Long‐term benzodiazepines and z‐drug prescribing in Australian general practice between 2011 and 2018: A national study

Background Heart failure (HF) is a serious condition that mostly affects older people. Despite the ageing population experiencing an increased prevalence of many chronic conditions, current guidelines focus on isolated management of HF. Objective To describe the burden of multimorbidity in patients with HF being managed in general practice in Australia. Design Data from the Bettering the Evaluation And Care of Health (BEACH) programme were used to determine (i) the prevalence of HF, (ii) the number of co-existing long-term conditions, and (iii) the most common disease combinations in patients with HF. The study was undertaken over fifteen, 5-week recording periods between November 2012 and March 2016. Results The dataset included a total of 25,790 general practitioner (GP) encounters with patients aged ≥45 years, collected by 1,445 GPs. HF had been diagnosed in 1,119 of these patients, a prevalence of 4.34% (95% confidence interval [CI] 3.99–4.68) among patients at GP encounters, and 2.08% (95% CI 1.87–2.29) when applied to the general Australian population overall. HF rarely occurred in isolation, with 99.1% of patients having at least one and 53.4% having six or more other chronic illnesses. The most common pair of comorbidities among active patients with HF was hypertension and osteoarthritis (43.4%). Conclusion Overall, one in every 20–25 GP encounters with patients aged ≥45 years in Australia is with a patient with HF. Multimorbidity is a typical presentation among this patient group and guidelines for general practice must take this into account.

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Psychotropic Drug Prescribing in an Australian General Practice

Family Practice ◽

10.1093/fampra/1.2.106 ◽

1984 ◽

Vol 1 (2) ◽

pp. 106-112 ◽

Cited By ~ 4

Author(s):

C BRIDGES-WEBB ◽

A MANT ◽

W HALL

Keyword(s):

General Practice ◽

Psychotropic Drug ◽

Drug Prescribing ◽

Australian General Practice

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Sustaining cardiovascular absolute risk management in Australian general practice

Australian Journal of Primary Health ◽

10.1071/py11091 ◽

2012 ◽

Vol 18 (4) ◽

pp. 304 ◽

Cited By ~ 3

Author(s):

Ruhie Vaidya ◽

Keval V. Pandya ◽

Elizabeth Denney-Wilson ◽

Mark Harris

Keyword(s):

General Practice ◽

Absolute Risk ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Extrinsic Factors ◽

Attitudes And Practices ◽

Absolute Cardiovascular Risk ◽

Australian General Practice ◽

Randomised Controlled

This study describes the attitudes and practices of patients and GPs 12 months after participating in a trial of absolute cardiovascular risk assessment in general practice. It involved a qualitative design using semistructured interviews with 12 Sydney GPs from the intervention arm of a cluster randomised controlled trial of cardiovascular absolute risk (CVAR) assessment and 15 of their moderate to high risk patients who participated in the assessments. Most GPs had sustained CVAR assessment in their practice, using it primarily to motivate patients to change their behaviour and adhere to management rather than to make decisions about pharmacotherapy or referral. Time was a barrier to its use. Patients who sustained changes to their behaviour had internalised the benefits to their health and received support from family and friends. Those who relapsed attributed this to their own lack of motivation and extrinsic factors. CVAR assessment needs to be incorporated into practice information systems and long-term planned preventive care if it is to be sustained in general practice and have long-term impacts on patient behaviour.

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Long-term Psychotropic Drug Prescribing for General Practice Patients

Family Practice ◽

10.1093/fampra/2.4.238 ◽

1985 ◽

Vol 2 (4) ◽

pp. 238-240 ◽

Cited By ~ 3

Author(s):

C BRIDGES-WEBB ◽

A MANT ◽

H BRITT

Keyword(s):

General Practice ◽

Psychotropic Drug ◽

Drug Prescribing

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Management of Cannabis and Psychostimulant Use among General Practice Patients

Australian Journal of Primary Health ◽

10.1071/py08045 ◽

2008 ◽

Vol 14 (3) ◽

pp. 132 ◽

Cited By ~ 1

Author(s):

A. Frewen ◽

A. Arcuri ◽

H. Britt ◽

J. Copeland ◽

C. Harrison

Keyword(s):

General Practice ◽

Drug Use ◽

Illicit Drug ◽

National Study ◽

Psychotic Symptoms ◽

Drug Problem ◽

Patient Demographics ◽

Australian General Practice ◽

Practice Activity ◽

Significant Health

While regular and heavy cannabis and psychostimulant use has been associated with significant health and psychological impairments, the extent to which their use is being identified and managed by general practitioners (GPs) remains unclear. The aim of this study was to explore the management of cannabis- and psychostimulant-related problems in Australian general practice. Data from the Bettering the Evaluation and Care of Health (BEACH) study of general practice between April 2000 and March 2007 were analysed. BEACH is an ongoing national study of general practice activity in Australia. It was estimated that during this period GPs in Australia managed illicit drug use about 55,000 times per year and that cannabis and psychostimulants made up 3.2% and 1.6%, respectively, of all encounters at which the illicit drug was specified. The only difference in patient demographics between patients in the two drug groups was that cannabis users were younger than psychostimulant users. Cannabis users were more likely to be managed concurrently for psychotic symptoms but less likely to be treated with antipsychotics. Conversely, patients using psychostimulants were more likely to be prescribed an antipsychotic and/or an anxiolytic for their presenting drug problem. These results suggest that GPs do manage problematic cannabis and psychostimulant use among their patients, and thus should be supported in carrying out appropriate screening, intervention and referral.

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Influenza immunisation coverage from 2015 to 2017: A national study of adult patients from Australian general practice

Vaccine ◽

10.1016/j.vaccine.2019.06.057 ◽

2019 ◽

Vol 37 (31) ◽

pp. 4268-4274 ◽

Cited By ~ 4

Author(s):

Carla De Oliveira Bernardo ◽

David Alejandro González-Chica ◽

Monique Chilver ◽

Nigel Stocks

Keyword(s):

General Practice ◽

Adult Patients ◽

National Study ◽

Immunisation Coverage ◽

Australian General Practice

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Are the needs of people with multiple long-term conditions being met? Evidence from the 2018 General Practice Patient Survey

BMJ Open ◽

10.1136/bmjopen-2020-041569 ◽

2020 ◽

Vol 10 (11) ◽

pp. e041569

Author(s):

Lucina Rolewicz ◽

Eilís Keeble ◽

Charlotte Paddison ◽

Sarah Scobie

Keyword(s):

General Practice ◽

Unmet Need ◽

Patient Survey ◽

Secondary Outcome ◽

Community Based ◽

Long Term Conditions ◽

Local Services ◽

Community Based Services ◽

Practice Patient

ObjectivesTo investigate individual, practice and area level variation in patient-reported unmet need among those with long-term conditions, in the context of general practice (GP) appointments and support from community-based services in England.DesignCross-sectional study using data from 199 150 survey responses.SettingPrimary care and community-based services.ParticipantsRespondents to the 2018 English General Practice Patient Survey with at least one long-term condition.Primary and secondary outcome measuresThe primary outcomes were the levels of unmet need in GP and local services among patients with multiple long-term conditions. Secondary outcomes were the proportion of variation explained by practice and area-level factors.ResultsThere was no relationship between needs being fully met in patients’ last practice appointment and number of long-term conditions once sociodemographic characteristics and health status were taken into account (5+conditions−OR=1.04, 95% CI 0.99 to 1.09), but there was a relationship for having enough support from local services to manage conditions (5+conditions−OR=0.84, 95% CI 0.80 to 0.88). Patients with multimorbidity that were younger, non-white or frail were less likely to have their needs fully met, both in GP and from local services. Differences between practices and local authorities explained minimal variation in unmet need.ConclusionsLevels of unmet need are high, particularly for support from community services to manage multiple conditions. Patients who could be targeted for support include people who feel socially isolated, and those who have difficulties with their day-to-day living. Younger patients and certain ethnic groups with multimorbidity are also more likely to have unmet needs. Increased personalisation and coordination of care among these groups may help in addressing their needs.

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Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice

BMJ Open ◽

10.1136/bmjopen-2020-039625 ◽

2020 ◽

Vol 10 (11) ◽

pp. e039625

Author(s):

Jason I Chiang ◽

John Furler ◽

Frances Mair ◽

Bhautesh D Jani ◽

Barbara I Nicholl ◽

...

Keyword(s):

Type 2 Diabetes ◽

General Practice ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Linear Regression Models ◽

Sectional Study ◽

Cross Sectional ◽

Long Term Conditions ◽

Australian General Practice

ObjectivesTo explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).DesignCross-sectional study.SettingAustralian general practice.Participants69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).Primary and secondary outcome measuresPrevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).ResultsMean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.ConclusionsMultimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.

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Long-Term Exposure to PM2.5 and Cognitive Decline: A Longitudinal Population-Based Study

Journal of Alzheimer s Disease ◽

10.3233/jad-200852 ◽

2021 ◽

pp. 1-9

Author(s):

Giulia Grande ◽

Jing Wu ◽

Petter L.S. Ljungman ◽

Massimo Stafoggia ◽

Tom Bellander ◽

...

Keyword(s):

Air Pollution ◽

Cognitive Decline ◽

Population Based ◽

Cerebrovascular Diseases ◽

Air Pollutant ◽

National Study ◽

Piecewise Regression ◽

Risk Increase ◽

Restricted Cubic Splines

Background: A growing but contrasting evidence relates air pollution to cognitive decline. The role of cerebrovascular diseases in amplifying this risk is unclear. Objectives: 1) Investigate the association between long-term exposure to air pollution and cognitive decline; 2) Test whether cerebrovascular diseases amplify this association. Methods: We examined 2,253 participants of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). One major air pollutant (particulate matter ≤2.5μm, PM2.5) was assessed yearly from 1990, using dispersion models for outdoor levels at residential addresses. The speed of cognitive decline (Mini-Mental State Examination, MMSE) was estimated as the rate of MMSE decline (linear mixed models) and further dichotomized into the upper (25%fastest cognitive decline), versus the three lower quartiles. The cognitive scores were used to calculate the odds of fast cognitive decline per levels of PM2.5 using regression models and considering linear and restricted cubic splines of 10 years exposure before the baseline. The potential modifier effect of cerebrovascular diseases was tested by adding an interaction term in the model. Results: We observed an inverted U-shape relationship between PM2.5 and cognitive decline. The multi-adjusted piecewise regression model showed an increased OR of fast cognitive decline of 81%(95%CI = 1.2–3.2) per interquartile range difference up to mean PM2.5 level (8.6μg/m3) for individuals older than 80. Above such level we observed no further risk increase (OR = 0.89;95%CI = 0.74–1.06). The presence of cerebrovascular diseases further increased such risk by 6%. Conclusion: Low to mean PM2.5 levels were associated with higher risk of accelerated cognitive decline. Cerebrovascular diseases further amplified such risk.

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Study protocol: content and perceived educational utility of different modalities of clinical teaching visit (CTV) workplace-based assessments within Australian general practice vocational training: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-045643 ◽

2021 ◽

Vol 11 (4) ◽

pp. e045643

Author(s):

Alison Fielding ◽

Benjamin Eric Mundy ◽

Amanda Tapley ◽

Linda Klein ◽

Sarah Gani ◽

...

Keyword(s):

General Practice ◽

Clinical Teaching ◽

Educational Practice ◽

Cross Sectional Study ◽

Practice Session ◽

Cross Sectional ◽

Human Research Ethics ◽

General Practice Registrar ◽

Australian General Practice ◽

The University

IntroductionClinical teaching visits (CTVs) are formative workplace-based assessments that involve a senior general practitioner (GP) observing a clinical practice session of a general practice registrar (specialist vocational GP trainee). These visits constitute a key part of Australian GP training. Despite being mandatory and resource-intensive, there is a paucity of evidence regarding the content and educational utility of CTVs. This study aims to establish the content and educational utility of CTVs across varying practice settings within Australia, as perceived by registrars and their assessors (‘CT visitors’). In addition, this study aims to establish registrar, CT visitor and practice factors associated with CTV content and perceived CTV utility ratings.Methods and analysisThis study will collect data prospectively using online questionnaires completed soon after incident CTVs. Participants will be registrars and CT visitors of CTVs conducted from March 2020 to January 2021. The setting is three Regional Training Organisations across four Australian states and territories (encompassing 37% of Australian GP registrars).Outcome factors will be a number of specified CTV content elements occurring during the CTV as well as participants’ perceptions of CTV utility, which will be analysed using univariate and multivariable regression.Ethics and disseminationEthics approval has been granted by the University of Newcastle Human Research Ethics Committee, approval number H-2020-0037. Study findings are planned to be disseminated via conference presentation, peer-reviewed journals, educational practice translational workshops and the GP Synergy research subwebsite.

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