Search

The important role of GPs and the high prevalence and burden of chronic disease in China have been discussed in other articles in this series, so there is no need to reiterate this background here. This article deals with the pedagogy of chronic disease management as presented to cohorts of Chinese GPs from Shenzhen attending an offshore program at Monash University in Australia. The program, which commenced in 2010, was 7 weeks in duration and has now expanded to 13 weeks, enabling greater coverage of important topics, more site visits, and instruction in teaching and research methods, along with development of research proposals often based on management of a chronic disease. [ABSTRACT FROM AUTHOR]

The commonest cause of chronic heat failure in China is ischemic heart disease, followed by hypertension and valvular heart disease. Echocardiography is essential in establishing a diagnosis as well as helping to identify a cause and to monitor progress. Management includes nonpharmacological as well as pharmacological treatment, and self-care with careful monitoring of salt and fluid intake as well as regular weight measurement. Care planning and team-based care are essential in managing patients with chronic heart failure, who often have concurrent multimorbidity and are receiving polypharmacy. [ABSTRACT FROM AUTHOR]

Background: In Australia, rural and remote communities have high rates of diabetes-related death and hospitalisation. General practitioners (GPs) play a major role in diabetes detection and management. Education of GPs could optimise diabetes management and improve patient outcomes at a population level. The study aimed to describe the uptake of a continuing medical education intervention for rural GPs and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control.Method: Trial design: the cluster randomised controlled trial involved towns as the unit of allocation and analysis with outcomes assessed by de-identified pathology data (not reported here). The intervention programme consisted of an online active learning module, direct electronic access to specialist advice and performance feedback. Multiple rounds of invitation were used to engage GPs with the online intervention content. Evidence-based strategies (e.g. pre-notification, rewards, incentives) were incorporated into the invitations to enrol in the programme. Recruitment to the programme was electronically monitored through the hosting software package during the study intervention period.Results: Eleven matched pairs of towns were included in the study. There were 146 GPs in the 11 intervention towns, of whom 34 (23.3%) enrolled in the programme, and 8 (5.5%) completed the online learning module. No town had more than 10% of the resident GPs complete the learning module. There were no contacts made by GPs regarding requests for specialist advice. Consequently, the trial was discontinued.Conclusion: There is an ongoing need to engage primary care physicians in improving diabetes monitoring and management in rural areas. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake, even when evidence-based recruitment strategies are implemented.Trial Registration: Australian New Zealand Clinical Trials Registry, identifier: ACTRN12611000553976 . Retrospectively registered on 31 May 2011. [ABSTRACT FROM AUTHOR]

Objective: To indicate levels of monitoring of type 2 diabetes in rural and regional Australia by examining patterns of glycated haemoglobin (HbA1c) and blood lipid testing. Design and Setting: Retrospective analysis of pathology services data from twenty regional and rural towns in eastern Australia over 24 months. Participants: Of 13 105 individuals who had either a single HbA1c result ≥7.0% (53 mmol mol-1); or two or more HbA1c tests within the study period. Main outcome measures: Frequency of testing of HbA1c and blood lipids (cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides) were compared with guideline recommendations. Results: About 58.3% of patients did not have the recommended 6-monthly HbA1c tests and 30.6% did not have annual lipid testing. For those who did not receive tests at the recommended interval, the mean between-test interval was 10.5 months (95% CI = 7.5-13.5) rather than 6 months for HbA1c testing; and 15.7 (95% CI = 13.3-18.1) months rather than annually for blood lipids. For those with at least one out-of-range test result, 77% of patients failed to receive a follow-up HbA1c test and 86.5% failed to receive a follow-up blood lipid test within the recommended 3 months. Patients less than 50 years of age, living in a more remote area and with poor diabetes control were less likely to have testing at the recommended intervals (P < 0.0001). Conclusions: Although poor diabetes testing is not limited to rural areas, more intensive diabetes monitoring is likely to be needed for patients living in nonmetropolitan areas, particularly for some subgroups. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this study were to identify the prevalence of depressive symptomatology in an elderly population using a screening scale; to assess general practitioner (GP) recognition of depression; to determine patient reasons for consultation; and to relate depression to social and demographic factors. Method: An analytical cross-sectional study was carried out on a systematic sample of elderly Chinese patients currently resident in Macau, who presented to general practices in December 1997. Data collected included patient demographics, economic and social supports, patient depressive status assessed using the Hospital Anxiety and Depression scale (HAD), reason for attendance, and the reason for the consultation. Clinical records were analysed in order to collect GP-registered morbidity and recent relevant management. Results: Data were collected from 386 elderly Chinese patients of 31 GPs (97% patient response rate). Patients presented with somatic symptoms rather than psychological issues. Using HAD cut-off score of >8, 47% of the population studied were depressed; with a HAD subscale score >11, 26.2% were depressed. Depression was detected more often in women (59%) and being female was associated with depressive status (p = 0.010). Age (greater than 75 years) was also associated with being depressed, as was not having someone to talk to (p = 0.037), and being from low social class (p = 0.050). Not having someone willing to listen to their problems, difficulties and worries, was significantly related to depression (p = 0.041). There were no referrals or antidepressive medications detected in the clinical charts. Conclusion: Participants’ characteristics such as being over 75 years of age, being female and socially isolated were related to depression. General practitioners can play an important role in the early detection and management of psychological disorders. Although studies on a sample of Chinese patients in Macau cannot be generalized to Chinese populations elsewhere, awareness of somatic presentation of psychological illness is crucial in detecting depression in this and possibly other Chinese populations. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes is one of the fastest growing chronic diseases internationally. The health complications associated with type 2 diabetes can be prevented, delayed, or improved via early diagnosis and effective management. This research aims to examine the impact of a primarily web-based educational intervention on the diabetes care provided by general practitioners (GPs) in rural areas, and subsequent patient outcomes. A population-level approach to outcome assessment is used, via whole-town de-identified pathology records. Methods/design: The study uses a cluster randomised controlled trial with rural communities as the unit of analysis. Towns from four Australian states were selected and matched on factors including rurality, population size, proportion of the population who were Indigenous Australians, and socio-economic status. Eleven pairs of towns from two states were suitable for the trial, and one town from each pair was randomised to the experimental group. GPs in the towns allocated to the experimental group are offered an intervention package comprising education on best practice diabetes care via an on-line active learning module, a moderated discussion forum, access to targeted and specialist advice through an on-line request form, and town-based performance feedback on diabetes monitoring and outcomes. The package is offered via repeated direct mail. Discussion: The benefits of the outcomes of the trial are described along with the challenges and limitations associated with the methodology. [ABSTRACT FROM AUTHOR]

Abstract: Background: Following recent reforms to Australia''s health system, nurses now comprise a significant and growing sector of the Australian primary care workforce, but there is little data describing the services they provide. Objectives: This study aimed to describe the patient consultations of nurses in Australian general practice, including patient characteristics, reasons for the consultation, treatments provided and other actions taken. Design: The study was a national cross-sectional survey, with each participating nurse collecting information about 50 nurse-patient encounters. Setting: General practice settings in all regions of Australia. Participants: 108 nurses volunteered in response to advertisements and 104 returned completed study materials. Participants included Registered (Division 1) and Enrolled (Division 2) nurses working in a general practice setting. Methods: Data were collected between May 2007 and May 2008 using a profile questionnaire and a series of encounter forms. Information was gathered on reasons for encounter, patient characteristics, and actions taken. Data were classified using the International Classification of Primary Care. Results: The final data set included 5,253 nurse-patient encounters. 37.2% of patients (95% CI 33.3–41.2) were aged 65 and over, and 57.1% were female (95% CI 54.9–59.5). The majority of encounters (90.7%) were with existing patients of the practice (95% CI 89.1–92.7). The most common reasons for encounter were general and unspecified problems (35.4 per 100 encounters; 95% CI 31.8–39.1), followed by skin-related problems (20.0; 95% CI 17.3–22.8), and cardiovascular problems (11.0; 95% CI 8.7–13.3). Common management actions included medical examinations (20.7 per 100 encounters), immunisations (22.5), diagnostic tests (10.6), and dressings (15.8). Approximately 30% of encounters involved advice-giving. Conclusions: The findings confirm the generalist nature of the General Practice Nurse role, with a wide range of patient types and clinical conditions. There is a clear influence of current funding and organisational arrangements on work patterns, with tasks that have specific funding (including immunisations and wound care) featuring prominently in nurses’ work. Whilst nurses’ rates for presenting conditions were similar to doctors at a general level, specific actions taken and problems managed differed. New policy reforms in Australia are supporting greater flexibility in the General Practice Nurse role, maximising efficient use of nurses’ skills in the primary health care context. [Copyright &y& Elsevier]

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.

In the context of substantial government expenditure on Primary Care Collaboratives in Australia, this study aimed to review the information available about the effectiveness of the Breakthrough Series methodology as an alternative quality improvement method and a form of continuing professional development for general practitioners (GPs) in Australia. A wide and comprehensive search was conducted seeking articles that provided information about four questions raised by GPs involved in the Monash Arthritis and Musculoskeletal Quality Improvement Program (AMQuIP) project: (1) follow-up studies (2) the generalisability, sustainability and validity of the methodology (3) randomised controlled trials using the methodology, and (4) continuing professional development programs. The search was conducted using several databases. The search found 102 articles, with 3 1 containing information relevant to the questions raised. Three articles reported and eight commented on follow-up; 25 commented on generalisability, 15 on sustainability, five on validity. No randomised controlled trials were located that used the methodology but seven commented on randomised controlled trials; three commented on continuing professional development. While the articles provide valuable information, many authors suggested further research is needed to provide greater insight into and understanding of the methodology as an alternative quality improvement method for use both in Australia and overseas. [ABSTRACT FROM AUTHOR]

This paper reports on the outcomes of a pilot study to optimise general practitioner (GP) management of patients with osteoarthritis (OA) of the hip and knee by identifying gaps between their current practice and best practice. The Breakthrough Series collaborative methodology with several Plan-Do-Study-Act (PDSA) cycles was employed. Participants comprised two Victorian Divisions of General Practice (one rural, one metropolitan), 12 general practitioners/practices (GPs/practices), 10 patients per GP/practice. GPs/practices attended an orientation and three learning workshops and a videoconference. GPs/practices completed PDSA cycles between workshops and reported results at the workshops. GPs/practices reported use of guidelines, change in patient management and change in practice management/systems. All recruited patients completed the SF-12v2 Health survey and WOMAC Osteoarthritis Index questionnaire twice; nine patients participated in face-to-face interviews twice. Follow-up activities including focus groups and face-to-face interviews were held six months after the final workshop. All GPs/ practices used the guidelines/key messages, introduced "new" management strategies to patients, and made positive changes to their practice management/systems. Patients reported positive changes and outcomes. There was little difference between rural and metropolitan results. By using a structured methodology and evidence-based guidelines/key messages, GPs can introduce new patient management strategies, and by identifying gaps in practice management/systems, positive change can be achieved. [ABSTRACT FROM AUTHOR]

While primary care physicians (PCPs) have opportunities to recognize patients who encounter domestic violence (DV) by intimate partners, warning symptoms such as unexplained physical injury, bruising, anxiety, and depression are often missed during clinic visits. This study investigated the barriers of Hong Kong PCPs toward managing DV, including recognition, management, and referrals of these patients. Four focus group interviews were conducted to explore the in-depth opinions of PCPs on managing DV in Hong Kong. The themes identified were investigated in a questionnaire survey with data from 504 PCPs working in public and private sectors. Factor analysis of the survey data suggested four major barrier factors: (a) worries about the potential harms of intervening in patients' domestic affairs and DV issues, (b) lack of guidelines and support services, (c) limited skills and time in managing DV, and (d) patients' reluctance in disclosing DV issues. PCPs with more years of practice had more worries about intervening in domestic issues (Factor 1), while the younger PCPs tended to perceive limited skills and time in managing DV cases as barriers (Factor 3). PCPs working in the public setting were more likely to ask patients about DV (M = 5.4 vs. 2.9), suspected DV (M = 3.8 vs. 2.3), and managed DV (M = 1.7 vs. 1.0) in the past 5 years compared with the private PCPs. Some PCPs in the focus groups expressed the view that DV cases should be handled by social workers instead of doctors. Survey respondents who held such views about doctors' limited role in DV management also scored higher in all of the barrier factors. The findings suggest that there are boundaries between domestic and medical realms, especially in a Chinese context. Resolving PCPs' worries by training, provision of DV management guidelines, and referral pathway to social workers may be good starting points to bridge the gaps. [ABSTRACT FROM AUTHOR]

Background: Domestic violence is common in the community. Many of its victims present to primary care physicians (PCPs) but are not being recognized and managed. The barriers, with specific reference to a Chinese cultural context, were investigated earlier. This paper explored the factors which facilitated the process of recognizing and managing suspected cases of domestic violence by PCPs in Hong Kong. Methods: Four focus group interviews were conducted to explore in-depth the experiences of PCPs in recognition, management and referral of domestic violence cases from which facilitators were identified. The relevant themes were then investigated in a questionnaire survey with 504 PCPs working in public and private sectors. Results: The focus group participants emphasized mood symptoms as useful indicators for probable abuse and continuity of care was important to unmask issues of domestic violence. The top facilitators perceived by the respondents of the survey included: a trusting doctor-patient relationship (99.8%), good communication skills (99.0%), patients' unexplained bruises (96.3%), medical history (94.6%), and mood symptoms (94.4%). Further, the survey found that PCPs with longer years of practice, a medical degree obtained from Western countries, and postgraduate training in family counselling or psychological medicine perceived more facilitators in managing domestic violence. Conclusions: Without a local screening policy and training protocol to manage domestic violence, PCPs regarded their skills in mental healthcare and good relationships with patients as the key facilitators. While training in mental health care helps PCPs manage domestic violence, a specific protocol emphasizing medical-social collaboration is anticipated to facilitate them to take a more proactive and effective stance from screening to management. [ABSTRACT FROM AUTHOR]

Our small group of expert GP academic trainers from Monash University and the University of Melbourne have been collaborating over the last decade to develop a GP model training program based in Luohu, Shenzhen, that deeply engages Chinese GPs and seeks to provide personal and professional development of the GPs. The program is closely linked to continuing offshore GP education in Australia, with many trainees of the program having attended intensive training hosted by Monash University in Australia. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes is one of the fastest growing chronic diseases internationally. The health complications associated with type 2 diabetes can be prevented, delayed, or improved via early diagnosis and effective management. This research aims to examine the impact of a primarily web-based educational intervention on the diabetes care provided by general practitioners (GPs) in rural areas, and subsequent patient outcomes. A population-level approach to outcome assessment is used, via whole-town de-identified pathology records.Methods/design: The study uses a cluster randomised controlled trial with rural communities as the unit of analysis. Towns from four Australian states were selected and matched on factors including rurality, population size, proportion of the population who were Indigenous Australians, and socio-economic status. Eleven pairs of towns from two states were suitable for the trial, and one town from each pair was randomised to the experimental group. GPs in the towns allocated to the experimental group are offered an intervention package comprising education on best practice diabetes care via an on-line active learning module, a moderated discussion forum, access to targeted and specialist advice through an on-line request form, and town-based performance feedback on diabetes monitoring and outcomes. The package is offered via repeated direct mail.Discussion: The benefits of the outcomes of the trial are described along with the challenges and limitations associated with the methodology.Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12611000553976. [ABSTRACT FROM AUTHOR]

Victims of domestic violence frequently attend health care facilities. In many cases, their abusive experience is neither disclosed nor discussed during clinical consultations. This study examined the barriers faced by women when discussing abuse with health care providers, specifically in cases involving Malaysian women with a history of domestic violence. A qualitative study using in-depth interviews was conducted with 10 women with a history of domestic violence residing at a shelter. Purposive sampling was conducted until data saturation. Using the grounded theory approach of analysis, themes that emerged from these interviews were then further analyzed to examine the barriers faced by these women. Women who experienced domestic violence faced multiple barriers while discussing their accounts of abuse with others. Values placed on the privacy of domestic violence; upholding the traditional gender roles; preserving the family unity; minimizing the abuse, the feeling of shame, self-blame; and fearing their abuser generally create internal barriers when discussing their encounters of abuse with health care providers. The perceived unknown role of health care professionals when dealing with patients experiencing domestic violence as well as the previous negative experiences in clinical consultations acted as external barriers for discussing abuse with health care providers. Women with domestic violence experiences faced internal and external barriers to discussing their abuse during clinical consultations. Physicians and health care providers must consider domestic violence in consultations with female patients. A good doctor–patient relationship that encompasses empathy, confidence, trust, support, assurance, confidentiality, and guidance can help patients with abusive backgrounds overcome these barriers, leading to the disclosure and discussion of their abusive encounters. Proper education, guidelines, and support for health care providers are required to help them assist women with histories of domestic violence. [ABSTRACT FROM AUTHOR]

The article outlines the method developed for the Transgenerational Learning Coordination Project at Monash University. Topics covered include the use of a Delphi technique in re-examining the teaching curriculum of ophthalmology and dermatology, the analysis of the learning objectives using Bloom's taxonomy and the possible utilization of a transgenerational approach to curriculum planning.

Abstract: Background: Although the potential to reduce hospitalisation and mortality in chronic heart failure (CHF) is well reported, the feasibility of receiving healthcare by structured telephone support or telemonitoring is not. Aims: To determine; adherence, adaptation and acceptability to a national nurse-coordinated telephone-monitoring CHF management strategy. The Chronic Heart Failure Assistance by Telephone Study (CHAT). Methods: Triangulation of descriptive statistics, feedback surveys and qualitative analysis of clinical notes. Cohort comprised of standard care plus intervention (SC+I) participants who completed the first year of the study. Results: 30 GPs (70% rural) randomised to SC+I recruited 79 eligible participants, of whom 60 (76%) completed the full 12 month follow-up period. During this time 3619 calls were made into the CHAT system (mean 45.81 SD±79.26, range 0–369), Overall there was an adherence to the study protocol of 65.8% (95% CI 0.54–0.75; p =0.001) however, of the 60 participants who completed the 12 month follow-up period the adherence was significantly higher at 92.3% (95% CI 0.82–0.97, p ≤0.001). Only 3% of this elderly group (mean age 74.7±9.3 years) were unable to learn or competently use the technology. Participants rated CHAT with a total acceptability rate of 76.45%. Conclusion: This study shows that elderly CHF patients can adapt quickly, find telephone-monitoring an acceptable part of their healthcare routine, and are able to maintain good adherence for a least 12 months. [Copyright &y& Elsevier]

Aim: To determine whether telephone support using an evidence-based protocol for chronic heart failure (CHF) management will improve patient outcomes and will reduce hospital readmission rates in patients without access to hospital-based management programs. Methods: The rationale and protocol for a cluster-design randomised controlled trial (RCT) of a semi-automated telephone intervention for the management of CHF, the Chronic Heart-failure Assistance by Telephone (CHAT) Study is described. Care is coordinated by trained cardiac nurses located in Heartline, the national call center of the National Heart Foundation of Australia in partnership with patients' general practitioners (GPs). Conclusions: The CHAT Study model represents a potentially cost-effective and accessible model for the Australian health system in caring for CHF patients in rural and remote areas. The system of care could also be readily adapted for a range of chronic diseases and health systems. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and/or Torres Strait Islander people experience dementia at a rate three to five times higher than the general Australian population. Aboriginal Community Controlled Health Services (ACCHSs) have a critical role to play in recognising symptoms of cognitive impairment, facilitating timely diagnosis of dementia, and managing the impacts of dementia. Little is known about the barriers and enablers to Aboriginal people receiving a timely dementia diagnosis and appropriate care once diagnosed. This study aims to explore, from the perspective of healthcare providers in the ACCHS sector across urban, regional and remote communities, the barriers and enablers to the provision of dementia diagnosis and care.Methods: A qualitative study involving semi-structured interviews with staff members working in the ACCHS sector. Aboriginal Health Workers, General Practitioners, nurses, practice or program managers, and Chief Executive Officers were eligible to participate. Consenting ACCHS staff completed a telephone interview administered by a trained interviewer. Interviews were audio-recorded, transcribed, and analysed using qualitative content analysis.Results: Sixteen staff from 10 ACCHSs participated. Most participants perceived their communities had a limited understanding of dementia. Symptoms of dementia were usually noticed by the GP or another healthcare worker at the ACCHS who had an ongoing relationship with the person. Most participants reported that their service had established referral pathways with either hospital-based geriatricians, geriatricians located with aged care assessment teams, or specialists who visited communities periodically. Key enablers to high quality dementia care included the use of routine health assessments as a mechanism for diagnosis; relationships within communities to support diagnosis and care; community and family relationships; comprehensive and holistic care models; and the use of tailored visual resources to support care. Key barriers to high quality care included: denial and stigma; dementia being perceived as a low priority health condition; limited community awareness and understanding of dementia; lack of staff education and training about dementia; and numerous gaps in service delivery.Conclusions: Substantially increased investments in supporting best-practice diagnosis and management of dementia in Aboriginal communities are required. ACCHSs have key strengths that should be drawn upon in developing solutions to identified barriers to care. [ABSTRACT FROM AUTHOR]

To undertake a review of general practitioner (GP) mental health training focusing on three teaching formats; lecture-based, skills-based, and multifaceted strategies. The databases of Medline, Educational Resources Information Centre, the Cochrane Database of Systematic Reviews, the Database of Abstacts of Reviews of Effectiveness were searched from the years 1980 to 2001. Search terms included general practice, family physician, family practice, mental disorders, quality of health care, professional education and combinations of these terms. Lecture-based approaches combined with case discussion demonstrated improvements in GP performance. Improvements in patient outcomes were achieved using skills-based and multifaceted teaching strategies. More research into GP mental health training is necessary, as well as increased focus on better sampling of GPs, and measurement of GP and patient outcomes using standardized instruments. [ABSTRACT FROM AUTHOR]

For hundreds of years, Chinese societies have been living in extended family settings. However, the import of Western cultures and values are challenging the traditional Chinese practices in Hong Kong. This study assesses the community attitudes to living arrangements between elderly and their adult children in Hong Kong and to identify the factors which influence these attitudes. A random sample of 888 adult Hong Kong residents were telephone-interviewed. They were asked about their attitudes to living arrangements when they turned 60, if disabled and non-disabled. The relationship between these attitudes and the social and demographic characteristics of the respondents was also analyzed. Nearly 59% of the respondents preferred to live with their children if non-disabled. However, 43.5% of the respondents would be unlikely to want to live with their children if disabled. If non-disabled at 60, females, professionals or those who had lived overseas before preferred not to live with their children. Females also preferred not to live with their children if disabled at 60. Other factors, such as age, social class, education level and experience in living with elderly or looking after elderly had no effect on the respondents‘ preference. This study provides important information on the community attitudes to living arrangements between the elderly and their adult children in Hong Kong. These attitudes will shed light on the provision of housing and institutional care to elderly, as well as the family relationship and care pattern of the elderly in the future decades in Hong Kong and other communities which are undergoing rapid growth and ’Westernization‘. [ABSTRACT FROM AUTHOR]

Background: The stepped care model for psychological distress has been promoted in recent years, leading to the enhancing roles of primary care professionals and alternative sources of help. However, most of the research findings come from Western countries. This study investigates help-seeking behaviours of Chinese patients among different types of professional and alternative sources for psychological distress in Hong Kong. Methods: A questionnaire survey was conducted with 1626 adult primary care attenders from 13 private and 6 public clinics, 650 (40.0%) reported that they had ever experienced psychological distress. Their help-seeking behaviours, demographic background and current distress level (measured by GHQ-12) were analysed. Results: Among the respondents with experience of psychological distress, 48.2% had sought help from professional and/or alternative sources for their distress [10.2% from professionals only, 12.6% from alternative sources only, and 25.4% from both]. Those who had sought help from professionals only were more likely to be less educated and with lower income. In contrast, those using alternative sources only were more likely to be younger, better educated, and have higher income. Allowing multiple responses, psychiatrists (22.3%) was reported to be the most popular professional source, followed by primary care physicians (17.5%), clinical psychologists (12.8%) and social workers/counsellors (12.0%). Family members/friends (28.6%) was the top alternative source, followed by exercise/sports (21.8%), religious/spiritual support (16.9%) and self-help websites/books/pamphlets (8.9%). Conclusion: While psychiatrists remain the most popular professional source of help to the Chinese patients in Hong Kong, primary care professionals and alternative sources also play significant roles. Distressed patients who are younger, better educated and have higher income are more likely to use alternative sources only. The outcomes need further research. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the attitudes and practices of Australian general practitioners (GPs) regarding infant gastro-oesophageal reflux disease (GORD) diagnosis and management.Methods: A national cross-sectional survey, involving a random sample of currently practising Australian GPs (n = 2319) was undertaken between July and September 2011. GPs attitudes and management of infant GORD were surveyed via an online and paper-based 41-item questionnaire.Results: In total, 400 responses were analysed (17.24% response rate). The majority of GPs employed empirical trials of acid-suppression medication and/or lifestyle modifications to diagnose infant GORD. GPs frequently recommended dietary modification despite the belief that they were only moderately effective at best. In addition, GPs frequently prescribed acid-suppression medication, despite concerns regarding their safety in the infant population. Other GP concerns included the lack of clinical guidelines and education for GPs about infant GORD, as well as the level of evidence available for the safety and efficacy of diagnostic tests and treatments.Conclusion: Despite the important role Australian GPs play in the diagnosis and management of infant GORD, high-level evidence-based guidelines for GPs are lacking. Consequently, GPs engage in diagnostic and management practices despite their concerns regarding the safety and effectiveness. [ABSTRACT FROM AUTHOR]

Background: Physical activity is associated with a host of health benefits, yet many individuals do not perform sufficient physical activity to realise these benefits. One approach to rectifying this situation is through modifying the built environment to make it more conducive to physical activity, such as by building walking tracks or recreational physical activity facilities. Often, however, modifications to the built environment are not connected to efforts aimed at encouraging their use. The purpose of the Monitoring and Observing the Value of Exercise (MOVE) study is to evaluate the effectiveness of two interventions designed to encourage the ongoing use of a new, multi-purpose, community-based physical activity facility. Methods/design: A two-year, randomised controlled trial with yearly survey points (baseline, 12 months follow-up, 24 months follow-up) will be conducted among 1,300 physically inactive adult participants aged 18-70 years. Participants will be randomly assigned to one of three groups: control, intervention 1 (attendance incentives), or intervention 2 (attendance incentives and tailored support following a model based on customer relationship management). Primary outcome measures will include facility usage, physical activity participation, mental and physical wellbeing, community connectedness, social capital, friendship, and social support. Secondary outcome measures will include stages of change for facility usage and social cognitive decision-making variables. Discussion: This study will assess whether customer relationship management systems, a tool commonly used in commercial marketing settings, can encourage the ongoing use of a physical activity facility. Findings may also indicate the population segments among which the use of such systems are most effective, as well as their cost-effectiveness. [ABSTRACT FROM AUTHOR]

The article presents research which examined the use of cognitive therapy in patients with depression. Topics covered include the effectiveness of the treatment in lessening depressive relapse and the long-term outcomes of the therapy. Also mentioned is the comparison of the efficiency of the treatment with antidepressants and mood stabilizer medications.

Background. During the influenza pandemic 2009/A/H1N1, the main burden of managing patients fell on primary care physicians (PCP). This provided an excellent opportunity to investigate the implications of pandemic policies for the PCP role. Aim. To examine policies affecting the role of PCP in the pandemic response in Australia (in the state of Victoria), Israel and England. Methods. Content analysis of the documents published by the health authorities in Australia, Israel and England during the pandemic 2009/A/H1N1. Results. The involvement of PCP in the pandemic response differed among the countries in timing and allocated responsibilities. The Israeli approach during the containment phase was to maximise the protection of PCP at the expense of putting pressure on hospitals where the suspected cases were tested and treated. In Australia and England, PCP managed the suspected patients from the beginning of the pandemic. The work of PCP in England was supported by the introduction of the National Pandemic Flu Service during the mitigation phase, whereas Australian PCP had no additional support structures and their role was constant and intensive throughout the pandemic period. Conclusion. Health authorities need to engage with representatives of PCP to evaluate policies for pandemic planning and management. Adequate support and protection for PCP during different stages of pandemic management should be provided. What is known about the topic? During the influenza pandemic 2009/A/H1N1, the main burden of diagnosing and managing the patients fell on PCP. The prominent role of PCP in the 2009/A/H1N1 pandemic presents an excellent opportunity to investigate implications of pandemic policies for primary care and to tackle the possible problems that these policies may impose on the ability of PCP to effectively participate in the public health response. What does this paper add? This paper examines policies that affected the roles of PCP in managing the influenza pandemic 2009/A/H1N1 in three countries: Australia, Israel and England. Although general evaluations of the pandemic response in different countries have previously been reported, this is the first study that focuses on policies for pandemic management at the primary care level. What are the implications for practitioners? Practitioners (PCP and primary care workers in general) would benefit if pandemic preparedness plans were constructed to provide an adequate system of support and protection to primary care workers during different stages of pandemic management. For policy makers, this analysis may help to overhaul the strategies for primary care engagement in the pandemic response. [ABSTRACT FROM AUTHOR]

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]

We describe the development process and completed structure, of a self-help online intervention for bipolar disorder, known as MoodSwings (www.moodswings.net.au). The MoodSwings program was adapted as an Internet intervention from an efficacious and validated face-to-face, group-based psychosocial intervention. The adaptation was created by a psychologist, who had previously been involved with the validation of the face-to-face program, in collaboration with website designers. The project was conducted under the supervision of a team of clinician researchers. The website is available at no cost to registered participants. Self-help modules are accessed sequentially. Other features include a mood diary and a moderated discussion board. There has been an average of 1,475,135 hits on the site annually (2008 and 2009), with some 7400 unique visitors each year. A randomised controlled trial based on this program has been completed. Many people with bipolar disorder are accepting of the Internet as a source of treatment and, once engaged, show acceptable retention rates. The Internet appears to be a viable means of delivering psychosocial self-help strategies. [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]

A letter to the editor is presented concerning trends impacting the paramedic workforce.

The article presents a study on the effectiveness of commonly used herbal remedies against insomnia. The study involves internet and electronic database searches of identified literature on the said herbal remedies. The result shows that time-honored herbal remedies for insomnia, including kava-kava, chamomile, and St. John's wort, are surprisingly receiving very little research attention.

Background. In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband based network known as the Chronic Disease Management Service (CDMS). Aims. To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS. Methods. A single cohort before and after study. Results. GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients. Conclusion. This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined. [ABSTRACT FROM AUTHOR]

The effectiveness of a therapist-supported Internet intervention program for tinnitus distress in an industrial setting was evaluated using a cluster randomised design. Fifty-six Australian employees of two industrial organisations were randomly assigned, based on their work site (18 work sites from BP Australia and five from BHP Billiton), to either a cognitive behavioural therapy (CBT) program or an information-only control program. Participants were assessed at pre- and postprogram, measuring tinnitus distress, depression, anxiety, stress, quality of life, and occupational health. The CBT program was not found to be superior to the information program for treating tinnitus distress. A high attrition rate and small sample size limit the generalisability of the findings, and further developments of the program and assessment process are needed to enhance engagement and compliance. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether participation in a clinical audit and education session would improve GP management of patients who smoke. Methods: GPs who participated in an associated smoking cessation research program were invited to complete a three-stage clinical audit. This process included a retrospective self-audit of smoking cessation management practices over the 6 months prior to commencing the study, attending a 2.5 hour education session about GP management of smoking cessation, and completion of a second retrospective self-audit 6 months later. Twenty-eight GPs completed the full audit and education process, providing information about their smoking cessation management with 1114 patients. The main outcome measure was changes in GP management of smoking cessation with patients across the audit period, as measured by the clinical audit tool. Results: The majority of GPs (57%) indicated that as a result of the audit process they had altered their approach to the management of patients who smoke. Quantitative analyses confirmed significant increases in various forms of evidence-based smoking cessation management practices to assist patients to quit, or maintain quitting across the audit period. However comparative analyses of patient data challenged these findings, suggesting that the clinical audit process had less impact on GP practice than suggested in GP's self-reported audit data. Conclusion: This study provides some support for the combined use of self-auditing, feedback and education to improve GP management of smoking cessation. However further research is warranted to examine GP- and patient-based reports of outcomes from clinical audit and other educational interventions. [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]

Sixty-six English-speaking postgraduate distance-education medical students completed the Learning Styles Questionnaire (LSQ: 40-item version). This was completed while attending a residential workshop at the beginning of the semester, and 44 of these students completed the same LSQ questionnaire 5 months later at the completion of the semester. The psychometric properties of the LSQ were assessed using Cronbach’s alpha (internal consistency), test-retest, correlational analyses and factor analysis. The results indicated that the LSQ (40-item version) has poor reliability and validity, and therefore requires further development and psychometric evaluation. [ABSTRACT FROM AUTHOR]

Objective: To assess the acceptability and benefits to general practitioners (GPs) of a short course on the management of depression and anxiety. Method: One hundred and twenty-two GPs from southeast metropolitan Melbourne participated in a five-session short course. Pre- and post-measures of knowledge, attitude and self-evaluated clinical practice and a post-measure of participant satisfaction were completed. Results: The course was overwhelmingly appreciated by participating GPs. In the group as a whole, knowledge, attitude and certain elements of clinical practice changed in a positive and predicted direction. General practitioners affirmed the use of an interpersonal and problem-solving framework for patients more commonly than a cognitive-behavioural one. Conclusions: Brief educational interventions are useful and, through improving GP knowledge, attitude and clinical practice, have an important role to play in enhancing the capacity of GPs to assist people with depression and anxiety. [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]

Background: Studies demonstrating efficacy of psychological therapies have predominantly been conducted in specialist psychiatric settings. Investigation of the effectiveness of these therapies when provided by general practitioners (GPs) in their specific work setting is lacking and much needed. Objectives: To develop and pilot test a new education and treatment program to assist GPs manage patients with a depressive illness. The Focused Education and Psychotherapy Program (FEPP) is intended to provide GPs and patients with a treatment and education program for the management of depressive illness using a psychological intervention within the cost and time constraints of general practice. Methods: Following consultation, we developed a draft program. This program incorporates established psychological therapies, Interpersonal Counselling (IPC) and Cognitive Behavioural strategies with patient education in a general practitioner manual and accompanying patient handbook. FEPP was reviewed by focus groups and was pilot tested using a simulated depressed patient who trialled the program with four GPs. Results: Consultation and pilot testing of the program identified important issues for both GPs and their patients. These were incorporated into the final version of the program, which includes a 12-week acute phase of treatment followed by a maintenance program and is based on IPC and cognitive behavioural strategies, and patient and GP education utilising a manualised format. Conclusions: A practical and accessible form of psychological treatment for the general practice setting has been developed. Effectiveness of this program now needs to be established. [ABSTRACT FROM AUTHOR]