Background: The Australian Government released a national strategy for antimicrobial resistance in 2015 that calls for a collaborative effort to change practices that have contributed to the development of drug-resistant infection and for... more
Background: The Australian Government released a national strategy for antimicrobial resistance in 2015 that calls for a collaborative effort to change practices that have contributed to the development of drug-resistant infection and for the implementation of new initiatives to reduce antibiotic use. Although many achievements have been made in antimicrobial stewardship (AMS), particularly in the acute-care hospital setting, progress more broadly has been slow, and novel solutions are now required to improve clinical practice and community awareness. A facilitated workshop was undertaken at the 2019 National Australian Antimicrobial Resistance Forum to explore the complexity of AMS implementation in Australia and to prioritize future action. Methods: Participants engaged in rotating rounds of discussion using a world café format. The participants sat face-to-face at tables of 7 or fewer. At each table were 2 facilitators: one was a note taker and the other was the discussion leader...
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BACKGROUND Acute upper respiratory tract infections (ARTIs) are common and mostly self-limiting. A range of treatments are used with the aim to cure or treat symptoms, including widespread use of homeopathic treatments. OBJECTIVES To... more
BACKGROUND Acute upper respiratory tract infections (ARTIs) are common and mostly self-limiting. A range of treatments are used with the aim to cure or treat symptoms, including widespread use of homeopathic treatments. OBJECTIVES To undertake a systematic review and meta-analysis of trials with the highest level of evidence, to establish the benefits and risks for oral homeopathic remedies used to treat and prevent ARTIs in children. DATA SOURCES MEDLINE, Embase, CINAHL, AMED, CAMbase, British Homeopathic Library, CENTRAL, WHO ICTRP and ClinicalTrials.gov registers to March 2018. STUDY ELIGIBILITY, PARTICIPANTS, AND INTERVENTIONS Double-blinded randomized trials in children, treated with oral homeopathic remedies versus placebo or conventional treatments for ARTI. APPRAISAL AND SYNTHESIS METHODS Studies were reviewed in duplicate for inclusion, data extraction and risk of bias. Meta-analysis was performed on only four outcomes. Other outcomes were reported narratively. RESULTS Eight studies (1562 children) were included. Four studies examined treatment and four prevention of ARTIs. Four studies involved homeopaths individualizing treatment versus four with non-individualized treatments. Three studies had high risk of bias in at least one domain. All studies with low risk of bias showed no benefit from homeopathy; trials at uncertain and high risk of bias reported beneficial effects. Two individualized treatment studies (N=155) did not show benefit on short-term or long-term cure. Prevention trials showed no significant outcomes: recurrence of ARTIs. No serious events were reported. LIMITATIONS Methodological inconsistencies and heterogeneity. CONCLUSIONS The effectiveness for homeopathic remedies for childhood ARTIs is not supported in higher quality trials. SYSTEMATIC REVIEW REGISTRATION NUMBER CD005974.
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Background: Atopic dermatitis (AD) is a common presentation in the general practice (GP) setting. Implementation of appropriate referral pathways is instrumental for best patient care and is an essential skill for Australian GP... more
Background: Atopic dermatitis (AD) is a common presentation in the general practice (GP) setting. Implementation of appropriate referral pathways is instrumental for best patient care and is an essential skill for Australian GP registrars. Objectives: We aimed to explore the prevalence and associations of GP registrar referrals to specialists for AD management. Methods: A cross-sectional analysis utilizing data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study that documents in-consultation clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors associated with referrals for AD were established using logistic regression. Results: A A total of 3,285 (0.55%) of 595,412 diagnoses managed were AD, of which 222 (6.8%) resulted in referral. Of these referrals, 70% were to dermatologists, 17% to allergists/immunologists, and 10% to pediatricians. Associations of referral included registrar fema...
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Introduction Discrete choice experiments (DCEs) have been used to measure patient and healthcare professionals preferences in a range of settings internationally. Using DCEs in primary care is valuable for determining how to improve... more
Introduction Discrete choice experiments (DCEs) have been used to measure patient and healthcare professionals preferences in a range of settings internationally. Using DCEs in primary care is valuable for determining how to improve rational shared decision making. The purpose of this systematic review is to assess the validity of the methods used for DCEs assessing the decision making of healthcare professionals in primary care. Main body A systematic search was conducted to identify articles with original data from a discrete choice experiment where the population was primary healthcare professionals. All publication dates from database inception to 29th February 2020 were included. A data extraction and validity assessment template based on guidelines was used. After screening, 34 studies met the eligibility criteria and were included in the systematic review. The sample sizes of the DCEs ranged from 10 to 3727. The published DCEs often provided insufficient detail about the proc...
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Purpose: To explore the association of Australian general practitioner (GP) registrars’ responses to uncertainty with their in-consultation information-, advice- and assistance-seeking.Design/methodology/approach: A cross-sectional... more
Purpose: To explore the association of Australian general practitioner (GP) registrars’ responses to uncertainty with their in-consultation information-, advice- and assistance-seeking.Design/methodology/approach: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study in four Australian states. In ReCEnT, GP registrars record details of 60 consecutive consultations, six-monthly, three times during training.Outcome factors in logistic regression models included whether the registrar sought in-consultation information or assistance from (i) their supervisor or (ii) an electronic or paper-based source. Independent variables were the four independent subscales of the Physicians’ Reaction to Uncertainty (PRU) instrument, as well as registrar, practice and consultation variables.Findings: 589 registrars contributed details of 70,412 consultations.On multivariable analysis, scores on the two ‘affective’ PRU subscales ‘anxiety regarding d...
Research Interests: Medicine, Humans, Child, Symptoms, Common Cold, and 14 moreAdult, Time Factors, Imidazoles, Intranasal Administration, Respiratory Tract Infection, Medicine and Health Sciences, Double Blind, Placebo Controlled Trial, Congestion, Combination, Pseudoephedrine, Randomized Controlled Trials as Topic, Medical and Health Sciences, and oxymetazoline
RATIONALE, AIMS, AND OBJECTIVES Urinary tract infection (UTI) is a common presentation to general practitioners (GPs). There is increasing antimicrobial resistance in urinary pathogens in many healthcare systems. Adherence to principles... more
RATIONALE, AIMS, AND OBJECTIVES Urinary tract infection (UTI) is a common presentation to general practitioners (GPs). There is increasing antimicrobial resistance in urinary pathogens in many healthcare systems. Adherence to principles of antimicrobial stewardship is important to combat this problem. Our aim was to describe the prevalence of presentations of clinically diagnosed new UTI to early-career GPs, to describe management choices made, and to identify associations of prescribing antibiotics at the index consultation for UTI. METHOD This is a cross-sectional analysis of the Registrar Clinical Encounters in Training cohort study. Early-career GPs from five Australian states (urban to very remote practices) collected data on 60 consecutive patient encounters during each of three 6-month training terms. Proportions of problems being new UTIs, antibiotics prescribed, urine microscopy and culture ordered were calculated. Univariate and multivariable logistic regressions established associations of patient, registrar, and practice factors with prescribing antibiotics for a new UTI. RESULTS One thousand three hundred thirty-three early-career GPs diagnosed 2850 new UTIs from 189 736 consultations (1.5%; 95% CI, 1.4-1.6). Antibiotics were prescribed at 86% (95% CI, 84.7-87.2) of these index consultations. Antibiotic choice followed Australian therapeutic guideline recommendations. Urine microscopy and culture were requested at the index consultation less than recommended by guidelines in men, 69.2% (95% CI, 62.6-75.1), and children, 80.8% (95% CI, 76.4-84.6). Adults were significantly more likely to be treated with antibiotics at the index consultation than children under 16. CONCLUSIONS A new UTI is a common presentation to Australian early-career GPs. There is general adherence to guidelines for antibiotic choice in UTIs. Further research is needed, however, to understand some decisions made when managing UTI in children and men. This may reflect diagnostic uncertainty with consequent attention to antibiotic stewardship by deferring antibiotic prescription.
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Background Transient ischemic attack incurs a risk of recurrent stroke that can be dramatically reduced by urgent guideline-recommended management at the point of first medical contact. Aims This study describes the prevalence and... more
Background Transient ischemic attack incurs a risk of recurrent stroke that can be dramatically reduced by urgent guideline-recommended management at the point of first medical contact. Aims This study describes the prevalence and associations of new transient ischemic attack presentations to general practice registrars and the management undertaken. Methods A cross-sectional analysis of the Registrar Clinical Encounters in Training cohort study. General practice registrars from five Australian states (urban to very remote practices) collected data on 60 consecutive patient encounters during each of their three six-month training terms. The proportion of problems managed being new transient ischemic attacks and proportion of transient ischemic attacks with guideline-recommended management were calculated. Univariate and multivariable logistic regression established associations of patient, registrar, and practice factors with a problem being a new transient ischemic attack. Results ...
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Regarding the question about the consequences of discrepant conclusions from systematic reviews, different conclusions can result in opposing recommendations (for example, to screen or not to screen). This can have important consequences... more
Regarding the question about the consequences of discrepant conclusions from systematic reviews, different conclusions can result in opposing recommendations (for example, to screen or not to screen). This can have important consequences which might be reflected in clinical guidelines, as is indeed the situation in our case, where the US guidelines recommended screening but the UK ones recommended not screening. We recommend that guideline writers and health policy makers should check all available systematic reviews to ensure such discrepancies do not exist. Where contradicting reviews are found they should address these discrepancies and justify any stand they take, not make a subjective decision to suit. This is where prior hunch disclosure would be of assistance. We have added this to the discussion.
Background Impetigo is a common superficial skin infection that affects people worldwide and is usually treated with antibiotics; therefore, its management has implications for global antibiotic stewardship. Objective This systematic... more
Background Impetigo is a common superficial skin infection that affects people worldwide and is usually treated with antibiotics; therefore, its management has implications for global antibiotic stewardship. Objective This systematic review and narrative synthesis compares and contrasts international impetigo management guidelines. Methods Guidelines for treatment of impetigo that were produced by a national authority; available to primary care physicians; and published since 2008 were included. Following a comprehensive search strategy, data extraction from eligible studies was performed independently in duplicate. Details of antiseptic and antibiotic treatment; methicillin-resistant Staphylococcus aureus treatment; and conservative management and preventative measures were tabulated and analysed descriptively. Results Fifty-one guidelines were included from 42 different countries. All guidelines recommended systemic antibiotics, 78% of these only for widespread lesions or failure ...
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Abstract Loneliness is an emerging and important public health concern associated with increased risk for health disorders and even mortality. Interventions targeting coping strategies might be effective in alleviating feelings of... more
Abstract Loneliness is an emerging and important public health concern associated with increased risk for health disorders and even mortality. Interventions targeting coping strategies might be effective in alleviating feelings of loneliness. However, the relationship between loneliness and coping strategies is not well understood. We systematically reviewed quantitative studies addressing the association between loneliness and coping. Studies were included if loneliness and coping styles were measured with a validated scale and the association between both was assessed quantitatively. We searched Medline, Embase, PsycINFO, Cochrane Library, and CINAHL databases in compliance with the predefined in- and exclusion criteria. Two independent reviewers performed the search, quality appraisal, and data extraction. Coping styles were subdivided according to problem-focused and emotion-focused coping strategies. We included twelve studies that measured the association between loneliness and coping. Half of the studies had low risk of bias (n = 6), in the remaining six the risk of bias was moderate (n = 1) or high (n = 5). All studies that showed a significant association between loneliness and coping consistently showed that problem-focused coping styles were associated with lower levels of loneliness, and emotion-focused coping styles with higher levels of loneliness. Our findings suggest that learning how to use problem-focused coping strategies could be an important aspect of interventions targeting loneliness. This should be further explored in randomized clinical trials. Trials should report changes is coping and changes in loneliness and also include multivariate models that investigate if changes in coping contributed to changes in loneliness. Furthermore, further research should explore the role of different subgroups (e.g. older people), and the role of different types of loneliness as these can affect the effectiveness of loneliness interventions.
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BackgroundDisease modifying antirheumatic drugs (DMARDs) have transformed the treatment of numerous autoimmune and inflammatory diseases but their perceived risk of harm be a barrier to use.MethodsIn a retrospective mixed-methods study,... more
BackgroundDisease modifying antirheumatic drugs (DMARDs) have transformed the treatment of numerous autoimmune and inflammatory diseases but their perceived risk of harm be a barrier to use.MethodsIn a retrospective mixed-methods study, we analysed conventional (c) and biologic (b) DMARDs-related calls and compared them with rest of calls (ROC) from consumers to an Australian national medicine call center operated by clinical pharmacists from September 2002 to June 2010. This includes the period where bDMARDs became available on the Pharmaceutical Benefits Scheme, the government-subsidized prescription medicines formulary. We compared caller and patient demographics, enquiry types and motivation to information-seek for both cDMARDs and bDMARDs with ROC, using a t-test for continuous data and a chi-square test for categorical data. We explored call narratives to identify common themes.ResultsThere were 1,547 calls involving at least one DMARD. The top three cDMARD enquiry types were ...
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Cochrane reviews are difficult to construct and may be difficult to read, but they produce trusted, high-quality research responses to common clinical questions. The objective of this article is to help clinicians navigate the Cochrane... more
Cochrane reviews are difficult to construct and may be difficult to read, but they produce trusted, high-quality research responses to common clinical questions. The objective of this article is to help clinicians navigate the Cochrane Library and Cochrane reviews. Using a common clinical scenario, we illustrate how to find the information required to guide evidence-based decision making with patients. Clinicians looking for answers to clinical questions often turn first to guidelines. However, these may not provide enough background to balance the pros and cons of a treatment. Cochrane reviews often inform guidelines and contain more in-depth clinical information for shared decision making. The introduction of Summary of Findings (SoF) tables has made the studies in Cochrane reviews more accessible. In this paper, we discuss how to read and interpret these SoF tables. Additional resources, such as journal summaries and podcasts, have also improved the accessibility of Cochrane revi...
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Australian General Practitioners (GPs) are generous prescribers of antibiotics, prompting concerns including increasing antimicrobial resistance in the community. Recent data show that GPs in vocational training have prescribing patterns... more
Australian General Practitioners (GPs) are generous prescribers of antibiotics, prompting concerns including increasing antimicrobial resistance in the community. Recent data show that GPs in vocational training have prescribing patterns comparable with the high prescribing rate of their established GP supervisors. Evidence-based guidelines consistently advise that antibiotics are not indicated for uncomplicated upper respiratory tract infections (URTI) and are rarely indicated for acute bronchitis. A number of interventions have been trialled to promote rational antibiotic prescribing by established GPs (with variable effectiveness), but the impact of such interventions in a training setting is unclear. We hypothesise that intervening while early-career GPs are still developing their practice patterns and prescribing habits will result in better adherence to evidence-based guidelines as manifested by lower antibiotic prescribing rates for URTIs and acute bronchitis. The interventio...
Research Interests: General Practice, Education, Research Design, Australia, Medicine, and 10 moreProspective studies, Humans, Graduate medical education, Anti-Bacterial Agents, Public health systems and services research, Bronchitis, Respiratory Tract Infections, Internet, Inappropriate Prescribing, and Guideline Adherence
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Research Interests: Primary Care, Leadership, Primary Health Care, Health Care, Australia, and 10 moreInternational Cooperation, Health Services Research, Research evaluation, Medicine, Humans, Federal Government, Clinical Sciences, Public health systems and services research, International Collaboration, and Cooperative Behavior
BACKGROUND Despite the high use of over-the-counter (OTC) cough and cold medicines, little is known about Australia's cough and cold medicines information needs. The aim of this study was to identify gaps in consumers' perceived... more
BACKGROUND Despite the high use of over-the-counter (OTC) cough and cold medicines, little is known about Australia's cough and cold medicines information needs. The aim of this study was to identify gaps in consumers' perceived knowledge and concerns, to better target consumer medicines information and improve quality use of medicines. METHODS We analysed cough-and-cold related enquiries from consumers who contacted an Australian national medicine call centre between September 2002 and June 2010. RESULTS Of 5503 cough and cold calls, female callers made up 86% of the calls and 33% were related to children. Questions most frequently related to drug-drug interactions (29%). An analysis of narratives over an 18-month period (248 calls) revealed 20% of the calls concerned potentially clinically relevant interactions, particularly those involving psychotropic agents. DISCUSSION The potential for interactions with cough and cold medicines purchased OTC is recognised by consumers....
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In 1992, the Journal of the American Medical Association published a paper launching a new paradigm for lifelong learning in medical practice - evidence based medicine (EBM). Twenty years later EBM is known well beyond the field of... more
In 1992, the Journal of the American Medical Association published a paper launching a new paradigm for lifelong learning in medical practice - evidence based medicine (EBM). Twenty years later EBM is known well beyond the field of clinical practice and has become an integral part of medical curricula worldwide.
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This article is the second in a series on general practice research in Australia. The series explores strategies to strengthen general practice research and further develop the evidence base for primary care.
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BACKGROUND The aim of this study was to explore the experiences of Australian general practitioners (GPs) with a Doctor of Philosophy (PhD) about their choice to abandon or pursue an academic career. METHODS A qualitative study of 18 GPs... more
BACKGROUND The aim of this study was to explore the experiences of Australian general practitioners (GPs) with a Doctor of Philosophy (PhD) about their choice to abandon or pursue an academic career. METHODS A qualitative study of 18 GPs (PhD obtained between 2006 and 2016) was conducted. Semi-structured telephone interviews were transcribed and analysed using concurrent thematic analysis. RESULTS General practice researchers faced insecure career pathways. They often work in isolation, there is a lack of critical mass, and research was often described as a hobby (ie unfunded, done from home). Solutions included expanding academic general practice registrar positions to include advanced research training, building professional networks, mentoring, and better marketing of general practice research. DISCUSSION Focused investment in developing clear and sustainable career pathways is essential to nurture and retain general practice researchers and research leaders. The research culture...
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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effectiveness of oral vitamin C supplements to prevent and treat acute upper respiratory tract infections in adults and children.
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Purpose of ReviewAutistic adults often experience unmet health-care needs. We conducted a review of the literature on the barriers and facilitators to health care for autistic adults without intellectual disability. We also describe... more
Purpose of ReviewAutistic adults often experience unmet health-care needs. We conducted a review of the literature on the barriers and facilitators to health care for autistic adults without intellectual disability. We also describe examples of available health supports for this population.Recent FindingsBarriers and facilitators to health care were grouped into three categories: (1) patient-level factors, (2) provider-level factors, and (3) system-level factors. Patient-level factors included communication issues, anxiety, sensory differences, socio-economic factors and previous experiences with health-care professionals. Provider-level factors included a lack of provider knowledge and training, and incorporating communication accommodations and supporters. System-level factors included accessibility of health-care facilities and limited referral pathways.SummaryAutism training for health professionals with an emphasis on: managing communicative differences; changing practice environments to be more “autism friendly”; and approaching physical examinations in a mindful manner which respects sensory sensitivities, can help facilitate access to and engagement in health-care services for autistic adults. Few evidence based health supports for autistic adults exist, with greater research needed in this area.
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ABSTRACT Patients with mental health conditions commonly present in General Practice. Mental health curricula are broad. We do not know that trainees are exposed to the learning they require. This study aimed to establish the prevalence,... more
ABSTRACT Patients with mental health conditions commonly present in General Practice. Mental health curricula are broad. We do not know that trainees are exposed to the learning they require. This study aimed to establish the prevalence, characteristics and associations of GP trainees’ management of mental health problems. This paper presents a cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing multisite cohort study of Australian GP trainees (registrars) documenting their clinical experiences over 60 consecutive consultations. Univariate and multivariable logistic regression analyses were conducted with outcome of the problem/diagnosis being a mental health condition. 1659 trainees provided data on 218,325 consultations and 340,453 problems/diagnoses. Mental health conditions were associated with patients being male, of Aboriginal or Torres Strait Islander or English-speaking background. Trainee characteristics were being more senior and having trained in Australia. Practice characteristics included being in low socioeconomic areas. Trainees sought less help for mental health concerns than they did for other problems. While early-career GPs see a broad range of mental health conditions, they may benefit from training to manage patients from cross-cultural contexts. They may also need support to generate appropriate learning goals and seek assistance if they are to continue to deepen competence.
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Objective Limited international evidence suggests general practice registrars' emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap... more
Objective Limited international evidence suggests general practice registrars' emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap by establishing the prevalence, nature and associations of Australian GP registrar ED referrals.Methods A cross-sectional analysis was performed of the Registrar Clinical Encounters in Training (ReCEnT) cohort study of GP registrars' consultation experiences, between 2010 and 2015. The outcome factor in logistic regression analysis was referral to an ED. Independent variables included patient-level, registrar-level, practice-level and consultation-level factors.Results In all, 1161 GP registrars (response rate 95.5%) contributed data from 166966 consultations, comprising 258381 individual problems. Based on responses, 0.5% of problems resulted in ED referral, of which nearly 25% comprised chest pain, abdominal pain and fractures. Significant (P ...
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Despite the high use of over-the-counter (OTC) cough and cold medicines, little is known about Australia's cough and cold medicines information needs. The aim of this study was to identify gaps in consumers' perceived knowledge... more
Despite the high use of over-the-counter (OTC) cough and cold medicines, little is known about Australia's cough and cold medicines information needs. The aim of this study was to identify gaps in consumers' perceived knowledge and concerns, to better target consumer medicines information and improve quality use of medicines. We analysed cough-and-cold related enquiries from consumers who contacted an Australian national medicine call centre between September 2002 and June 2010. Of 5503 cough and cold calls, female callers made up 86% of the calls and 33% were related to children. Questions most frequently related to drug-drug interactions (29%). An analysis of narratives over an 18-month period (248 calls) revealed 20% of the calls concerned potentially clinically relevant interactions, particularly those involving psychotropic agents. The potential for interactions with cough and cold medicines purchased OTC is recognised by consumers. Patient information should address th...
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Research Interests: Nursing, General Practice, Documentation, Australia, Adolescent, and 15 moreMedicine, Pregnancy, Humans, Female, Confidence intervals, Clinical Sciences, Public Administration and Policy, Adult, Public health systems and services research, Cross Sectional Studies, Australian Health, Health Care Surveys, Interviews as topic, Patient identification systems, and Culturally Competent Care
Research Interests: Chemistry, Biology, Atherosclerosis, Cytokines, Chronic Fatigue Syndrome, and 15 moreAdolescent, Clinical Chemistry, Biological Sciences, Humans, Female, Color Vision, Clinical Sciences, Aged, Adult, Cytotoxic Activity, Health Care System, Biological markers, Disease Progression, Case Control Studies, and Dark Adaptation
Sexual abuse and abusive relationships are known to be especially common in people with intellectual disability. This study explored how women with intellectual disability understand sex, relationships and sexual abuse, the effects of... more
Sexual abuse and abusive relationships are known to be especially common in people with intellectual disability. This study explored how women with intellectual disability understand sex, relationships and sexual abuse, the effects of sexual abuse on their lives, and how successfully they protect themselves from abuse. Semistructured narrative interviews with nine women with mild intellectual disability in Queensland, Australia. Interviews were audio recorded, transcribed, coded and analysed qualitatively. Major themes that emerged were: sexual knowledge and sources of knowledge; negotiating sexual relationships; declining unwanted sexual contact; self protection strategies; sexual abuse experiences; and sequelae of sexual abuse. Most participants reported unwanted or abusive sexual experiences. They described sequelae such as difficulties with sex and relationships, and anxiety and depression. They described themselves as having inadequate self protection skills and difficulty reporting abuse and obtaining appropriate support. Their understanding of sex was limited and they lacked the literacy and other skills to seek information independently. It is important for general practitioners to be aware of the possibility of sexual abuse against women with intellectual disability, and to offer appropriate interventions.
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BMJ : British Medical Journal. BMJ Publishing Group Ltd. ...
Research Interests: British medical history, Masks, Humans, Protocols, Cohort Study, and 15 moreCost effectiveness, Meta Analysis, Public health systems and services research, BMJ, Communicable disease control, Observational Study, Case Control Study, Data Extraction, Protective Clothing, Confidence Interval, Case Control Studies, Cochrane, Acute Disease, Number needed to treat, and High risk
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BackgroundAntibiotic prescribing is a major concern that contributes to the problem of antibiotic resistance.AimTo assess the effect on antibiotic prescribing in primary care of telehealth (TH) consultations compared to face-to-face... more
BackgroundAntibiotic prescribing is a major concern that contributes to the problem of antibiotic resistance.AimTo assess the effect on antibiotic prescribing in primary care of telehealth (TH) consultations compared to face-to-face (F2F).Design & settingSystematic review and meta-analysis of adult or paediatric patients with a history of a community acquired acute infection (respiratory, urinary, or skin and soft tissue). We included studies that compared synchronous TH consultations (phone or video based) to F2F consultations in primary care.MethodWe searched PubMed, Embase, Cochrane CENTRAL (inception-2021), clinical trial registries and citing-cited references of included studies. Two review authors independently screened the studies and extracted the data.ResultsWe identified 13 studies. The one small randomised controlled trial found a non-significant 25% relative increase in antibiotic prescribing in the TH group. The remaining 10 were observational studies but did not contro...
Background: There is considerable concern about increasing antidepressant use, with Australians among the highest users in the world. Evidence suggests this is driven by patients on long-term rather than new prescriptions. Most... more
Background: There is considerable concern about increasing antidepressant use, with Australians among the highest users in the world. Evidence suggests this is driven by patients on long-term rather than new prescriptions. Most antidepressant prescriptions are generated in general practice and it is likely that attempts to discontinue are either not occurring or are proving unsuccessful. Aim: To explore GPs’ insights about long-term antidepressant prescribing. Design and Setting: A qualitative interview study with Australian GPs. Method: Semi-structured interviews explored GPs’ discontinuation experiences, decision-making, perceived risks and benefits, and support for patients. Data were analysed using reflexive thematic analysis. Results: Three overarching themes were identified from interviews with 22 GPs. The first, ‘Not a simple deprescribing decision’, speaks to the complex decision-making GPs undertake in determining whether a patient is ready to discontinue. The second, ‘A jo...
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ObjectiveLong-acting reversible contraception (LARC) is the most effective form of contraception but use in Australia is low. Uptake of LARC prescribing by early-career general practitioners (GPs) has important implications for community... more
ObjectiveLong-acting reversible contraception (LARC) is the most effective form of contraception but use in Australia is low. Uptake of LARC prescribing by early-career general practitioners (GPs) has important implications for community reproductive health. We aimed to investigate the prevalence and associations of Australian GP registrars’ LARC prescribing.MethodsA cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) cohort study 2010–2017. GP registrars collected data on 60 consecutive consultations on three occasions during their training. The outcome factor was prescription of LARC (compared with non-LARC). A secondary analysis was performed with problems involving prescription of LARC (compared with other problems). Associations with patient, practice, registrar and consultation independent variables were assessed by univariate and multivariable logistic regression.Results1737 registrars recorded 5382 problems/diagnoses involving women aged 12–55 ...
Background General practice (GP) trainees may seek supervisor assistance to complete their patient consultations. This in-consultation assistance plays a key role in the supervisory oversight of trainees and in trainee learning. It may be... more
Background General practice (GP) trainees may seek supervisor assistance to complete their patient consultations. This in-consultation assistance plays a key role in the supervisory oversight of trainees and in trainee learning. It may be obtained face-to-face, or using phone or messaging systems, and either in front of patients or outside their hearing. Trainee concerns about decreased patient impressions of their competence, and discomfort presenting patients within their hearing, act as barriers to seeking help during consultations. Little is known about the frequency and associations of trainee concerns about these patient-related barriers, or the various trainee-supervisor-patient configurations used to obtain in-consultation assistance. Methods Australian GP trainees rated their frequency of use of five specific configurations for obtaining in-consultation assistance, perceived change in patient impressions of their competence after this assistance, and relative trainee comfor...
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Background General practice (GP) trainees may seek supervisor assistance when hesitant to complete patient consultations independently. Trainees describe patient-related barriers to this in-consultation help-seeking, despite its key role... more
Background General practice (GP) trainees may seek supervisor assistance when hesitant to complete patient consultations independently. Trainees describe patient-related barriers to this in-consultation help-seeking, despite its key role in supervisory oversight. Little is known, however, about trainee strategies for seeking assistance, or the frequency and associations of trainee concerns about these barriers. Methods Australian GP trainees rated their frequency of use of five specific strategies for obtaining in-consultation assistance, perceived change in patient impressions of their competence after this assistance, and relative trainee comfort presenting patients outside, compared to within, patients’ hearing. Statistical analyses included descriptive statistics and multivariable logistic regression. Results Responses were received from 778 Australian GP trainees (response rate 89%). Help-seeking strategies did not differ between trainees at different training stages, except fo...
Background: Impetigo is a mild bacterial skin infection of childhood that is usually managed empirically in primary care. Objective: To establish the prevalence and associations of impetigo in general practice (GP) registrars’... more
Background: Impetigo is a mild bacterial skin infection of childhood that is usually managed empirically in primary care. Objective: To establish the prevalence and associations of impetigo in general practice (GP) registrars’ consultations. Methods: Cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study data. Results: Impetigo was managed in 0.24% of problems and 0.43% of consultations. Patient variables associated with impetigo presentations were younger age and impetigo as a new problem, while patients with non–English-speaking backgrounds were less likely to present with impetigo. Associated registrar variables were being new to the registrar and practicing in outer regional/remote locations. Compared with all other problems/diagnoses, impetigo more often involved information seeking, ordering pathology, and prescription of medication, but less often involved follow-up or referral. Conclusions: Impetigo accounts for 0.43 per 100 GP registrar con...
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Antipsychotic drugs are often used to treat behavioral and psychological symptoms (BPSD) in adults aged 65 years and older with dementia, although there is uncertainty about the effectiveness of long-term use for this indication and there... more
Antipsychotic drugs are often used to treat behavioral and psychological symptoms (BPSD) in adults aged 65 years and older with dementia, although there is uncertainty about the effectiveness of long-term use for this indication and there are concerns that they may cause harm. To evaluate whether discontinuation of long-term antipsychotic drugs for BPSD is successful in adults aged 65 years and older with dementia. This article is based on a Cochrane review updated in 2018. A Cochrane systematic review and meta-analysis. Eight databases were searched in January 2018 to identify 10 randomized controlled trials with 632 older adults. We used standard methodological procedures according to the Cochrane Handbook for Systematic Reviews of Interventions. We assessed the number of patients completing the study. We considered sustained withdrawal of antipsychotics until the end of the study period as successful outcome. Based on assessment of 7 studies (n = 446), discontinuation may make li...
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Australian and international guidelines recommend benzodiazepines and related drugs (hereafter "benzodiazepines") as second-line, short-term medications only. Most benzodiazepines are prescribed by general practitioners (GPs;... more
Australian and international guidelines recommend benzodiazepines and related drugs (hereafter "benzodiazepines") as second-line, short-term medications only. Most benzodiazepines are prescribed by general practitioners (GPs; family physicians). Australian GP registrars ("trainees" or "residents" participating in a post-hospital training, apprenticeship-like, practice-based vocational training program), like senior GPs, prescribe benzodiazepines at high rates. Education within a training program, and experience in general practice, would be expected to reduce benzodiazepine prescribing. To establish if registrars' prescribing of benzodiazepines decreases with time within a GP training program DESIGN: Longitudinal analysis from the Registrar Clinical Encounters in Training multi-site cohort study PARTICIPANTS: Registrars of five of Australia's 17 Regional Training Providers. Analyses were restricted to patients ≥ 16 years. The main outcome factor...