FEASIBILITY OF CONDUCTING CARDIOVASCULAR OUTCOME RESEARCH IN AUSTRALIAN GENERAL PRACTICE: RESULTS FROM THE ANBP2 PILOT STUDY

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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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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Persistent pain management in Australian general practice

Australian Journal of Primary Health ◽

10.1071/py16141 ◽

2017 ◽

Vol 23 (2) ◽

pp. 105

Author(s):

Felicity C. Veal ◽

Angus J. Thompson ◽

Luke R. Bereznicki ◽

Gregory M. Peterson

Keyword(s):

General Practice ◽

Pain Management ◽

Persistent Pain ◽

Australian General Practice

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Moving into the ‘patient-centred medical home’: reforming Australian general practice

Education for Primary Care ◽

10.1080/14739879.2016.1218300 ◽

2016 ◽

pp. 1-3

Author(s):

Paul Hayes ◽

Anthony Lynch ◽

Jenni Stiffe

Keyword(s):

General Practice ◽

Medical Home ◽

Australian General Practice

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Epidemiology of chronic kidney disease in Australian general practice: National Prescribing Service MedicineWise MedicineInsight dataset

Nephrology ◽

10.1111/nep.13537 ◽

2018 ◽

Vol 24 (10) ◽

pp. 1017-1025 ◽

Cited By ~ 4

Author(s):

Janette Radford ◽

Alex Kitsos ◽

Jim Stankovich ◽

Ronald Castelino ◽

Masuma Khanam ◽

...

Keyword(s):

Chronic Kidney Disease ◽

General Practice ◽

Kidney Disease ◽

Australian General Practice

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Attitudes to chlamydia screening in general practice among Australian university students: a pilot study

Sexual Health ◽

10.1071/sh07097 ◽

2008 ◽

Vol 5 (4) ◽

pp. 359 ◽

Cited By ~ 8

Author(s):

Bernadette Zakher ◽

Melissa Kang

Keyword(s):

At Risk ◽

General Practice ◽

Pilot Study ◽

Young People ◽

University Students ◽

Risk Group ◽

Chlamydia Infection ◽

Chlamydia Screening ◽

Sexually Active ◽

Sexually Transmissible Infections

Background: Chlamydia screening of sexually active young people in general practice is key to the Australian National Sexually Transmissible Infections Strategy 2005–2008. Overseas research indicates that young people have positive attitudes towards opportunistic screening by a general practitioner (GP). This pilot study aims to investigate the attitudes of Australian university students towards chlamydia screening in primary care. Methods: Students (16–25 years) attending a class in one of three faculties at the University of Sydney participated by completing a questionnaire, which collected information about demographics, sexual history, chlamydia knowledge, attitudes towards and preferences for chlamydia screening. Results: One hundred and eighty-five students (78% female) returned questionnaires (participation rate 92%). Arts students were younger, more likely to be sexually active and to report having little or no knowledge of chlamydia. Males in the study were less likely to have had sex as a group compared to the group of females in the sample. Science students were also less likely to have had sex compared to their counterparts in other faculties. Seventy-six percent of students were comfortable with opportunistic testing for chlamydia by their GP. Reasons for not being comfortable included ‘don’t think I’m at risk’ (65%) and ‘not comfortable discussing sexual matters with my GP’ (38%). Although comfortable with GP-based testing, the likelihood of being tested in the upcoming year for most students was low, as was personal concern about chlamydia infection. Conclusions: Findings suggest that the most at risk group for chlamydia infection is not well educated about their risk of infection. The limited numbers of tests among sexually active individuals in this sample indicate that health practitioners are not screening this high-risk group for chlamydia infection.

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Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study

BMJ Open ◽

10.1136/bmjopen-2019-035087 ◽

2020 ◽

Vol 10 (6) ◽

pp. e035087

Author(s):

Karen Cardwell ◽

Susan M Smith ◽

Barbara Clyne ◽

Laura McCullagh ◽

Emma Wallace ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Pilot Study ◽

Medication Review ◽

Controlled Trial ◽

Cost Savings ◽

Practice Team ◽

Patient Reported ◽

General Practices ◽

Medication Changes

ObjectiveLimited evidence suggests integration of pharmacists into the general practice team could improve medicines management for patients, particularly those with multimorbidity and polypharmacy. This study aimed to develop and assess the feasibility of an intervention involving pharmacists, working within general practices, to optimise prescribing in Ireland.DesignNon-randomised pilot study.SettingPrimary care in Ireland.ParticipantsFour general practices, purposively sampled and recruited to reflect a range of practice sizes and demographic profiles.InterventionA pharmacist joined the practice team for 6 months (10 hours/week) and undertook medication reviews (face to face or chart based) for adult patients, provided prescribing advice, supported clinical audits and facilitated practice-based education.Outcome measuresAnonymised practice-level medication (eg, medication changes) and cost data were collected. Patient-reported outcome measure (PROM) data were collected on a subset of older adults (aged ≥65 years) with polypharmacy using patient questionnaires, before and 6 weeks after medication review by the pharmacist.ResultsAcross four practices, 786 patients were identified as having 1521 prescribing issues by the pharmacists. Issues relating to deprescribing medications were addressed most often by the prescriber (59.8%), compared with cost-related issues (5.8%). Medication changes made during the study equated to approximately €57 000 in cost savings assuming they persisted for 12 months. Ninety-six patients aged ≥65 years with polypharmacy were recruited from the four practices for PROM data collection and 64 (66.7%) were followed up. There were no changes in patients’ treatment burden or attitudes to deprescribing following medication review, and there were conflicting changes in patients’ self-reported quality of life.ConclusionsThis non-randomised pilot study demonstrated that an intervention involving pharmacists, working within general practices is feasible to implement and has potential to improve prescribing quality. This study provides rationale to conduct a randomised controlled trial to evaluate the clinical and cost-effectiveness of this intervention.

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