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...
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INTRODUCTION Eye conditions are common presentations in Australian general practice, with the potential for serious sequelae. Pre-vocational ophthalmology training for General Practitioner (GP) trainees is limited. AIM To describe the... more
INTRODUCTION Eye conditions are common presentations in Australian general practice, with the potential for serious sequelae. Pre-vocational ophthalmology training for General Practitioner (GP) trainees is limited. AIM To describe the rate, nature and associations of ophthalmic problems managed by Australian GP trainees, and derive implications for education and training. METHODS Cross-sectional analysis from an ongoing cohort study of GP trainees' clinical consultations. Trainees recorded demographic, clinical and educational details of consecutive patient consultations. Descriptive analyses report trainee, patient and practice demographics. Proportions of all problems managed in these consultations that were ophthalmology-related were calculated with 95% confidence intervals (CI). Associations were tested using simple logistic regression within the generalised estimating equations (GEE) framework. RESULTS In total, 884 trainees returned data on 184,476 individual problems or d...
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Tolerance for ambiguity is essential for optimal learning and professional competence. General practice trainees must be, or must learn to be, adept at managing clinical uncertainty. However, few studies have examined associations of... more
Tolerance for ambiguity is essential for optimal learning and professional competence. General practice trainees must be, or must learn to be, adept at managing clinical uncertainty. However, few studies have examined associations of intolerance of uncertainty in this group. The aim of this study was to establish levels of tolerance of uncertainty in Australian general practice trainees and associations of uncertainty with demographic, educational and training practice factors. A cross-sectional analysis was performed on the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study. Scores on three of the four independent subscales of the Physicians' Reaction to Uncertainty (PRU) instrument were analysed as outcome variables in linear regression models with trainee and practice factors as independent variables. A total of 594 trainees contributed data on a total of 1209 occasions. Trainees in earlier training terms had higher scores for '...
Research Interests: General Practice, Education, Anxiety Disorders, Medical Education, Australia, and 13 moreUncertainty, Humans, Female, Male, Graduate medical education, Adult, General Practitioners, Cross Sectional Studies, Cohort Studies, Surveys and Questionnaires, Psychology and Cognitive Sciences, internship and residency, and Medical and Health Sciences
To investigate the prevalence and associations of general practitioner registrars' (trainees') management of women with menopause-related symptoms. A cross-sectional analysis from the Registrar Clinical Encounters in Training... more
To investigate the prevalence and associations of general practitioner registrars' (trainees') management of women with menopause-related symptoms. A cross-sectional analysis from the Registrar Clinical Encounters in Training (ReCEnT) cohort study. In ReCEnT registrars collected data of 60 consecutive consultations on three occasions during training. The outcome factor was menopause-related problems/diagnoses (compared with other problems/diagnoses). Associations of registrar, patient, practice, and consultation-independent variables were assessed by univariate and multivariable logistic regression. In all, 1,333 registrars conducted 189,774 consultations involving 295,017 problems/diagnoses. Of these, there were 1,291 problems/diagnoses (0.44% of all problems/diagnoses) relating to menopause. Significant multivariable independent associations of a problem being menopause-related were registrar female sex (odds ratio [OR] 2.74, 95% confidence interval [CI] 2.30-3.26) and reg...
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Introduction Community-based longitudinal clinical placements for medical students are becoming more common globally. The perspective of supervising clinicians about their experiences and processes involved in maximising these training... more
Introduction Community-based longitudinal clinical placements for medical students are becoming more common globally. The perspective of supervising clinicians about their experiences and processes involved in maximising these training experiences has received less attention than that of students. Aims This paper explores the general practitioner (GP) supervisor perspective of positive training experiences with medical students undertaking urban community-based, longitudinal clinical placements in the early years of medical training. Methods Year 2 medical students spent a half-day per week in general practice for either 13 or 26 weeks. Transcribed semi-structured interviews from a convenience sample of participating GPs were thematically analysed by two researchers, using a general inductive approach. Results Identified themes related to the attributes of participating persons and organisations: GPs, students, patients, practices and their supporting institution; GPs' perceptio...
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In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates - antibiotics are mostly prescribed for acute respiratory infections, for... more
In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates - antibiotics are mostly prescribed for acute respiratory infections, for which they provide only minor benefits. Current surveillance is inadequate for monitoring community antibiotic resistance rates, prescribing rates by indication, and serious complications of acute respiratory infections (which antibiotic use earlier in the infection may have averted), making target setting difficult. Categories of interventions that may support general practitioners to reduce prescribing antibiotics are: regulatory (eg, changing the default to "no repeats" in electronic prescribing, changing the packaging of antibiotics to facilitate tailored amounts of antibiotics for the right indication and restricting access to prescribing selected antibiotics to conserve them), externally administered (eg, academic detailing and audit...
Research Interests: General Practice, Decision Making, Australia, Health Education, Humans, and 7 moreMicrobial genetic and drug resistance, Clinical Sciences, Anti-Bacterial Agents, Public health systems and services research, Respiratory Tract Infections, Randomized Controlled Trials as Topic, and Inappropriate Prescribing
Inappropriate antibiotic prescription and consequent antibacterial resistance is a major threat to healthcare. To evaluate the efficacy of a multifaceted intervention in reducing early career general... more
Inappropriate antibiotic prescription and consequent antibacterial resistance is a major threat to healthcare. To evaluate the efficacy of a multifaceted intervention in reducing early career general practitioners' (GPs') antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis/bronchiolitis. A pragmatic non-randomized trial employing a non-equivalent control group design nested within an existing cohort study of GP registrars' (trainees') clinical practice. The intervention included access to online modules (covering the rationale of current clinical guidelines recommending non-prescription of antibiotics for URTI and bronchitis/bronchiolitis, and communication skills in management of acute bronchitis) followed by a face-to-face educational session. The intervention was delivered to registrars (and their supervisors) in two of Australia's seventeen regional GP training providers (RTPs). Three other RTPs were the control group. Outcomes were proportion of registrars' URTI consultations and bronchitis/bronchiolitis consultations prescribed antibiotics. Intention-to-treat analyses employed logistic regression within a Generalised Estimating Equation framework, adjusted for relevant independent variables. The predictors of interest were time; treatment group; and an interaction term for time-by-treatment group. The P value associated with an interaction term determined statistically significant differences in antibiotic prescribing. Analyses include data of 217 intervention RTPs' and 311 control RTPs' registrars. There was no significant reduction in antibiotic prescribing for URTIs. For bronchitis/bronchiolitis, a significant reduction (interaction P value = 0.024) remained true for analysis adjusted for independent variables (P value = 0.040). The adjusted absolute reduction in prescribing was 15.8% (95% CI: 4.2%-27.5%). A multifaceted intervention reduced antibiotic prescribing for bronchitis/bronchiolitis but not URTIs.
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Testing for asymptomatic prostate cancer with prostate specific antigen (PSA) is of uncertain benefit. Most relevant authorities recommend against screening, and for informed patient choice. We aimed to establish the prevalence and... more
Testing for asymptomatic prostate cancer with prostate specific antigen (PSA) is of uncertain benefit. Most relevant authorities recommend against screening, and for informed patient choice. We aimed to establish the prevalence and associations of "non-symptomatic" PSA-testing of men aged 40 or older by early-career general practitioners (GP registrars). A cross-sectional analysis from the ReCEnT cohort study of registrars' consultations, 2010-2014 (analysed in 2016). Registrars record 60 consecutive consultations each 6-month training term. The outcome factor was ordering an "asymptomatic" PSA test (a PSA ordered for an indication that was not prostate-related symptoms or prostatic disease monitoring). Independent variables were patient, registrar, practice, consultation and educational factors. A total of 856 registrars contributed details of 21,372 individual consultations and 35,696 problems/diagnoses of males 40 or older. Asymptomatic PSAs were ordered for 1.8% (95%CI: 1.7-2.0%) of consultations and for 1.1% (95%CI: 1.0-1.2%) of problems/diagnoses. Multivariable associations of asymptomatic PSA testing (compared with problems/diagnoses for which a PSA was not ordered) included patient age (OR 2.32 [95%CI: 1.53-3.53] for 60-69 years compared with 40-49), patient ethnicity (OR 0.40 [95%CI: 0.19-0.86] for non-English speaking background), the patient being new to both the registrar and practice (ORs 1.46 [95%CI: 1.08-1.99] and 1.79 [95%CI: 1.03-3.10]), the number of problems/diagnoses addressed (OR 1.44 [95%CI: 1.25-1.66] for each extra problem) and more pathology tests being ordered (OR 1.88 [95%CI: 1.79-1.97] for each extra test). GP registrars frequently order "asymptomatic" PSA tests. Our findings suggest that non-compliance with current guidelines for PSA screening may be relatively common and that targeted education is warranted.
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The present study aimed to describe referral patterns of general practitioner (GP) registrars to dietitians/nutritionists. There is a paucity of research regarding GP referral patterns to dietitians/nutritionists. Limited data show... more
The present study aimed to describe referral patterns of general practitioner (GP) registrars to dietitians/nutritionists. There is a paucity of research regarding GP referral patterns to dietitians/nutritionists. Limited data show increasing referrals from established GPs to dietitians/nutritionists. There are no data on GP registrar (trainee) referrals. This was a cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing, multicentre, prospective cohort study of registrars, which documents 60 consecutive consultations of each registrar in each of the three six-month GP training terms. The outcome factor in this analysis was a problem/diagnosis resulting in dietitian/nutritionist referral (2010-2015). Independent variables were related to registrar, patient, practice and consultation. A total of 1124 registrars contributed data from 145 708 consultations. Of 227 190 problems/diagnoses, 587 (0.26% (confidence interval: 0.23-0.29)) resulted in dietitian/nutritionist referral. The most common problems/diagnoses referred related to overweight/obesity (27.1%) and type 2 diabetes (21.1%). Of referrals to a dietitian/nutritionist, 60.8% were for a chronic disease, and 38.8% were related to a Chronic Disease Management plan. Dietitian/nutritionist referral was significantly associated with a number of independent variables reflecting continuity of care, patient complexity, chronic disease, health equity and registrar engagement. Established patients with chronic disease and complex care needs are more likely than other patients to be referred by registrars to dietitians/nutritionists. Nutrition behaviours are a major risk factor in chronic disease, and we have found evidence for dietitian/nutritionist referrals representing one facet of engagement by registrars with patients' complex care needs.
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Research Interests: General Practice, Primary Health Care, Australia, Diet, Patient reported outcome measures, and 13 moreLibrary and Information Studies, Humans, Chronic Disease, Female, Male, Cluster Analysis, Feedback, Aged, Middle Aged, Adult, Public health systems and services research, Retrospective Studies, and Surveys and Questionnaires
To assess the number of pathology tests ordered by general practice registrars during their first 18-24 months of clinical general practice. Longitudinal analysis of ten rounds of data collection (2010-2014) for the Registrar Clinical... more
To assess the number of pathology tests ordered by general practice registrars during their first 18-24 months of clinical general practice. Longitudinal analysis of ten rounds of data collection (2010-2014) for the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing, multicentre, cohort study of general practice registrars in Australia. The principal analysis employed negative binomial regression in a generalised estimating equations framework (to account for repeated measures on registrars).Setting, participants: General practice registrars in training posts with five of 17 general practice regional training providers in five Australian states. The registrar participation rate was 96.4%. Number of pathology tests requested per consultation. The time unit for analysis was the registrar training term (the 6-month full-time equivalent component of clinical training); registrars contributed data for up to four training terms. 876 registrars contributed data for 114 58...
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As well as generating patient-specific questions, patient consultations are a rich source of questions relating to clinicians' need to acquire or maintain wider clinical knowledge. This is especially so for GP trainees. To establish... more
As well as generating patient-specific questions, patient consultations are a rich source of questions relating to clinicians' need to acquire or maintain wider clinical knowledge. This is especially so for GP trainees. To establish the prevalence and associations of GP trainees' generation of 'learning goals' (LGs: questions generated during clinical consultations for intended post-consultation answering). Also, to characterize the type of learning goals generated. A cross-sectional analysis (2010-15) of an ongoing cohort study of Australian GP trainees' consultations. Once each 6-month training term, trainees record detailed data of 60 consecutive consultations. The primary outcome was generation of an LG. Analysis was at the level of individual problem/diagnosis managed. The secondary outcome was the problems/diagnoses to which the LGs related. One thousand one hundred and twenty-four trainees contributed data for 154746 consultations including 222307 problems...
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Inadequate patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidemia. Improved adherence rates may result in significantly improved cardiovascular outcomes in populations treated with... more
Inadequate patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidemia. Improved adherence rates may result in significantly improved cardiovascular outcomes in populations treated with lipid-lowering therapy. The purpose of this metaanalysis was to evaluate the effectiveness of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases through January 14, 2015, and also used the results from previous Cochrane reviews of this title. Randomized controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with measurable outcomes were evaluated with criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. Twenty-seven studi...
Immunisation is crucial to population health. This study aimed to identify the information needs and concerns of health consumers regarding childhood vaccination. We analysed 1,342 calls concerning childhood vaccination to an Australian... more
Immunisation is crucial to population health. This study aimed to identify the information needs and concerns of health consumers regarding childhood vaccination. We analysed 1,342 calls concerning childhood vaccination to an Australian pharmacist-operated medicines call centre (MCC). Data were available from September 2002 until June 2010. We identified key themes and compared these for callers from high and low immunisation coverage areas. Most calls related to safety concerns (60.4%), with many questions about vaccine constituents (31.6%). In low immunisation areas, a higher level of concern persisted about vaccine preservatives (mercury and thiomersal) despite their removal from vaccines in 2000. Of specific vaccines, the measles, mumps and rubella vaccine raised most questions (29.9%). Common motivations to call the MCC were 'inadequate information' (54%), 'second opinion' (21%) 'conflicting information' (9%) and 'worrying symptom' (6%). The cons...
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Antibiotic resistance is a public health concern, and is linked to over-prescribing. In self-limiting infections such as acute otitis media (AOM) and acute sinusitis, prescribing remains high despite strong guideline recommendations... more
Antibiotic resistance is a public health concern, and is linked to over-prescribing. In self-limiting infections such as acute otitis media (AOM) and acute sinusitis, prescribing remains high despite strong guideline recommendations against the routine use of antibiotics. Early career General Practitioners may find evidence-based prescribing challenging. To establish the prevalence and associations of antibiotic prescribing for AOM and acute sinusitis by Australian vocational trainees in General Practice. A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. This ongoing, multicentre prospective cohort study documents trainees' consultation-based clinical experiences. Univariate and logistic regression analyses were conducted on data recorded in consultations for AOM or acute sinusitis in nine collection periods during 2010-2014. Data from 856 individual trainees (response rate 95.2%) were analysed. AOM was managed in 0.9% of encou...
Research Interests: Evidence Based Medicine, Australia, Family Practice, Prospective studies, Humans, and 11 moreFemale, Male, Anti-Bacterial Agents, Sinusitis, Adult, Public health systems and services research, Otitis Media, Cross Sectional Studies, Inappropriate Prescribing, Guideline Adherence, and internship and residency
To investigate older patients' encounters with general practice registrars (GPRs) to inform training and clinical practice. Cross-sectional analysis of data from GPR consultations across five regional training providers in Australia.... more
To investigate older patients' encounters with general practice registrars (GPRs) to inform training and clinical practice. Cross-sectional analysis of data from GPR consultations across five regional training providers in Australia. Data were analysed using simple and multiple logistic regression models. Our analysis included details of 118 831 consultations, 20 555 (17.6%, 95% CI 17.4-17.8) with patients aged ≥65 years. Older patient encounters had an increased likelihood of including chronic disease (OR 1.77, 95% CI 1.70, 1.86) and more problems (OR 1.24, 95% CI 1.20, 1.27). However, in-consultation information or advice was less likely to be sought (OR 0.92, 95% CI 0.88, 0.97), and consultations were briefer (OR 0.99, 95% CI 0.99, 1.00). Our results suggest relatively limited GPR exposure to older patients coupled with less complex consultations than expected. Solutions will need to be carefully constructed not only to increase caseloads, but also to address training and sup...
Research Interests: General Practice, Australia, Multivariate Analysis, Humans, Female, and 15 moreMale, Graduate medical education, Educational Models, Aged, Middle Aged, Adult, Time Factors, Odds ratio, Age Factors, General Practitioners, Cross Sectional Studies, Logistic Models, Psychology and Cognitive Sciences, Medical and Health Sciences, and Referral and consultation
Whether general practitioner (GP) registrars have adequate exposure to, and feel confident in, managing children's health during training is unknown. To... more
Whether general practitioner (GP) registrars have adequate exposure to, and feel confident in, managing children's health during training is unknown. To determine the prevalence and associations of GP registrars' paediatric vs. non-paediatric consultations. Cross-sectional analysis from a cohort study of Australian GP registrars' 2010-2014 consultations. 889 registrars contributed details for 26,427 (21.8% (95% CI: 21.4-22.2) paediatric consultations. Paediatric patients were more likely to be male and new to the practice. Although paediatric patients were less likely to have a chronic disease (OR 0.38, 95% CI 0.36, 0.40) and presented with fewer problems (OR 0.59, 95% CI 0.57, 0.61), registrars were more likely to seek in-consultation advice (OR 1.25, 95% CI 1.19, 1.31) and generate learning goals (OR 1.12, 95% CI 1.07, 1.18) for paediatric consultations. GP registrars appear to feel less confident in managing paediatric compared with adult consultations, suggesting an unmet training need.
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The aim of this study was to assess the validity of a set of European quality indicators for assessing antimicrobial prescribing in Australian General Practice. A modified UCLA/RAND appropriateness method was used to assess the validity... more
The aim of this study was to assess the validity of a set of European quality indicators for assessing antimicrobial prescribing in Australian General Practice. A modified UCLA/RAND appropriateness method was used to assess the validity of 30 antimicrobial prescribing indicators. An expert panel of 12 general practitioners scored the validity of each indicator for measuring quality in Australian general practice. Four quality domains were considered: monitoring antibiotic resistance, benefit to individual patients, value for money and value to policymakers. Panel members were also asked to comment on the relevance to the Australian context and proposed benchmarks for each indicator. All panel members were in agreement regarding the validity of each indicator in each of the specified domains with exception of the indicator assessing the use of systemic antibiotics for pneumonia. The majority of the indicators and their associated benchmarks were considered valid for assessing quality in Australian General Practice, however, there were differences regarding the quality domain that each indicator was considered valid for. Monitoring quality considering individual patient benefit was the most problematic domain with respect to validity. This study demonstrates the validity of 30 European indicators for assessing quality of antimicrobial prescribing in general practice in a non-European setting and provides guidance regarding acceptable benchmarks for the indicators. With international concerns regarding misuse of antibiotics and global interest in prescribing quality, valid evidence-based antimicrobial prescribing indicators and associated benchmarks are an essential tool for assessing prescribing quality.
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Financial incentives and audit plus feedback on performance are two strategies commonly used by governments to motivate general practitioners (GP) to undertake specific healthcare activities. However, in recent years, governments have... more
Financial incentives and audit plus feedback on performance are two strategies commonly used by governments to motivate general practitioners (GP) to undertake specific healthcare activities. However, in recent years, governments have reduced or removed incentive payments without evidence of the potential impact on GP behaviour and patient outcomes. This trial (known as ACCEPt-able) aims to determine whether preventive care activities in general practice are sustained when financial incentives and/or external audit plus feedback on preventive care activities are removed. The activity investigated is annual chlamydia testing for 16- to 29-year-old adults, a key preventive health strategy within this age group. ACCEPt-able builds on a large cluster randomised controlled trial (RCT) that evaluated a 3-year chlamydia testing intervention in general practice. GPs were provided with a support package to facilitate annual chlamydia testing of all sexually active 16- to 29-year-old patients...
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This study explored consumer knowledge gaps and concerns regarding medication use in children. Calls concerning or made by people under 18 to the pharmacist-operated, national consumer medicines call centre National Prescribing Service... more
This study explored consumer knowledge gaps and concerns regarding medication use in children. Calls concerning or made by people under 18 to the pharmacist-operated, national consumer medicines call centre National Prescribing Service Medicines Line (2002 to June 2010) were analysed. Calls were classified and narratively explored by age group: <1, 1-4, 5-14 and 15-17 years. Consumer Medication Information (CMI) and evidence-based resources were examined to determine information concordance for common questions. There were 14 753 paediatric-related calls (mean age 4.1 years). Callers were predominantly female (91.5%), mean age was 35.8 years. Most (89.4%) phoned for a child and 2.2% for themselves. Main enquiry types were: lactation (22.1%), treatment/prophylaxis (11.1%), dose (10.2%), adverse reaction (10.0%), interaction (8.4%) and vaccination (8.4%). However, the primary enquiry differed by age group: lactation (<1 year), dosing (1-4, 5-14 years) and interactions (15-17 yea...
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For many medicines, safe use during pregnancy is not established and adherence is often poor due to safety concerns. Therefore, it is important to identify consumers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;... more
For many medicines, safe use during pregnancy is not established and adherence is often poor due to safety concerns. Therefore, it is important to identify consumers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; medicines information needs during pregnancy. A retrospective, mixed methods analysis was conducted on eight years of pregnancy-related calls to an Australian national medicines call centre. The call profile of pregnancy and non-pregnancy-related questions were compared. Medicines involved in pregnancy calls were categorised by class (Anatomical Therapeutic Chemical (ATC)3 level), and Therapeutic Goods Administration pregnancy category. Questions in these calls were also themed by pregnancy stage. We identified 4573 pregnancy-related and 118 547 non-pregnancy-related calls. The caller profile for pregnancy-related calls was female (93.7%), asking for herself (83.0%), and while 70.1% of questions involved one medicine, 9.6% involved three or more medicines. Pregnancy enquiries were prompted more often by conflicting information, inadequate information or desire for a second opinion. For 1166 calls, where the stage of pregnancy was available, most questions concerned safety. Medication classified as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;safe&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; during pregnancy accounted for 34% of these questions. After antidepressants, most calls were made about over-the-counter (OTC) medicines (paracetamol, dexchlorpheniramine, codeine). Safe treatment for everyday conditions was of increasing concern as the pregnancy progressed. Pregnant women are concerned about the safety of medication use in pregnancy and a significant proportion overestimate risk. Psychotropic medication and fertility are strong drivers to seek information during preconception. Everyday illnesses and self-medication with OTC medication are a common concern throughout pregnancy, even though many medicines are safe to use.
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While there is a significant focus on the health and well-being of women during pregnancy, labour and birth, much less emphasis is placed on the care of postpartum women and their infants in primary care following the birth. Some studies... more
While there is a significant focus on the health and well-being of women during pregnancy, labour and birth, much less emphasis is placed on the care of postpartum women and their infants in primary care following the birth. Some studies have investigated the role of GPs in postpartum care, and others examined facilitators and barriers to mothers accessing care. However there is little information available to investigate the effect of practice related factors on access to care of mothers and infants at this time. A 20-item questionnaire for completion by the practice managers was mailed to 497 general practices in Southern Queensland, Australia between February and July 2013. Questionnaire items included practice demographics, practice procedures and personnel including appointment scheduling, billing, practice nurse function and qualifications and a free-text option for comments. Descriptive statistics are presented as numbers and percentages. Chi Squared test compared practice lo...
Research Interests: General Practice, Primary Health Care, Australia, Library and Information Studies, Humans, and 12 moreQueensland, Female, Infant, Mothers, Health Expenditures, Nurse Practitioners, Adult, Public health systems and services research, Analysis of Variance, Cross Sectional Studies, Postnatal Care, and Surveys and Questionnaires
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To identify consumer information needs about paracetamol, the most commonly used analgesic and antipyretic worldwide. Retrospective analysis of medicines questions from the public. Australian consumer medicines call centre. Callers to... more
To identify consumer information needs about paracetamol, the most commonly used analgesic and antipyretic worldwide. Retrospective analysis of medicines questions from the public. Australian consumer medicines call centre. Callers to National Prescribing Service Medicines Line between September 2002 and June 2010 (n=123 217). Enquiry profile: demographics, enquiry type and concurrent medicines included in paracetamol calls; question themes derived from subset of call narratives. Paracetamol comprised part of the enquiry in 5.2% of calls (n=6367). The caller age distribution for paracetamol calls was skewed towards a younger cohort, with 45.2% made by those aged 25-44 vs 37.5% in 'rest of calls'. Significantly more paracetamol-related calls were made for a child (23.7%) compared with 'rest of calls' (12.7%, p<0.001). The most frequent concurrently asked about medicines were codeine (11%, n=1521) and ibuprofen (6.4%, n=884). Questions underpinned by paracetamol ris...
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The Lancet in 1999 suggested that &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;neglect of research has made primary care one of the most intellectually underdeveloped disciplines... more
The Lancet in 1999 suggested that &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;neglect of research has made primary care one of the most intellectually underdeveloped disciplines in medicine&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and later labelled general practice research &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;a lost cause&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. According to the Medical Journal of Australia, this underdevelopment &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;stems from a lack of research culture, a heavy service commitment and the late arrival of academic GPs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;.
Research Interests: Primary Care, General Practice, Publishing, Australia, Forecasting, and 12 moreHealth Services Research, Capacity Building, Family Practice, Continuing Medical Education, Humans, Biomedical Research, Academic research, Commissioning, Clinical Sciences, Public health systems and services research, Clinical Competence, and Quality of health care
Research Interests:
Acute lower respiratory tract infections (LRTIs) (e.g. pneumonia) are a major cause of morbidity and mortality and management focuses on early treatment. Chest radiographs (X-rays) are one of the commonly used strategies. Although... more
Acute lower respiratory tract infections (LRTIs) (e.g. pneumonia) are a major cause of morbidity and mortality and management focuses on early treatment. Chest radiographs (X-rays) are one of the commonly used strategies. Although radiological facilities are easily accessible in high-income countries, access can be limited in low-income countries. The efficacy of chest radiographs as a tool in the management of acute LRTIs has not been determined. Although chest radiographs are used for both diagnosis and management, our review focuses only on management. To assess the effectiveness of chest radiographs in addition to clinical judgement, compared to clinical judgement alone, in the management of acute LRTIs in children and adults. We searched CENTRAL 2013, Issue 1; MEDLINE (1948 to January week 4, 2013); EMBASE (1974 to February 2013); CINAHL (1985 to February 2013) and LILACS (1985 to February 2013). We also searched NHS EED, DARE, ClinicalTrials.gov and WHO ICTRP (up to February 2013). Randomised controlled trials (RCTs) of chest radiographs versus no chest radiographs in acute LRTIs in children and adults. Two review authors independently applied the inclusion criteria, extracted data and assessed risk of bias. A third review author compiled the findings and any discrepancies were discussed among all review authors. We used the standard methodological procedures expected by The Cochrane Collaboration. Two RCTs involving 2024 patients (1502 adults and 522 children) were included in this review. Both RCTs excluded patients with suspected severe disease. It was not possible to pool the results due to incomplete data. Both included trials concluded that the use of chest radiographs did not result in a better clinical outcome (duration of illness and of symptoms) for patients with acute LRTIs. In the study involving children in South Africa, the median time to recovery was seven days (95% confidence interval (CI) six to eight days (radiograph group) and six to nine days (control group)), P value = 0.50, log-rank test) and the hazard ratio for recovery was 1.08 (95% CI 0.85 to 1.34). In the study with adult participants in the USA, the average duration of illness was 16.9 days versus 17.0 days (P value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) in the radiograph and no radiograph groups respectively. This result was not statistically significant and there were no significant differences in patient outcomes between the groups with or without chest radiograph.The study in adults also reports that chest radiographs did not affect the frequencies with which clinicians ordered return visits or antibiotics. However, there was a benefit of chest radiographs in a subgroup of the adult participants with an infiltrate on their radiograph, with a reduction in length of illness (16.2 days in the group allocated to chest radiographs and 22.6 in the non-chest radiograph group, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), duration of cough (14.2 versus 21.3 days, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and duration of sputum production (8.5 versus 17.8 days, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The authors mention that this difference in outcome between the intervention and control group in this particular subgroup only was probably a result of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;the higher proportion of patients treated with antibiotics when the radiograph was used in patient care&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;.Hospitalisation rates were only reported in the study involving children and it was found that a higher proportion of patients in the radiograph group (4.7%) required hospitalisation compared to the control group (2.3%) with the result not being statistically significant (P = 0.14). None of the trials report the effect on mortality, complications of infection or adverse events from chest radiographs. Overall, the included studies had a low or unclear risk for blinding, attrition bias and reporting bias, but a high risk of selection bias. Both trials had strict exclusion criteria which is important but may limit the clinical practicability of the results as participants may not reflect those presenting in clinical practice. Data from two trials suggest that routine chest radiography does not affect the clinical outcomes in adults and children presenting to a hospital with signs and symptoms suggestive of a LRTI. This conclusion may be weakened by the risk of bias of the studies and the lack of complete data available.
Research Interests:
Research Interests:
Skin conditions are commonly encountered in general practice but dermatology is underrepresented in undergraduate medical courses. Australian and international studies have shown that the dermatological diagnostic ability of general... more
Skin conditions are commonly encountered in general practice but dermatology is underrepresented in undergraduate medical courses. Australian and international studies have shown that the dermatological diagnostic ability of general practitioners (GPs) is suboptimal, contributing to increased dermatology outpatient referrals. Dermatological experience in GP vocational training is thus of particular importance. We aimed to document the prevalence of skin disease presentations and the range of skin diseases encountered by GP trainees. We also sought to establish associations of GP trainee's skin disease experience, including their personal characteristics, consultation factors, and the actions arising from the consultation. This study took place in the Registrars Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing, prospective, multi-site cohort study of Australian GP trainees' consultations. A descriptive cross-sectional analysis was performed on trainees'...
Research Interests:
Research Interests:
Guidelines recommend anxiolytics and hypnotics (A/H) as second-line, short-term medications. We aimed to establish prevalence and associations of A/H prescribing by Australian general practice (GP) trainees. A cross-sectional analysis... more
Guidelines recommend anxiolytics and hypnotics (A/H) as second-line, short-term medications. We aimed to establish prevalence and associations of A/H prescribing by Australian general practice (GP) trainees. A cross-sectional analysis from a cohort study of vocational trainees from four GP Regional Training Providers during 2010-2013. General practice trainees act as independent practitioners (including for prescribing purposes) while having recourse to advice from a GP supervisor. Practice and trainee demographic data were collected as well as patient, clinical and educational data from 60 consecutive consultations of each trainee each training term. Analysis was at the level of individual problem managed, with the outcome factor being prescription of any anxiolytic or hypnotic. Overall, 645 registrars (response rate 94.0%) prescribed 68 582 medications in 69 621 consultations (with 112 890 problems managed). A/Hs were prescribed for 1.3% of problems managed and comprised 2.2% of all prescriptions. They were prescribed particularly for insomnia (28.2%) or anxiety (21.8%), but also for many &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;off-label&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; indications. Significant associations of A/H prescriptions were: patient-level (greater age, Aboriginal and Torres Strait Islander status, English-speaking background, being new to the trainee but not to the practice); trainee-level (male) and consultation-level (longer duration, pre-existing problem, specialist referral not being made). Prescribing was significantly lower in one of the four Regional Training Providers. GP trainees, inconsistent with most guideline recommendations, prescribe A/Hs mainly as maintenance therapy to unfamiliar and older patients. Our results suggest that changes in management approaches are needed which may be facilitated by support for psychotherapeutic training. [Holliday SM, Morgan S, Tapley A, Henderson KM, Dunlop AJ, van Driel ML, Spike NA, McArthur LA, Ball J, Oldmeadow CJ, Magin PJ. The pattern of anxiolytic and hypnotic management by Australian general practice trainees. Drug Alcohol Rev 2016;00:000-000].
Research Interests:
Research Interests:
Limited evidence exists regarding the relationship between health literacy and health-related quality of life (HRQoL) in Australian patients from primary care. The objective of this study was to investigate the impact of health literacy... more
Limited evidence exists regarding the relationship between health literacy and health-related quality of life (HRQoL) in Australian patients from primary care. The objective of this study was to investigate the impact of health literacy on HRQoL in a large sample of patients without known vascular disease or diabetes and to examine whether the difference in HRQoL between low and high health literacy groups was clinically significant. This was a cross-sectional study of baseline data from a cluster randomised trial. The study included 739 patients from 30 general practices across four Australian states conducted in 2012 and 2013 using the standard Short Form Health Survey (SF-12) version 2. SF-12 physical component score (PCS-12) and mental component score (MCS-12) are derived using the standard US algorithm. Health literacy was measured using the Health Literacy Management Scale (HeLMS). Multilevel regression analysis (patients at level 1 and general practices at level 2) was applie...
Research Interests:
There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory... more
There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice. This is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization. This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infecti...
Research Interests:
Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide. We aimed to establish whether early-career 'apprenticeship-model' experience in family practice influences... more
Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide. We aimed to establish whether early-career 'apprenticeship-model' experience in family practice influences antibiotic prescribing for respiratory tract infections and to also establish other associations of antibiotic prescribing changes during this early-career experience. A longitudinal analysis (2010-2014) of a cohort study of Australian GP registrars' (vocational trainees') consultations. Registrars from five regional training programs recorded data from 60 consecutive consultations, once each 6-month training Term, including the diagnoses managed and medications prescribed. The outcomes were whether an antibiotic was prescribed for the diagnoses 'upper respiratory tract infection (URTI)' and 'acute bronchitis/bronchiolitis'. Generalized linear mixed modelling was used to account for repeated measures on registrars and to include th...
Research Interests:
Acute sore throat is a common condition presenting to family practitioners. It is usually self-limiting, with antibiotic treatment recommended only for high-risk presentations. Overprescribing of antibiotics contributes to individual and... more
Acute sore throat is a common condition presenting to family practitioners. It is usually self-limiting, with antibiotic treatment recommended only for high-risk presentations. Overprescribing of antibiotics contributes to individual and community resistance. Learning to prescribe in the context of diagnostic uncertainty and patient pressures is a challenge for early-career doctors. Prescribing habits develop early and tend not to change with time. To establish the prevalence and associations of antibiotic prescribing for acute sore throat by Australian vocational trainees in family practice. A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. This ongoing, multicentre prospective cohort study documents the nature of trainees&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; consultation-based clinical experiences. Univariate and logistic regression analyses were conducted on data recorded in consultations for sore throat in nine collection periods during 2010-14. Data from 856 individual trainees (response rate 95.2%) were analysed. Sore throat was managed in 2.3% encounters. Antibiotics were prescribed for 71.5% of sore throat diagnoses. The variables associated with prescribing were inner-regional location and higher socio-economic area. There was no significant association with younger age of patient or greater trainee experience. If an antibiotic was prescribed, the trainee was more likely to seek information from guidelines or a supervisor. The high frequency of antibiotic prescribing and the lack of attenuation in prescribing with increased experience suggest current educational interventions and the apprenticeship model of training is not fostering appropriate practice in this important clinical area. Targeted educational interventions, for supervisors as well as trainees, are indicated.
Research Interests:
This is the third article in a series providing evidence-based answers to common questions about complementary medicines from consumers and healthcare professionals.
Research Interests: Depression, Drug interactions, Consumer Health Information, Humans, Blood Glucose, and 15 moreDiabetes mellitus, Blood Pressure, Complementary Therapies, Female, Anticoagulants, Clinical Sciences, Aged, Glucosamine, Adult, Cardiovascular Diseases, Hypericum, Ginkgo Biloba, Health Personnel, Antihypertensive agents, and Antidepressive agents
To determine the impact of the presence of a medical student on the satisfaction and process of the general practice consultation from the perspective of the general practitioner (GP), patient and student. An observational study was... more
To determine the impact of the presence of a medical student on the satisfaction and process of the general practice consultation from the perspective of the general practitioner (GP), patient and student. An observational study was conducted in regional general practices accepting third-year medical students. General practitioners, patients and medical students were asked to complete a questionnaire after each consultation. The main outcome measures were: patient satisfaction; GPs' perceived ability to deliver care; medical students' satisfaction with their learning experience; length of consultation; and patient waiting times. Of the 26 GP practices approached, 11 participated in the study (42.3%). Patients returned 477 questionnaires: 252 consultations with and 225 without a student present. Thirteen GPs completed 473 questionnaires: 248 consultations with and 225 without a student. Twelve students attended 255 consultations. Most patients (83.5%) were comfortable with th...
Research Interests: General Practice, Education, Medical Education, Problem Based Learning, Adolescent, and 15 moreHumans, Female, Male, Young Adult, Patient Satisfaction, Waiting lists, Aged, Middle Aged, Adult, Time Factors, General Practitioners, Cross Sectional Studies, Psychology and Cognitive Sciences, Medical and Health Sciences, and Physician-Patient Relations
International research has proved that academic detailing positively influences the prescribing behaviour of physicians. In the North-East Flanders region of Belgium, a quantitative study of the feasibility and acceptability of academic... more
International research has proved that academic detailing positively influences the prescribing behaviour of physicians. In the North-East Flanders region of Belgium, a quantitative study of the feasibility and acceptability of academic detailing in general practice has demonstrated that academic detailers are appreciated by physicians. In addition to the quantitative study, a qualitative study was carried out to determine physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes to academic detailing and their objections against it. This study took place in general practice in the North-East Flanders region of Belgium, using semistructured interviews. Nineteen physicians who had previously had a visit from an academic detailer in the quantitative study, and 19 who had refused were invited for an interview. Eighteen physicians who had been visited by an academic detailer, and nine who had refused a visit agreed to be interviewed. Although most physicians who had had a visit from an academic detailer appreciated the visit, some barriers were revealed. Physicians had doubts about the objectivity, stated that the information was not new or that they had other ways to obtain information. These barriers were also mentioned by the physicians who had refused a visit. Additional barriers were that the visits were time-consuming, meant to cut expenses, politically coloured, and patronising. Doubts about independence and objectivity of the information were stated as important barriers both by physicians who had accepted a visit from an academic detailer and by those who had not. These issues need to be dealt with when designing future interventions with academic detailers.
Research Interests:
Over-prescription of antibiotics for non-pneumonia respiratory tract infections (RTIs) is a major concern in general practice. Australian general practice registrars (trainees) have inappropriately high rates of prescription of... more
Over-prescription of antibiotics for non-pneumonia respiratory tract infections (RTIs) is a major concern in general practice. Australian general practice registrars (trainees) have inappropriately high rates of prescription of antibiotics for RTIs. The &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;apprenticeship&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; educational model and the trainee-trainer relationship are drivers of this inappropriate prescribing. We aimed to reduce registrars&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; non-pneumonia RTI antibiotic prescribing via an educational intervention (a 90-min face-to-face workshop supported by online modules), complemented by delivery of the same intervention, separately, to their trainers. We conducted a pre- and post-intervention comparison of the registrars&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; intention to prescribe antibiotics for common RTIs using McNemar&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s test. We similarly tested changes in supervisors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; intended prescribing. Prescribing intentions were elicited by responses to six written clinical vignettes (upper respiratory tract infection, otitis media, sore throat and three acute bronchitis vignettes). We found that, for registrars, there were statistically significant reductions in antibiotic prescribing for the sore throat (24.0% absolute reduction), otitis media (17.5% absolute reduction) and two of the three acute bronchitis (12.0% and 18.0% absolute reduction) vignettes. There were significant reductions in…
Research Interests: General Practice, Australia, Humans, Female, Male, and 12 moreGraduate medical education, Middle Aged, Anti-Bacterial Agents, Adult, Public health systems and services research, Bronchitis, Otitis Media, Respiratory Tract Infections, Internet, Inappropriate Prescribing, internship and residency, and pharyngitis
Continuity of care is a defining characteristic of general practice. Practice structures may limit continuity of care experience for general practice registrars (trainees). This study sought to establish prevalence and associations of... more
Continuity of care is a defining characteristic of general practice. Practice structures may limit continuity of care experience for general practice registrars (trainees). This study sought to establish prevalence and associations of registrars&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; continuity of care. We performed an analysis of an ongoing cohort study of Australian registrars&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; clinical consultations. Primary outcome factors were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Upstream&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; continuity (having seen the patient prior to the index consultation) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Downstream&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; continuity (follow-up organised post-index consultation). Independent variables were registrar, practice, patient, consultation and educational factors. 400 registrars recorded 48,114 consultations. 43% of patients had seen the registrar pre-index consultation, and 49% had follow-up organised.…
Research Interests:
Objectives Informational and management continuity of care assists in providing a seamless transition for women and infants from tertiary or secondary to primary care during the post partum period. Few studies have evaluated the... more
Objectives Informational and management continuity of care assists in providing a seamless transition for women and infants from tertiary or secondary to primary care during the post partum period. Few studies have evaluated the interaction between different aspects of the health system following a woman's discharge from hospital after the birth of her infant. The present study describes how general practitioners (GPs) experience communications with hospitals and other post partum care providers relevant to continuity of care.Methods In the present cross-sectional study, a 52-item questionnaire adapted from a previously used survey was mailed to 932 GPs in southern Queensland, Australia, between February and July 2013. Questionnaire items included participant demographics, the timeliness and usability of discharge summaries, communication with other post partum care providers and consultation practices.Results The response rate was 17.4%. Nearly one-quarter of participants never...
Research Interests: Nursing, Pregnancy, Humans, Queensland, Female, and 15 moreMale, Newborn Infant, Aged, Middle Aged, Public Administration and Policy, Adult, Public health systems and services research, Interdisciplinary Communication, General Practitioners, Continuity of Patient Care, Cross Sectional Studies, Postnatal Care, Australian Health, Surveys and Questionnaires, and Patient discharge
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To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease. 32 urban general practices in 4 Australian states. Stratified randomisation of practices. 122 general practitioners (GPs)... more
To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease. 32 urban general practices in 4 Australian states. Stratified randomisation of practices. 122 general practitioners (GPs) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21 848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness. The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information. Primary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting bl...
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Australia is one of the highest users of antibiotics in the developed world. This study aimed to identify consumer antibiotic information needs to improve targeting of medicines information. We conducted a retrospective, mixed-method... more
Australia is one of the highest users of antibiotics in the developed world. This study aimed to identify consumer antibiotic information needs to improve targeting of medicines information. We conducted a retrospective, mixed-method study of consumers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; antibiotic-related calls to Australia&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s National Prescribing Service (NPS) Medicines Line from September 2002 to June 2010. Demographic and question data were analysed, and the most common enquiry type in each age group was explored for key narrative themes. Relative antibiotic call frequencies were determined by comparing number of calls to antibiotic utilization in Australian Statistics on Medicines (ASM) data. Between 2002 and 2010, consumers made 8696 antibiotic calls to Medicines Line. The most common reason was questions about the role of their medicine (22.4%). Patient age groups differed in enquiry pattern, with more questions about lactation in the 0- to 4-year age group (33.6%), administration (5-14 years: 32.4%), interactions (15-24 years: 33.4% and 25-54 years: 23.3%) and role of the medicine (55 years and over: 26.6%). Key themes were identified for each age group. Relative to use in the community, antibiotics most likely to attract consumer calls were ciprofloxacin (18.0 calls/100000 ASM prescriptions) and metronidazole (12.9 calls/100000 ASM prescriptions), with higher call rates than the most commonly prescribed antibiotic amoxicillin (3.9 calls/100000 ASM prescriptions). Consumers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge gaps and concerns about antibiotics vary with age, and certain antibiotics generate greater concern relative to their usage. Clinicians should target medicines information to proactively address consumer concerns.
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ABSTRACT
In the context of increasing over-testing and the implications for patient safety, to establish the prevalence and nature of pathology test-ordering of GP trainees, and to describe the associations of this test-ordering. A cross-sectional... more
In the context of increasing over-testing and the implications for patient safety, to establish the prevalence and nature of pathology test-ordering of GP trainees, and to describe the associations of this test-ordering. A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study. Five of Australia's 17 general practice regional training providers, encompassing urban-to-very remote practices. GP trainees. The number of pathology tests ordered per problem/diagnosis managed. A total of 856 individual trainees (response rate 95.2%) contributed data from 1832 trainee-terms, 108 759 encounters and 169 304 problems. Pathology test-ordering prevalence was 79.3 tests (95% CI: 78.8-79.8) per 100 encounters, 50.9 (95% CI: 50.6-51.3) per 100 problems, and at least 1 test was requested in 22.4% of consultations. Most commonly ordered was full blood count (6.1 per 100 problems). The commonest problem prompting test-ordering was 'check-up...
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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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Young people aged 12-25 years are poorly serviced by current models of healthcare; they are under represented in Medicare data and are poor seekers of healthcare. However, the majority of mental health problems commence during this age... more
Young people aged 12-25 years are poorly serviced by current models of healthcare; they are under represented in Medicare data and are poor seekers of healthcare. However, the majority of mental health problems commence during this age span, significant sexual health issues arise, and there is poor compliance with treatment for chronic disease. This article describes a holistic, multisector primary healthcare delivery model which may provide a way forward to improve both access and outcomes for young people. The &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;headspace Gold Coast&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; model incorporates the relationship the young person has with both the organisation and the individuals within it; a focus on social and vocational rehabilitation; and a team based approach. The model provided at headspace serves an unmet need for young people in urban settings. However, more and ongoing support is crucial, including options for integration into existing primary care.
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In 2008, Australian Family Physician (AFP) was accepted on the list of journals listed in Science Citation Index Expanded and, thus, will generate an impact factor over the next 2 years. Impact factor is important to authors from research... more
In 2008, Australian Family Physician (AFP) was accepted on the list of journals listed in Science Citation Index Expanded and, thus, will generate an impact factor over the next 2 years. Impact factor is important to authors from research and academic backgrounds and will make AFP an increasingly attractive journal in which to publish. To describe the impact factor, its method of calculation, and its flaws. Impact factor is the number of a journal's cited research papers divided by the total number of citable papers it has published. It is distorted by several different factors: sub-discipline, region, basic versus applied research, and whether the journal editor deliberately tries to strategically increase their impact factor. Impact factor is an oversimplified single measure of 'impact', which may underestimate the contribution of the AFP to society. However, no accepted alternative metric currently exists.
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DESCRIPTION A systematic review of clinical guidelines. URL for QR code generation purpose only.
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 repo...
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Pioglitazone pour le diabète: espoirs déçus Dormandy JA, Charbonnel B, Eckland DJA et al; PROactive investigators. Secondary prevention of macro- vascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised...more
General practice is central to Aboriginal and Torres Strait Islander health care, and this area is a core element of Australian general practice (GP) training. We aimed to describe the prevalence, nature and associations of GP registrar... more
General practice is central to Aboriginal and Torres Strait Islander health care, and this area is a core element of Australian general practice (GP) training. We aimed to describe the prevalence, nature and associations of GP registrar encounters with Aboriginal and Torres Strait Islander patients. A cross-sectional analysis from a cohort study of GP registrars' clinical consultations 2010-2013. Registrars record demographic, clinical and educational details of consecutive patient encounters. Multivariable associations were tested with logistic regression. A total of 592 registrars contributed data from 69,188 consultations. Encounters with Aboriginal and Torres Strait Islander patients comprised 1.0% of consultations. Significant positive associations included younger patient age; new patient to the registrar; lower socioeconomic status of practice location; non-urban practice setting; more problems managed; and follow-up arranged. A greater proportion of Aboriginal and Torres...
Research Interests: General Practice, Australia, Cultural Competency, Family Practice, Applied Economics, and 15 moreMultivariate Analysis, Humans, Female, Male, Aged, Prevalence, Middle Aged, Public Administration and Policy, Adult, Public health systems and services research, Cross Sectional Studies, Logistic Models, Cohort Studies, Health Personnel, and Referral and consultation
Although older cancer survivors commonly report psychosocial problems, the impact of both cancer and ageing on the occurrence of these problems remains largely unknown. The evolution of depression, cognitive functioning, and fatigue was... more
Although older cancer survivors commonly report psychosocial problems, the impact of both cancer and ageing on the occurrence of these problems remains largely unknown. The evolution of depression, cognitive functioning, and fatigue was evaluated in a group of older cancer patients in comparison with a group of younger cancer patients and older persons without cancer. Older (≥70 years) and younger cancer patients (50 - 69 years) with breast or colorectal cancer stage I - III, and older persons without cancer (≥70 years) were included. Data were collected at baseline and one year follow-up and were available for 536 persons. Depression was evaluated with the 15-item Geriatric Depression Scale. Cognitive functioning was measured with the cognitive functioning subscale of the European Organization for Research and Treatment of Cancer. Fatigue was measured with a Visual Analogue Scale. Risk factors for depression, cognitive functioning, and fatigue were analysed using multivariate logis...
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To evaluate whether fatigue severity can serve as a cue to investigate the presence of depression in older adult patients with cancer.
. Cross-sectional observational cohort study.
. Seven hospitals and general practices in Belgium and... more
To evaluate whether fatigue severity can serve as a cue to investigate the presence of depression in older adult patients with cancer.
. Cross-sectional observational cohort study.
. Seven hospitals and general practices in Belgium and the Netherlands.
. 205 older adult patients with cancer and 436 older adults without cancer (aged 70 years or older).
. The diagnostic accuracy of fatigue as a proxy for depression was evaluated using sensitivity, specificity, and predictive values.
. Fatigue was measured with a visual analog scale, and depression was measured with the 15-item Geriatric Depression Scale.
. Fifty-six percent of the population experienced fatigue, and 13% were depressed. For fatigue as a cue for depression, sensitivity was 82%, specificity was 47%, positive predictive value was 18%, and negative predictive value was 95%.
. The data confirm that fatigue is a valuable cue to investigate the presence of depression because 82% of depressed participants were correctly iden...
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To investigate the feasibility and acceptability of academic detailing in general practice in the North-East-Flanders region of Belgium. All local quality groups in the study region were randomly allocated to either (1) two academic... more
To investigate the feasibility and acceptability of academic detailing in general practice in the North-East-Flanders region of Belgium. All local quality groups in the study region were randomly allocated to either (1) two academic detailing visits to the individual members or (2) two academic detailing visits during the meetings of the local quality group. During these visits, the results of a systematic review of the literature on non-steroidal anti-inflammatory agents (NSAIDs) were presented. Of 14 local quality groups, 12 allocated to the individual intervention agreed to participate. Of the 184 physicians invited to receive an academic detailer, 142 had two visits on NSAIDs. One hundred and five physicians gave their opinion on the visits by means of a questionnaire. The great majority of the responders (90%) wished to receive an academic detailer on other topics in the future, with a frequency of two visits per year. Of 13 local quality groups, 12 allocated to the group inter...
Research Interests: General Practice, Family Practice, Belgium, Humans, Female, and 15 moreFeasibility Studies, Male, Physicians, European, Aged, Middle Aged, Pilot study, Professional Practice, Questionnaires, Adult, General practitioner, North East, Pilot Projects, Pharmacology and pharmaceutical sciences, and Drug prescriptions
Fatigue is the most common undifferentiated problem presenting in general practice. Previous studies have shown that this presentation leads to multiple investigations. There is no published literature describing the management of... more
Fatigue is the most common undifferentiated problem presenting in general practice. Previous studies have shown that this presentation leads to multiple investigations. There is no published literature describing the management of patients with fatigue by general practice (GP) registrars. To document the investigation-ordering behaviour of GP registrars in managing patients with a new diagnosis of unexplained fatigue. This was a cross-sectional analysis of data from Registrar Clinical Encounters in Training (ReCEnT), an ongoing cohort study of GP registrars' consultations. We established the prevalence of new diagnoses of unexplained fatigue and associations with that diagnosis, the rate of test ordering and the number and types of investigations ordered. 644 registrars contributed data from 68 986 encounters. In 0.78% of patient encounters, a new diagnosis of unexplained fatigue was made. Pathology was ordered in 78.4% of these problems (versus 18.1% in non-fatigue problems), a...
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Research Interests: General Practice, Australia, Access To Information, Adolescent, Applied Economics, and 13 moreHumans, Female, Male, Aged, Middle Aged, Public Administration and Policy, Adult, Public health systems and services research, Medical Records, Cross Sectional Studies, Logistic Models, health status indicators, and healthcare disparities
Objective To establish prevalence and associations of general practice nurses’ (GPNs) involvement in general practitioner (GP) registrars’ consultations. Methods A cross-sectional analysis from an ongoing cohort study of registrars’... more
Objective To establish prevalence and associations of general practice nurses’ (GPNs) involvement in general practitioner (GP) registrars’ consultations. Methods A cross-sectional analysis from an ongoing cohort study of registrars’ clinical consultations in five Australian states. Registrars recorded detailed data from 60 consecutive consultations per 6-month training term. Problems and diagnoses encountered, including chronic disease classification, were coded using the International Classification of Primary Care, second edition duplication system (ICPC-2plus) classification system. The outcome factor in our analysis was GPN involvement in management of individual problems and diagnoses. Independent variables were a range of patient, registrar, practice, consultation and educational factors. Results We analysed 108759 consultations of 856 registrars including 169307 problems or diagnoses. Of the problems/diagnoses, 5.1% (95% confidence interval (CI) 5.0–5.2) involved a GPN. Follo...
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The apprenticeship model of general practice (GP) training is based on appropriate supervision. A central component of supervision - in-consultation information-seeking of GP trainees from their trainer - has not been documented. We aimed... more
The apprenticeship model of general practice (GP) training is based on appropriate supervision. A central component of supervision - in-consultation information-seeking of GP trainees from their trainer - has not been documented. We aimed to establish the prevalence, characteristics and associations (trainee, practice, patient and consultation) of this information-seeking. Australian trainees recorded demographic, clinical and educational details of 60 consecutive consultations in each GP term of their training, including the rate and nature of information-seeking. Six-hundred and forty-five trainees contributed data for 1426 trainee-rounds, 84 723 consultations and 131 583 problems. Information was sought from the trainer for 9130 (6.9% (95% CI 6.8-7.1)) of all problems encountered (and in 7833 (9.2% (95% CI 9.0-9.4)) of consultations): 11.7% (95% CI 11.0- 12.4) were for diagnosis, 53.1% (95% CI 52.1-54.2) for management and 35.2% (95% CI 34.2-36.2) for both diagnosis and managemen...
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Answering clinical questions arising from patient care can improve that care and offers an opportunity for adult learning. It is also a vital component in practising evidence-based medicine. GPs' sources of in-consultation information... more
Answering clinical questions arising from patient care can improve that care and offers an opportunity for adult learning. It is also a vital component in practising evidence-based medicine. GPs' sources of in-consultation information can be human or non-human (either hard copy or electronic). To establish the prevalence and associations of GP trainees' in-consultation information-seeking, and to establish the prevalence of use of different sources of information (human, hard copy and electronic) and the associations of choosing particular sources. A cross-sectional analysis of data (2010-13) from an ongoing cohort study of Australian GP trainees' consultations. Once each 6-month training term, trainees record detailed data of 60 consecutive consultations. The primary outcome was whether the trainee sought in-consultation information for a problem/diagnosis. Secondary outcomes were whether information-seeking was from a human (GP, other specialist or other health profess...
Research Interests: General Practice, Australia, Family Practice, Problem Solving, Humans, and 10 moreFemale, Male, Information Seeking Behavior, Adult, Public health systems and services research, Interdisciplinary Communication, Cross Sectional Studies, Internet, internship and residency, and interprofessional relations
We studied the frequency and evolution of social and emotional loneliness in older cancer patients in comparison with younger cancer patients and older people without cancer. We evaluated if changes in common cancer-related and... more
We studied the frequency and evolution of social and emotional loneliness in older cancer patients in comparison with younger cancer patients and older people without cancer. We evaluated if changes in common cancer-related and ageing-related problems such as fatigue, cognitive functioning and functional status contributed to the occurrence of loneliness. This study was part of the KLIMOP study (Dutch acronym for project on older cancer patients in Belgium and the Netherlands) and included older (≥70 years) and younger cancer patients (50-69 years) and older people without cancer. Data were collected at baseline and 1-year follow-up. Loneliness was measured with the loneliness scale of De Jong-Gierveld. The relationship between loneliness after 1 year and changes in fatigue, cognitive functioning and functional status was tested in multivariate logistic regression analyses. Data were available for 475 participants. At baseline, older cancer patients were less lonely compared with ol...
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Travel medicine is a common and challenging area of clinical practice and practitioners need up-to-date knowledge and experience in a range of areas. Australian general practitioners (GPs) play a significant role in the delivery of travel... more
Travel medicine is a common and challenging area of clinical practice and practitioners need up-to-date knowledge and experience in a range of areas. Australian general practitioners (GPs) play a significant role in the delivery of travel medicine advice. We aimed to describe the rate and nature of travel medicine consultations, including both the clinical and educational aspects of the consultations. A cross-sectional analysis from an ongoing cohort study of GP trainees' clinical consultations was performed. Trainees contemporaneously recorded demographic, clinical, and educational details of consecutive patient consultations. Proportions of all problems/diagnoses managed in these consultations that were coded "travel-related" and "travel…
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Indiscriminate health screening is increasingly seen as being problematic. In particular, vitamin D testing rates are increasing rapidly despite recommendations against population screening. The purpose of this study was to determine the... more
Indiscriminate health screening is increasingly seen as being problematic. In particular, vitamin D testing rates are increasing rapidly despite recommendations against population screening. The purpose of this study was to determine the level of vitamin D testing among family practice/general practitioner (GP) trainees and to establish associations of this testing. Cross-sectional analysis of data from the ReCEnT (Registrars Clinical Encounters in Training) cohort study. The setting was GP practices in four Australian states. Data from 60 consecutive consultations per trainee were recorded each 6-month training term (up to four terms). Vitamin D tests were ordered in 726 (1.0%) of encounters (n = 69 412). Vitamin D test ordering was significantly associated with patients being older, female and non-English speaking. Trainees were more likely to test if they worked in a completely bulk-billing practice (i.e. a practice without any patient payment), if more problems were dealt with, ...
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Little is known about consumer information needs regarding antipsychotic medicines. Medicines call centre (MCC)-derived data are underutilised; and could provide insight into issues of importance to consumers. This study aimed to explore... more
Little is known about consumer information needs regarding antipsychotic medicines. Medicines call centre (MCC)-derived data are underutilised; and could provide insight into issues of importance to consumers. This study aimed to explore consumers' information needs about antipsychotic medication sought from a national MCC in Australia. Questions received by the National Prescribing Service Medicines Line relating to antipsychotic medication from September 2002 to June 2010 were examined by antipsychotic subclass and in relation to other medication queries. We identified 6,295 calls related to antipsychotic medication. While female callers predominated, the percentage of males with antipsychotic questions was statistically significantly higher than for other medication calls (33.9 vs 22.6 %; p < 0.001). There were distinct gender differences in medicines information seeking across age ranges. Younger men asked about second-generation antipsychotics, shifting toward first-gene...
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Antibiotic resistance is a public health concern worldwide. A high proportion of antibiotics are prescribed in primary care, often for conditions where there is no evidence of benefit. Without a change in these prescribing patterns,... more
Antibiotic resistance is a public health concern worldwide. A high proportion of antibiotics are prescribed in primary care, often for conditions where there is no evidence of benefit. Without a change in these prescribing patterns, resistance will persist as a significant problem in the future. Little is known about how trainees in general practice perceive and develop their prescribing. To explore the attitudes of trainees in general practice towards antibiotic use and resistance, and the perceived influences on their prescribing. A qualitative study of 17 vocational trainees in general practice (GP registrars) in both rural and urban areas in Australia employing semi-structured interviews and a focus group. Maximum variation purposive sampling of GP registrars from diverse backgrounds and training stages continued until thematic saturation was achieved. Topics of discussion included awareness of antibiotic resistance, use of evidence-based guidelines, and perceived influences on ...
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People with intellectual disability experience difficulty forming intimate relationships and are prone to sexual exploitation and abuse. This study sought information from people involved in the care of adults with intellectual disability... more
People with intellectual disability experience difficulty forming intimate relationships and are prone to sexual exploitation and abuse. This study sought information from people involved in the care of adults with intellectual disability regarding how they supported them in the areas of sexuality, relationships and abuse prevention. Semistructured interviews and focus groups were held with 28 family members and paid support workers caring for adults with intellectual disabilities. Interviews and focus groups were audio recorded, transcribed, coded and analysed qualitatively. Major themes emerging included views on sexuality and intellectual disability, consent and legal issues, relationships, sexual knowledge and education, disempowerment, exploitation and abuse, sexual health and parenting. People with intellectual disability were described as lonely, disempowered and vulnerable to abuse. The sex industry, internet and mobile telephones were identified as new forms of risk. While ...
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The Lancet in 1999 suggested that 'neglect of research has made primary care one of the most intellectually underdeveloped disciplines in medicine' and later labelled general practice research 'a lost cause'. According to... more
The Lancet in 1999 suggested that 'neglect of research has made primary care one of the most intellectually underdeveloped disciplines in medicine' and later labelled general practice research 'a lost cause'. According to the Medical Journal of Australia, this underdevelopment 'stems from a lack of research culture, a heavy service commitment and the late arrival of academic GPs'.
Research Interests: Primary Care, General Practice, Publishing, Australia, Forecasting, and 12 moreHealth Services Research, Capacity Building, Family Practice, Continuing Medical Education, Humans, Biomedical Research, Academic research, Commissioning, Clinical Sciences, Public health systems and services research, Clinical Competence, and Quality of health care
The literature on prevention and therapy of urinary tract infection (UTI) in patients with spinal cord injury (SCI) was reviewed using 3 levels of evidence. Antibiotic therapy is only indicated in symptomatic bacteriuria or in symptomatic... more
The literature on prevention and therapy of urinary tract infection (UTI) in patients with spinal cord injury (SCI) was reviewed using 3 levels of evidence. Antibiotic therapy is only indicated in symptomatic bacteriuria or in symptomatic exacerbations of chronic UTI. During the acute phase of a SCI, UTI's are more prevalent and bacteria are different and more resistant to antibiotics compared with the chronic phase of SCI. In SCI in general, routine screening urine cultures are not valuable as a high species turn over is seen. Intermittent catheterisation, tapping or Crédé manoeuvre coincide significantly with lower frequency of UTI compared to permanent catheter drainage. No measures are proven efficient in the long term in prevention of bacteriuria or UTI. Methenamine salts are perhaps useful in the prevention of UTI but not in patients with a permanent catheter (level III). Antibiotic prophylaxis was found useful in reducing asymptomatic bacteriuria but not in the prevention...
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Research Interests: Primary Care, Leadership, Primary Health Care, Health Care, Australia, and 9 moreInternational Cooperation, Health Services Research, Research evaluation, Humans, Federal Government, Clinical Sciences, Public health systems and services research, International Collaboration, and Cooperative Behavior
To compare the efficacy of amoxicillin vs placebo in patients with an acute upper respiratory tract infection and purulent rhinorrhea. Double-blind randomized placebo-controlled trial. The 416 patients included from 69 family practices... more
To compare the efficacy of amoxicillin vs placebo in patients with an acute upper respiratory tract infection and purulent rhinorrhea. Double-blind randomized placebo-controlled trial. The 416 patients included from 69 family practices were 12 years or older, presenting with acute upper respiratory complaints, and having a history of purulent rhinorrhea and no signs of complications of sinusitis. Therapy success (disappearance of symptoms that most greatly affected the patient's health) at day 10 and duration of general illness, pain, and purulent rhinorrhea. Therapy was successful in 35% of patients with amoxicillin and in 29% of patients with placebo (relative risk [RR] 1.14, 95% confidence interval [CI], 0.92-1.42). There was no effect on duration of general illness or pain. Duration of purulent rhinorrhea was shortened by amoxicillin (9 days vs 14 for clearing of purulent rhinorrhea in 75% of patients; P =.007). Diarrhea was more frequent with amoxicillin (29% vs 19%, RR 1.2...
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The vast health inequities experienced by people with intellectual disability remain indisputable. Persistent and contemporary challenges exist for primary healthcare providers and researchers working to contribute to improvements to the... more
The vast health inequities experienced by people with intellectual disability remain indisputable. Persistent and contemporary challenges exist for primary healthcare providers and researchers working to contribute to improvements to the health and well-being of people with intellectual disability. Over two decades after the only review of supports for primary healthcare providers was published, this paper contributes to an evolving research agenda that aims to make meaningful gains in health-related outcomes for this group. The present authors updated the existing review by searching the international literature for developments and evaluations of multinational models of care. Based on our review, we present three strategies to support primary healthcare providers: (i) effectively using what we know, (ii) considering other strategies that offer support to primary healthcare professionals and (iii) researching primary health care at the system level. Strengthening primary care by supporting equitable provision of health-related care for people with intellectual disability is a much needed step towards improving health outcomes among people with intellectual disability. More descriptive quantitative and qualitative research, as well as intervention-based research underpinned by rigorous mixed-methods evaluating these strategies at the primary care level, which is sensitive to the needs of people with intellectual disability will assist primary care providers to provide better care and achieve better health outcomes. Many people with intellectual disability have poor health. The authors reviewed what has been written by other researchers about how to improve the health of people with intellectual disability. In the future, people who support adults with intellectual disability should continue doing what they do well, think of other ways to improve health, and do more research about health. At all times, the needs of people with intellectual disability should be the greatest concern for those trying to support them.
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Samenvatting We vragen ons allemaal wel eens af of onze patiënten ons advies opvolgen en de voorgeschreven medicamenten trouw zullen innemen. Toch is het schokkend om vast te moeten stellen dat in de geïndustrialiseerde landen slechts de... more
Samenvatting We vragen ons allemaal wel eens af of onze patiënten ons advies opvolgen en de voorgeschreven medicamenten trouw zullen innemen. Toch is het schokkend om vast te moeten stellen dat in de geïndustrialiseerde landen slechts de helft van de patiënten met een chronische aandoening de voorgeschreven medicatie min of meer trouw inneemt. Informatie over het effect van een behandeling leren
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We have been aware for decades - perhaps as a somewhat far-off theoretical problem - that antibiotic resistance is a threat to healthcare worldwide. However, the crisis is now here and very real. Each year in Europe alone, 25 000 deaths... more
We have been aware for decades - perhaps as a somewhat far-off theoretical problem - that antibiotic resistance is a threat to healthcare worldwide. However, the crisis is now here and very real. Each year in Europe alone, 25 000 deaths are directly attributed to antibiotic resistance. New antibiotics are not being produced fast enough, and resistance means we are running out of antibiotics of last resort.
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Older people often suffer from multiple diseases. Therefore, universal cross-disease outcomes (e.g. functional status, quality of life, overall survival) are more relevant than disease-specific outcomes, and a range of potential outcomes... more
Older people often suffer from multiple diseases. Therefore, universal cross-disease outcomes (e.g. functional status, quality of life, overall survival) are more relevant than disease-specific outcomes, and a range of potential outcomes are needed for medical decision-making. To assess how patient-relevant outcomes have penetrated randomized controlled trials (RCTs), reporting of these outcomes was reviewed in heart failure trials that included patients with multimorbidity. We systematically reviewed RCTs (Jan 2011-June 2012) and evaluated reported outcomes. Heart failure was chosen as condition of interest as this is common among older patients with multimorbidity. The main outcome was the proportion of RCTs reporting all-cause mortality, all-cause hospital admission, and outcomes in four domains of health, i.e. functional, signs and symptoms, psychological, and social domains. Of the 106 included RCTs, 50 (47 %) reported all-cause mortality and cardiovascular mortality and 29 (27...
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Chronic fatigue syndrome, or myalgic encephalomyelitis (CFS), is a severe disabling condition. Patients with CFS usually trial many different medicines, both conventional and complementary. An overview of the pharmacological treatments... more
Chronic fatigue syndrome, or myalgic encephalomyelitis (CFS), is a severe disabling condition. Patients with CFS usually trial many different medicines, both conventional and complementary. An overview of the pharmacological treatments used by CFS patients and the available evidence underpinning the use of these treatments would be of great value to both patients and their healthcare providers. Ninety-four CFS patients recruited into an Australian study investigating immunological biomarkers filled out a questionnaire assessing the medicines they were taking. Evidence from randomised clinical trials was sought in biomedical databases. The 94 CFS patients used 474 different medicines and supplements. The most commonly used medicines were antidepressants, analgesics, sedatives, and B vitamins. We identified 20 randomised controlled trials studying these medicines in CFS patients. While conventional and complementary medicines are widely used by CFS patients, the evidence for effective...
Research Interests: Treatment Outcome, Chronic Fatigue Syndrome, Prospective studies, Humans, Complementary Therapies, and 11 moreCognitive Therapy, Young Adult, Follow-up studies, Dietary Supplements, Clinical Sciences, Aged, Middle Aged, Questionnaires, Adult, Public health systems and services research, and Retrospective Studies
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ABSTRACT The Hepatitis C virus (HCV) affects some 150 million people worldwide. However, unlike hepatitis A and B there is no vaccination for HCV and approximately 75% of people exposed to HCV develop chronic hepatitis. In Australia,... more
ABSTRACT The Hepatitis C virus (HCV) affects some 150 million people worldwide. However, unlike hepatitis A and B there is no vaccination for HCV and approximately 75% of people exposed to HCV develop chronic hepatitis. In Australia, around 226,700 people live with chronic HCV infection costing the government approximately $252 million per year. Historically, the standard approved/licenced treatment for HCV is pegylated interferon with ribavirin. There are major drawbacks with interferon-based therapy including side effects, long duration of therapy, limited access and affordability. Our previous survey of an at-risk population reported HCV treatment coverage of only 5%. Since April 2013, a new class of interferon-free treatments for chronic HCV is subsidised under the Pharmaceutical Benefits Scheme: boceprevir and telaprevir - estimated to cost the Australian Government in excess of $220 million over five years. Other biologic interferon-free therapeutic agents are scheduled to enter the Australian market. Use of small molecule generic pharmaceuticals has been advocated as a means of public cost savings. However, with the new biologic agents, generics (biosimilars) may not be feasible or straightforward, due to long patent life; marketing exclusivity; and regulatory complexity for these newer products. Research Question: How prepared is Australia for the regulation of biosimilars? Methodology: Exploratory case-study analysis of the regulatory framework for biosimilars in Australia. The case studied was the introduction of biosimilar-epoetin in 2006. Findings: Our current pharmaceutical regulatory framework is grounded in small molecule generics rather than biosimilars of innovator biologic therapies or vaccines. When biosimilar-epoetins entered the market, misapprehension of the nature of small molecule generics vs. biosimilars resulted in significant mortality and morbidity. Australia’s Therapeutic Goods Administration looks to the European Medicines Agency for guidance on regulating biosimilars; however, this contradicts IP Australia’s position, which advocates identical approaches to both biosimilars and small molecule generics. Australia’s pharmaceutical regulation is influenced by economic pressure from its major trading partners. Policy Implications: Australia requires a consistent approach to the regulation of biosimilars, underpinned by the National Medicines Policy (2000): equity of access, safety and quality of pharmaceutical, whilst fostering innovation in Australia’s pharmaceutical industry.
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ABSTRACT A QUM partnership approach to regulating biosimilars in Australia Despite the realisation of the potential implications from biosimilars is relatively recent, much has already been written about raising the awareness of... more
ABSTRACT A QUM partnership approach to regulating biosimilars in Australia Despite the realisation of the potential implications from biosimilars is relatively recent, much has already been written about raising the awareness of differences between biosimilars and originating/ reference listed (innovator) pharmaceuticals. The European Medicines Agency has led the global charge in regulating biosimilars. Regardless of sufficient similarities across international regulations, differences do exist across jurisdictions. The consideration of regulating biosimilars demands a congruent approach across all stages: pre-registration (Australian copyright protection, patent, international obligations), registration (confidential information, international regulators, safety and efficacy), post-registration (Pharmaceutical Benefit Scheme, prescriber and dispenser awareness). Our National Medicines Policy could provide the necessary congruent framework and function for national and international regulation of biosimilars. The Policy concedes that pharmaceuticals will be affected by financial policies and trade considerations, international treaty obligations, industrial policies, education policies and the need for public-private partnerships.
Australian medical students should graduate with an understanding of the principles of medical law and ethics, and their application to clinical settings. Although student perspectives have been studied previously, the teacher experience... more
Australian medical students should graduate with an understanding of the principles of medical law and ethics, and their application to clinical settings. Although student perspectives have been studied previously, the teacher experience of ethical issues also needs to be understood, particularly in the general practice setting. Interviews were conducted with a convenience sample of 13 general practitioner teachers. They were asked to reflect on common and/or important ethical issues in their day-to-day practice. An inductive thematic analysis of the data was performed by two investigators, who reached a consensus on major themes using an iterative, dialogic process. Participants reported negotiating ethical issues frequently. Major themes included patient-doctor relationships, professional differences, truth-telling, ethically 'grey' areas and the personal demands of ethical decision making. General practitioners in this study describe sometimes needing to apply judgement a...
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BACKGROUND Previous studies have found that general practitioner (GP) trainees (registrars) see a different spectrum of clinical problems compared to trainers, including less chronic disease and more acute minor illness. Our aim was to... more
BACKGROUND Previous studies have found that general practitioner (GP) trainees (registrars) see a different spectrum of clinical problems compared to trainers, including less chronic disease and more acute minor illness. Our aim was to describe the case mix of first-term Australian GP trainees. This was a cross-sectional analysis of trainee consultations. Descriptive analyses were used to report patient demographics and the number and type of problems managed. Two-hundred-and-three trainees provided data on 36182 consultations and 55740 problems. Overall, 60.7% of patients seen were female and 56.2% were new to the trainee. Trainees managed a mean of 154.1 problems per 100 encounters. Problems managed most commonly were respiratory (23.9 per 100 encounters), general/unspecified (21.8) and skin (16.4). New problems comprised 51.5% of the total, and 22.4% of problems were chronic diseases. Trainees gain reasonably broad exposure overall in terms of patient demographics and problems ma...
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Antibiotic resistance is among the most important current public health issues. Most antibiotics are prescribed in primary care. There is strong consensus that they are overprescribed, especially for conditions such as upper respiratory... more
Antibiotic resistance is among the most important current public health issues. Most antibiotics are prescribed in primary care. There is strong consensus that they are overprescribed, especially for conditions such as upper respiratory tract infections (URTI) and acute bronchitis, where they provide limited benefit. Interventions to alter prescribing patterns have shown limited effect. Trainees in family practice may be an appropriate target, as their prescribing habits are still developing. To establish prevalence and associations of trainee prescribing of antibiotics for URTI and acute bronchitis/bronchiolitis. A cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing cohort study of Australian General Practice (GP) trainees documenting the nature of their consultation-based clinical experiences. Trainees record details of 60 consecutive patient encounters every 6-month training term. Univariate and logistic regression analys...
Research Interests: Primary Health Care, Australia, Family Practice, Prospective studies, Humans, and 13 moreFemale, Male, Middle Aged, Anti-Bacterial Agents, Adult, Public health systems and services research, Bronchitis, Respiratory Tract Infections, Cross Sectional Studies, Logistic Models, Acute Disease, Inappropriate Prescribing, and Guideline Adherence
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Abstract Introduction: Consulting with patients is the core learning activity of Australian family medicine (general practice/GP) training, providing a rich source of reflective learning for trainees. We have developed a reflective... more
Abstract Introduction: Consulting with patients is the core learning activity of Australian family medicine (general practice/GP) training, providing a rich source of reflective learning for trainees. We have developed a reflective learning program for postgraduate vocational trainees based on clinical encounters. Methods: The Registrar Clinical Encounters in Training (ReCEnT) program is an educational program documenting GP trainees&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; consultations in five Australian GP training providers. Trainees record patient demographics, consultation details, problems managed, management practices and educational factors from sixty consecutive consultations per six-month training term. Trainees receive a detailed feedback report comparing individual data to aggregated trainee data and national GP data. Results: The patient encounter system provides multiple opportunities for reflective learning across a number of domains of exposure and practice. Reflection can occur during completion of the encounter form; as self-reflection on the feedback report; as facilitated reflection with the GP trainer and medical educator; and as part of integration of data into teaching. We have identified areas for further development, including enhancing the reflective skills of trainees and trainers. Conclusion: The ReCEnT patient encounter program provides a rich platform for reflective learning for vocational trainees and supports development of skills in lifelong learning.
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Chlamydia screening is widely advocated. General practice registrars are an important stage of clinical behaviour development. This study aimed to determine rates of, and factors associated with,... more
Chlamydia screening is widely advocated. General practice registrars are an important stage of clinical behaviour development. This study aimed to determine rates of, and factors associated with, registrars&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; chlamydia testing including asymptomatic screening. A cross-sectional analysis of data from Registrars Clinical Encounters in Training (ReCEnT), a cohort study of registrars&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; consultations. Registrars record details of 60 consecutive consultations in each GP-term of training. Outcome factors were chlamydia testing, asymptomatic screening and doctor-initiated screening. Testing occurred in 2.5% of 29,112 consultations (398 registrars) and in 5.8% of patients aged 15-25. Asymptomatic screening comprised 47.5% of chlamydia tests, and 55.6% of screening tests were doctor-initiated. Chlamydia testing was associated with female gender of doctor and patient, younger patient age, and patients new to doctor or practice. Asymptomatic screening was associated with practices where patients incur no fees, and in patients new to doctor or practice. Screening of female patients was more often doctor-initiated. GP registrars screen for chlamydia disproportionately in younger females and new patients. Our findings highlight potential opportunities to improve uptake of screening for chlamydia, including targeted education and training for registrars, campaigns targeting male patients, and addressing financial barriers to accessing screening services.
Research Interests: General Practice, Adolescent, Family Practice, Applied Economics, Screening, and 14 moreHumans, Reproductive health, Female, Male, Young Adult, Registries, Chlamydia, Middle Aged, Public Administration and Policy, Adult, Public health systems and services research, Cross Sectional Studies, mass Screening, and Referral and consultation
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Many GPs undertake postpartum care for women and their infants. GP follow-up enables early identification and management of problems, education and support for parenting, and reconnection with general practice following the birth.... more
Many GPs undertake postpartum care for women and their infants. GP follow-up enables early identification and management of problems, education and support for parenting, and reconnection with general practice following the birth. However, there is little information about GPs’ understanding of their role in postpartum care and how it is undertaken. This cross-sectional survey of GPs in Southern Queensland, conducted between February and July 2013, describes the involvement of GPs in postpartum care. GPs were posted a 52-item questionnaire adapted from a previous Victorian GP study and were telephoned 2 weeks later. GPs completed the survey on paper or online. The response rate was 17.4% (163 GPs). Approximately 39% were uncertain whether women were happy with the GP-provided postpartum care. GPs’ recommendations for the timing of postpartum reviews were inconsistent within and across birthing sectors and consultations took longer than anticipated. Developing guidelines around the t...
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Samenvatting Matthys J, De Meyere M, Van Driel ML, De Sutter A. Verschillen tussen nationale faryngitisrichtlijnen niet louter academisch. Huisarts Wet 2009;52(2):63-7. Doel Veel landen hanteren nationale richtlijnen voor de behandeling... more
Samenvatting Matthys J, De Meyere M, Van Driel ML, De Sutter A. Verschillen tussen nationale faryngitisrichtlijnen niet louter academisch. Huisarts Wet 2009;52(2):63-7. Doel Veel landen hanteren nationale richtlijnen voor de behandeling van faryngitis. Wij hebben een vergelijking gemaakt van de aanbevelingen en het gerapporteerde bewijsmateriaal in nationale richtlijnen voor de behandeling van acute keelpijn bij volwassenen. Methode Voor een review verzamelden
Samenvatting Frans is 63 en voelt zich prima, hij heeft wel hypertensie en sinds enkele jaren ook diabetes. Met evidence-based richtlijnen in de hand zet u het optimale beleid uit voor deze patiënt.
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Research Interests: Nutrition, Primary Health Care, Obesity, Health Literacy, Australia, and 15 morePhysical Activity, Counseling, Overweight, Humans, Female, Male, Exercise, Aged, Middle Aged, Adult, Public health systems and services research, Multilevel Analysis, Primary Prevention, Preventive Health Services, and healthcare disparities
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In primary care settings, the diagnosis of rhinosinusitis is generally based on clinical signs and symptoms. Technical investigations are not routinely performed, nor recommended. Individual trials show a trend in favour of antibiotics,... more
In primary care settings, the diagnosis of rhinosinusitis is generally based on clinical signs and symptoms. Technical investigations are not routinely performed, nor recommended. Individual trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear. To assess the effect of antibiotics in adults with clinically diagnosed rhinosinusitis in primary care settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2012), MEDLINE (January 1950 to February week 4, 2012) and EMBASE (January 1974 to February 2012). Randomised controlled trials (RCTs) of antibiotics versus placebo in participants with rhinosinusitis-like signs or symptoms. Two authors independently extracted data and assessed the risk of bias. We contacted trial authors for additional information. We collected information on adverse effects from the trials. We included 10 trials involving 2450 participants. Overall, the risk of bias in...
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ABSTRACT The aim of this review is to review the efficacy and safety of percutaneous transluminal angioplasty (PTA) alone versus PTA with stenting of infrapopliteal arterial lesions (anterior tibial artery, posterior tibial artery,... more
ABSTRACT The aim of this review is to review the efficacy and safety of percutaneous transluminal angioplasty (PTA) alone versus PTA with stenting of infrapopliteal arterial lesions (anterior tibial artery, posterior tibial artery, peroneal artery and the common tibioperoneal trunk) in patients with critical limb ischaemia (CLI)
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Acute lower respiratory tract infections (LRTIs) (e.g. pneumonia) are a major cause of morbidity and mortality and management focuses on early treatment. Chest radiographs (X-rays) are one of the commonly used strategies. Although... more
Acute lower respiratory tract infections (LRTIs) (e.g. pneumonia) are a major cause of morbidity and mortality and management focuses on early treatment. Chest radiographs (X-rays) are one of the commonly used strategies. Although radiological facilities are easily accessible in high-income countries, access can be limited in low-income countries. The efficacy of chest radiographs as a tool in the management of acute LRTIs has not been determined. Although chest radiographs are used for both diagnosis and management, our review focuses only on management. To assess the effectiveness of chest radiographs in addition to clinical judgement, compared to clinical judgement alone, in the management of acute LRTIs in children and adults. We searched CENTRAL 2013, Issue 1; MEDLINE (1948 to January week 4, 2013); EMBASE (1974 to February 2013); CINAHL (1985 to February 2013) and LILACS (1985 to February 2013). We also searched NHS EED, DARE, ClinicalTrials.gov and WHO ICTRP (up to February 2013). Randomised controlled trials (RCTs) of chest radiographs versus no chest radiographs in acute LRTIs in children and adults. Two review authors independently applied the inclusion criteria, extracted data and assessed risk of bias. A third review author compiled the findings and any discrepancies were discussed among all review authors. We used the standard methodological procedures expected by The Cochrane Collaboration. Two RCTs involving 2024 patients (1502 adults and 522 children) were included in this review. Both RCTs excluded patients with suspected severe disease. It was not possible to pool the results due to incomplete data. Both included trials concluded that the use of chest radiographs did not result in a better clinical outcome (duration of illness and of symptoms) for patients with acute LRTIs. In the study involving children in South Africa, the median time to recovery was seven days (95% confidence interval (CI) six to eight days (radiograph group) and six to nine days (control group)), P value = 0.50, log-rank test) and the hazard ratio for recovery was 1.08 (95% CI 0.85 to 1.34). In the study with adult participants in the USA, the average duration of illness was 16.9 days versus 17.0 days (P value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) in the radiograph and no radiograph groups respectively. This result was not statistically significant and there were no significant differences in patient outcomes between the groups with or without chest radiograph.The study in adults also reports that chest radiographs did not affect the frequencies with which clinicians ordered return visits or antibiotics. However, there was a benefit of chest radiographs in a subgroup of the adult participants with an infiltrate on their radiograph, with a reduction in length of illness (16.2 days in the group allocated to chest radiographs and 22.6 in the non-chest radiograph group, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), duration of cough (14.2 versus 21.3 days, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and duration of sputum production (8.5 versus 17.8 days, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The authors mention that this difference in outcome between the intervention and control group in this particular subgroup only was probably a result of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;the higher proportion of patients treated with antibiotics when the radiograph was used in patient care&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;.Hospitalisation rates were only reported in the study involving children and it was found that a higher proportion of patients in the radiograph group (4.7%) required hospitalisation compared to the control group (2.3%) with the result not being statistically significant (P = 0.14). None of the trials report the effect on mortality, complications of infection or adverse events from chest radiographs. Overall, the included studies had a low or unclear risk for blinding, attrition bias and reporting bias, but a high risk of selection bias. Both trials had strict exclusion criteria which is important but may limit the clinical practicability of the results as participants may not reflect those presenting in clinical practice. Data from two trials suggest that routine chest radiography does not affect the clinical outcomes in adults and children presenting to a hospital with signs and symptoms suggestive of a LRTI. This conclusion may be weakened by the risk of bias of the studies and the lack of complete data available.
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Background and Purpose— The 2001 Revised Consolidated Standards of Reporting of Trials (CONSORT) statement requires reporting of Randomized Controlled Trials (RCTs) to include participants’ baseline demographics. This enables comparison... more
Background and Purpose— The 2001 Revised Consolidated Standards of Reporting of Trials (CONSORT) statement requires reporting of Randomized Controlled Trials (RCTs) to include participants’ baseline demographics. This enables comparison of intervention and control groups on potential confounding variables as well as assessment of study generalizability. Socioeconomic status (SES) is associated with access to care and outcomes (mortality, functional outcome, recurrent stroke, and hospital readmission) poststroke. We aimed to document the reporting of baseline SES in reports of RCTs of stroke and transient ischemic attack. Methods— Measures of SES were extracted from studies reporting trials of stroke or transient ischemic attack published in 12 major journals in the disciplines of general medicine, general neurology, cerebrovascular disease, and rehabilitation subsequent to revised CONSORT. Percentages of studies reporting SES measures were calculated. Differences in reporting betwee...
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Research Interests: Primary Care, Primary Health Care, Family Practice, Belgium, Humans, and 15 moreFemale, Male, Cluster Analysis, Randomised Controlled Trial, Middle Aged, Questionnaires, Adult, Public health systems and services research, Curriculum and Pedagogy, Quality and safety in health care, Medical Audit, Rhinitis, Acute Disease, Guideline Adherence, and Drug utilization review
To explore the effect on prescribing of policies that lift reimbursement restrictions on selected H2-antihistamines and proton pump inhibitors (PPI) and of practice recommendations. Monthly claims based data for proton pump inhibitors... more
To explore the effect on prescribing of policies that lift reimbursement restrictions on selected H2-antihistamines and proton pump inhibitors (PPI) and of practice recommendations. Monthly claims based data for proton pump inhibitors (PPIs) and H2-antihistamines were obtained from the national health insurance database (Farmanet 1997-2005). Two policies were issued. In March 2001 two H2-antihistamines and in March 2003 two PPIs became available without restrictions. An evidence report was distributed in September 2004. Periods before and after implementation of the interventions were compared. Interrupted time series with segmented regression analysis was used to assess and compare time trends. The first policy resulted in an increase of volume (1.6 million DDDs; 95% CI 1.4-1.8 million; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) and expenditure (euro 637,744; 95% CI 177 052-1 098 437; p = .026) for H2-antihistamines, but consumption of PPIs continued to grow. After the second policy use of selected PPIs also increased (4.7 million DDDs increase; 95% CI 3.9-5.5 million; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), but more than the desired shift toward selected PPIs. Although total expenditure stabilized at a lower level, there was no significant change of trend. Publication of the evidence report did not have any impact on prescribing. Policies that lift reimbursement restrictions did not result in meaningful changes in utilization or cost saving. They may even have unintended effects. Collaboration between policymakers and guideline developers and linking policies to evidence-based guidelines could be a more effective way to pursue cost-containment and better quality of care.
Research Interests: Pharmacoepidemiology, Evidence Based Medicine, Time Series, Health Policy, Belgium, and 15 moreQuality of Care, Humans, Regression Analysis, Public health systems and services research, Time Factors, Drug Costs, Cost Saving, Cost Savings, Drug Utilization, Pharmacoepidemiology and drug safety, Proton Pump Inhibitor, National Health Insurance, Proton Pump Inhibitors, Guideline Adherence, and Pharmacology and pharmaceutical sciences
2 .M inerva heeft dit span- ningsveld al een aantal keren belicht 3,4 . Ten eerste wordt gepleit voor de onafhankelijkheid van de onderzoeker zowel in de keuze van de geneesmiddelen, het opstellen van het protocol én de verwerking van de... more
2 .M inerva heeft dit span- ningsveld al een aantal keren belicht 3,4 . Ten eerste wordt gepleit voor de onafhankelijkheid van de onderzoeker zowel in de keuze van de geneesmiddelen, het opstellen van het protocol én de verwerking van de resultaten. Het document wijst op toestanden zoals publicatieverbod en quasi-exclusiviteitscontracten. Het tweede deel gaat over de arts als voorschrijver .D e Koninklijke Academie wijst op het gevaar dat de meeste tijdschriften, om te overleven in belangrijke mate afhankelijk zijn van geneesmiddelenpubliciteit. Op zichzelf kan dit al leiden tot heel wat onwetenschappelijke informatie. Maar het wordt pas problematisch als sommige academici hun naam lenen als auteurs voor artikels die in werkelijkheid door anderen zijn geschreven. Het is een publiek geheim dat hiervoor een royale vergoe- ding is voorzien. Daarbij komt dan nog dat de publiciteit dicht aanleunt bij de inhoud van het artikel, zodat het onderscheid voor de lezer niet meer duidelijk is. V...
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... Original Text. Rory Collins a Email Address , Jane Armitage a, Sarah Parish a, Peter Sleight a, Richard Peto a, for the MRC/BHF Heart Protection Study ... This SE of 3 means that the 95% CI for the absolute reduction in stroke is 8—20... more
... Original Text. Rory Collins a Email Address , Jane Armitage a, Sarah Parish a, Peter Sleight a, Richard Peto a, for the MRC/BHF Heart Protection Study ... This SE of 3 means that the 95% CI for the absolute reduction in stroke is 8—20 per 1000 (calculated as (14±1·96×3). The ...
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The Australian Prader-Willi Syndrome (PWS) database was established to monitor the efficacy and safety of growth hormone (GH) treatment in PWS. This study aims to compare response to GH based on eligibility criteria. Comparative study: 72... more
The Australian Prader-Willi Syndrome (PWS) database was established to monitor the efficacy and safety of growth hormone (GH) treatment in PWS. This study aims to compare response to GH based on eligibility criteria. Comparative study: 72 children received GH on the basis of short stature or evidence of GH deficiency (pre-2009: PWS-SS) and 94 on a genetic diagnosis (post-2009: PWS-Dx). We report on mandatory patient data for GH prescription: median and standard deviation score (SDS) for height and body mass index (BMI), waist/height ratio, bone age/chronological age ratio and adverse events. Comparisons were made using non-parametric tests. At baseline, the PWS-SS cohort was shorter (height SDS: -2.6 vs. -1.1, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), had a lower BMI (0.6 vs. 1.5 SDS, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and greater bone age delay (bone age/chronological age: 0.7 vs. 0.9,…
Research Interests:
Research Interests: Primary Care, Primary Health Care, Evidence Based Medicine, Evaluation, Health Services Research, and 8 moreHealth Policy, Quality of Care, Humans, Public health systems and services research, Practice Education/Clinical Evaluation, quality assurance in health care, Quality of health care, and Outcome assessment (Health care)
Research Interests:
Research Interests: Publishing, Research Design, Methodology, Bibliometrics, Evidence Based Medicine, and 13 moreEvidence Based Practice, Clinical Epidemiology, Bias, Systematic Reviews, Humans, Mathematical Sciences, Metaanalysis, Bibliographic Databases, Meta Analysis, Systematic review, Publication Bias, Review Literature As Topic, and Medical and Health Sciences
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Research Interests: Chronic Fatigue Syndrome, Prospective studies, Humans, Affective Disorders, Natural Killer cells, and 10 moreFemale, Male, Middle Aged, microRNAs, Longitudinal Studies, Adult, Biological markers, Psychology and Cognitive Sciences, reverse transcriptase polymerase chain reaction, and Medical and Health Sciences
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Research Interests: General Practice, Evidence Based Medicine, Implementation Science, Australia, Humans, and 10 moreCluster Analysis, Diffusion of Innovation, Aged, Middle Aged, Adult, Cardiovascular Diseases, Clinical Protocols, interprofessional relations, Outcome assessment (Health care), and Medical and Health Sciences
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ABSTRACT Eco-paediatrics is an occasional feature in Evidence-Based Child Health: A Cochrane Review Journal. Our goal is to contribute to the worldwide discussion on reducing waste in health care. In each instalment, we will select a... more
ABSTRACT Eco-paediatrics is an occasional feature in Evidence-Based Child Health: A Cochrane Review Journal. Our goal is to contribute to the worldwide discussion on reducing waste in health care. In each instalment, we will select a recent Cochrane review highlighting a practice, still in use, which the available evidence tells us should be discontinued.
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Research Interests: General Practice, Family Practice, Belgium, Humans, Female, and 15 moreFeasibility Studies, Male, Physicians, European, Aged, Middle Aged, Pilot study, Professional Practice, Questionnaires, Adult, General practitioner, North East, Pilot Projects, Pharmacology and pharmaceutical sciences, and Drug prescriptions
McGuire, Treasure, Walters, Julie, Dean, Angela, Van Driel, Mieke, Del Mar, Christopher, Moses, Geraldine, Pache, David, Loadsman, Peter and Williamson, Margaret (2010). Evaluating complementary medicines resources: Sifting fact from... more
McGuire, Treasure, Walters, Julie, Dean, Angela, Van Driel, Mieke, Del Mar, Christopher, Moses, Geraldine, Pache, David, Loadsman, Peter and Williamson, Margaret (2010). Evaluating complementary medicines resources: Sifting fact from fiction. In:, 16th ...
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Research Interests:
In his 1913 novel Chance, Joseph Conrad wrote about the changing fashion for certain words: “You know the power of words. We pass through periods dominated by this or that word—it may be development, or it may be competition, or... more
In his 1913 novel Chance, Joseph Conrad wrote about the changing fashion for certain words: “You know the power of words. We pass through periods dominated by this or that word—it may be development, or it may be competition, or education, or purity or efficiency or even sanctity. It is the word of the time.” Today’s word is quality.
Research Interests: Assessment, Primary Health Care, Health Care, Forecasting, Complexity, and 13 moreQuality of Mental Health Care, Health Services Research, Medicine, Primary, British medical history, Approach, Quality assessment, Multidimensional, Great Britain, Public health systems and services research, BMJ, Health Services Administration, and Quality of health care
Research Interests: British medical history, Masks, Humans, Protocols, Cohort Study, and 15 moreQuarantine, Cost 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, and Number needed to treat
Research Interests:
Research Interests: Decision Making, Humans, United States, Advisory Committees, Depressive Disorder, and 9 moreRisk factors, Meta Analysis, Publication Bias, Public health systems and services research, Risk Factors, Randomized Controlled Trials as Topic, Organizational case studies, Outcome assessment (Health care), and mass Screening
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© Copyright for the text content, document structure, formatting, layout and presentation is held by National Prescribing Service Limited. Permission is granted to view these documents for private or academic use. You may download,... more
© Copyright for the text content, document structure, formatting, layout and presentation is held by National Prescribing Service Limited. Permission is granted to view these documents for private or academic use. You may download, display, print or reproduce this material in ...