehabilitation (CR) are poorly understood and may include assessment, monitoring and review activities enabled by continuity of care and this is investigated in this study., Objectives: To identify active assessment components of CR., Methods: A qualitative study using focus groups and individual interviews. CR staff (n = 39) were recruited via professional association email and network contacts and organised into major themes., Results: CR staff assessment strategies and timely actions undertaken provided a sophisticated post-discharge safety net for patients. Continuity of care enabled detection of adverse health indicators, of which medication issues were prominent. Interventions were timely and personalised and therefore likely to impact outcomes, but seldom documented or reported and thus invisible to audit., Conclusion: CR staff assessment and intervention activities provide an unrecognised safety net of activities enabled by continuity of care, potentially contributing to the effectiveness of CR., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: International studies suggest almost half of all major coronary episodes annually occur in survivors of acute coronary syndrome (ACS)., Objective: A greater focus on medium- and long-term ACS management and adherence to proven therapies is essential if out-of-hospital reductions in mortality and morbidity are to be optimized., Methods: A national panel of clinical and research opinion leaders in ACS care met for 2 days to set future priorities in health care delivery., Results: Lifestyle, control of risk factors, and prescription of pharmacological therapies can improve the course of coronary heart disease (CHD) by reducing all-cause and cardiovascular mortality by 15% to 25%. All ACS patients stand to benefit from rehabilitation and systematic secondary prevention, however, underutilization and suboptimal adherence to rehabilitation and secondary prevention measures persist globally., Results: A range of new initiatives in Australia and elsewhere indicate that time is ripe for change to improve the uptake of preventative treatments in patients after ACS. Key universal drivers of delivering best evidence practice for medium- to long-term care after ACS are economics and locality., Conclusions: Health-service redesign involving all stakeholders will be integral to increasing access, uptake, and adherence to lifestyle, control of risk factors, and pharmacologic therapies shown to improve cardiovascular outcomes., (Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.)