Experiences of telehealth in general practice in Australia: research protocol for a mixed methods study

BackgroundDue to the COVID-19 pandemic, use of telehealth has expanded rapidly. However, little is known about the impact of delivering care through telehealth on communication between clinicians and patients. At an interactional level, the ways in which clinicians establish rapport and connection with their patients in telehealth consultations is not well understood.AimThis study will explore interactional practices of general practitioners (GPs) and patients in telehealth consultations to develop evidence-based resources to improve communication.Design & settingThe study will be conducted within the Australian general practice setting.MethodConversation analysis and sociolinguistic discourse analysis of recorded telehealth consultations will provide direct evidence of specific elements contributing to successful and less successful instances of telehealth communication. This analysis will be complemented by co-design techniques such as qualitative and reflective interviews and collaborative workshops with telehealth users, including both general practitioners and patients.ConclusionEffective communication is critical for telehealth consultations and is central to achieving optimal clinical outcomes and patient satisfaction. This study will co-develop with end-users, evidence-based guidelines encompassing effective telehealth communication strategies.

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Compliance with pathology testing guidelines in Australian general practice: protocol for a secondary analysis of electronic health record data

BMJ Open ◽

10.1136/bmjopen-2018-024223 ◽

2018 ◽

Vol 8 (11) ◽

pp. e024223 ◽

Cited By ~ 2

Author(s):

Gorkem Sezgin ◽

Andrew Georgiou ◽

Rae-Anne Hardie ◽

Ling Li ◽

Lisa G Pont ◽

...

Keyword(s):

General Practice ◽

General Practitioners ◽

Evidence Based ◽

Department Of Health ◽

General Practices ◽

Electronic Health ◽

Haemoglobin Testing ◽

Evidence Based Guidelines ◽

The Impact ◽

Test Ordering

IntroductionIn Australia, general practitioners usually are the first point of contact for patients with non-urgent medical conditions. Appropriate and efficient utilisation of pathology tests by general practitioners forms a key part of diagnosis and monitoring. However overutilisationand underutilisation of pathology tests have been reported across several tests and conditions, despite evidence-based guidelines outlining best practice in pathology testing. There are a limited number of studies evaluating the impact of these guidelines on pathology testing in general practice. The aim of our quantitative observational study is to define how pathology tests are used in general practice and investigate how test ordering practices align with evidence-based pathology guidelines.Methods and analysisAccess to non-identifiable patient data will be obtained through electronic health records from general practices across three primary health networks in Victoria, Australia. Numbers and characteristics of patients, general practices, encounters, pathology tests and problems managed over time will be described. Overall rates of encounters and tests, alongside more detailed investigation between subcategories (encounter year, patient’s age, gender, and location and general practice size), will also be undertaken. To evaluate how general practitioner test ordering coincides with evidence-based guidelines, five key candidate indicators will be investigated: full blood counts for patients on clozapine medication; international normalised ratio measurements for patients on warfarin medication; glycated haemoglobin testing for monitoring patients with diabetes; vitamin D testing; and thyroid function testing.Ethics and disseminationEthics clearance to collect data from general practice facilities has been obtained by the data provider from the RACGP National Research and Evaluation Ethics Committee (NREEC 17–008). Approval for the research group to use these data has been obtained from Macquarie University (5201700872). This study is funded by the Australian Government Department of Health Quality Use of Pathology Program (Agreement ID: 4-2QFVW4M). Findings will be reported to the Department of Health and disseminated in peer-reviewed academic journals and presentations (national and international conferences, industry forums).

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Guidelines for assessing postnatal problems: introducing evidence-based guidelines in Australian general practice

Family Practice ◽

10.1093/fampra/cmg408 ◽

2003 ◽

Vol 20 (4) ◽

pp. 382-389 ◽

Cited By ~ 20

Author(s):

Jane Gunn ◽

Donna Southern ◽

Patty Chondros ◽

Philippa Thomson ◽

Kathryn Robertson

Keyword(s):

General Practice ◽

Evidence Based ◽

Australian General Practice ◽

Evidence Based Guidelines

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Differences in patient throughput between community health centre and private general practitioners

Australian Health Review ◽

10.1071/ah960056a ◽

1996 ◽

Vol 19 (3) ◽

pp. 56 ◽

Cited By ~ 1

Author(s):

Michael Montalto ◽

David Dunt ◽

Jeff Richardson

Keyword(s):

General Practice ◽

Community Health ◽

General Practitioners ◽

Private Practice ◽

Health Centre ◽

Community Health Centre ◽

Control Group ◽

Patient Throughput ◽

Australian General Practice ◽

The Impact

This study sought to compare the rate of patient throughput by community healthcentre general practitioners (GPs) and their private practice fee-for-servicecounterparts.The study group comprised 44 community health centre GPs (out of an identified51) in 16 community health centres; the control group comprised 268 GPs.Community health centre GPs were found to have significantly fewer consultationsand significantly smaller rebates than their private practice counterparts. Thedifference of means for consultation numbers and rebates was 30.3- per cent. Thepattern was reversed in the case of rural community health centre GPs (who retainfee-for-service arrangements).Figures are uncorrected for patient status, and data relate to Medicare billing practicesrather than observed activity or outcome. However, at face value they would indicatethat if Australian general practice moved to a community health centre model, withpredominantly salaried GPs, then patient throughput in general practice could beexpected to drop. Whether these results reflect the impact of incentives on throughputand, if so, whether this indicates a difference in the quality or accessibility of theservice provided to patients is not certain.

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Evaluation of the impact of the first evidence-based guidelines for congenital toxoplasmosis in Armenia (Quindío) Colombia: An observational retrospective analysis

The Lancet Regional Health - Americas ◽

10.1016/j.lana.2021.100010 ◽

2021 ◽

pp. 100010

Author(s):

Manuela Mejia-Oquendo ◽

Elizabeth Marulanda-Ibarra ◽

Jorge Enrique Gomez-Marin

Keyword(s):

Retrospective Analysis ◽

Congenital Toxoplasmosis ◽

Evidence Based ◽

Evidence Based Guidelines ◽

The Impact

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Mental Health Research in General Practice

Australasian Psychiatry ◽

10.1080/j.1440-1665.2005.02185.x ◽

2005 ◽

Vol 13 (2) ◽

pp. 181-184 ◽

Cited By ~ 6

Author(s):

Harry Minas ◽

Steven Klimidis ◽

Renata Kokanovic

Keyword(s):

Mental Health ◽

General Practice ◽

General Practitioners ◽

Health Research ◽

Mental Health Research ◽

Practice Research ◽

Practice Setting ◽

Key Issues ◽

Practice Time ◽

Time Limitations

Objective: To explore problems in carrying out a mental health research project in the general practice setting. Method: Open-ended interviews were conducted with general practice stakeholders, focusing on impediments to the conduct of mental health research in general practice and possible means for improving the participation of general practitioners in such research. Participants in the consultations were members of ?ve divisions of general practice, senior staff within an academic department of general practice, four general practitioners and a research group engaged with general practice research. The discussions were recorded in detailed interview notes, and key issues and themes emerging from consultations were derived by the researchers. Results: Three main themes summarized most of the issues reported through the consultations, including structural issues (e.g. disruption of practice, time limitations and lack of remuneration), process issues (e.g. researcher–general practice communication, researcher-imposed issues and need for partnerships) and content issues (e.g. study design, study procedures and methods). Conclusions: The consultations revealed similar ?ndings to previously published reports concerning general practice research, with an emphasis on the need for partnerships between researchers and general practice organizations in the conduct of such research.

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Exploration of sedentary behaviour among general practitioners: protocol for a mixed methods study

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20210145 ◽

2021 ◽

Vol 8 (1) ◽

pp. 51

Author(s):

Richard S. Mayne ◽

Nigel D. Hart ◽

Neil Heron

Keyword(s):

General Practice ◽

Mixed Methods ◽

Sedentary Behaviour ◽

General Practitioners ◽

Mixed Methods Study ◽

Structured Interviews ◽

New Ways Of Working ◽

Adverse Health Outcomes ◽

Sequential Mixed Methods ◽

Working Day

Background: Many general practitioners (GPs) are sedentary for most of their working day. Levels of sedentary behaviour may have been exacerbated by increased use of telemedicine in light of the COVID-19 pandemic, as this is traditionally performed while sitting down. Excessive sedentary behaviour is associated with many adverse health outcomes and increased all-cause mortality. This study will gain quantitative data on levels of sedentary behaviour among GPs and general practice specialty trainees (GPSTs), to identify to what extent general practice is a sedentary occupation, as well as qualitative data regarding the barriers and facilitators to reducing sedentary behaviour in the general practice setting.Methods: The study follows a sequential, mixed-methods model. The first stage will involve the dissemination of a questionnaire survey, where participants self-estimate their sedentary behaviour on a working day and on a non-working day. The second stage will use thigh-worn accelerometers and a sleep/work log to obtain objective data regarding sedentary behaviour among a purposive subset of participants who responded to the questionnaire. The third stage will involve semi-structured interviews with a purposive subset of accelerometer study participants, analysed with the application of a theoretical framework regarding the acceptability of healthcare interventions.Conclusions: This paper outlines a protocol for a sequential, mixed-methods study exploring sedentary behaviour among GPs and GPSTs. Findings of this study will shed light on the new ways of working as a result of the COVID-19 pandemic, which will be relevant to clinicians working in similar primary care settings throughout the world.Trial Registration: ClinicalTrials.gov Identifier: NCT04556695. Date of registration: 21st September 2020.

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General Practitioners’ Attitudes toward Municipal Initiatives to Improve Antibiotic Prescribing—A Mixed-Methods Study

Antibiotics ◽

10.3390/antibiotics8030120 ◽

2019 ◽

Vol 8 (3) ◽

pp. 120 ◽

Cited By ~ 3

Author(s):

Marthe Sunde ◽

Marthe Marie Nygaard ◽

Sigurd Høye

Keyword(s):

General Practice ◽

Quality Improvement ◽

Mixed Methods ◽

General Practitioners ◽

Treatment Guidelines ◽

National Level ◽

Medical Officer ◽

Mixed Methods Study ◽

Antibiotic Prescribing ◽

E Mail

Antimicrobial stewardship (AMS) interventions directed at general practitioners (GPs) contribute to an improved antibiotic prescribing. However, it is challenging to implement and maintain such interventions at a national level. Involving the municipalities’ Chief Medical Officer (MCMO) in quality improvement activities may simplify the implementation and maintenance, but may also be perceived challenging for the GPs. In the ENORM (Educational intervention in NORwegian Municipalities for antibiotic treatment in line with guidelines) study, MCMOs acted as facilitators of an AMS intervention for GPs. We explored GPs’ views on their own antibiotic prescribing, and their views on MCMO involvement in improving antibiotic prescribing in general practice. This is a mixed-methods study combining quantitative and qualitative data from two data sources: e-mail interviews with 15 GPs prior to the ENORM intervention, and online-form answers to closed and open-ended questions from 132 GPs participating in the ENORM intervention. The interviews and open-ended responses were analyzed using systematic text condensation. Many GPs admitted to occasionally prescribing antibiotics without medical indication, mainly due to pressure from patients. Too liberal treatment guidelines were also seen as a reason for overtreatment. The MCMO was considered a suitable and acceptable facilitator of quality improvement activities in general practice, and their involvement was regarded as unproblematic (scale 0 (very problematic) to 10 (not problematic at all): mean 8.2, median 10). GPs acknowledge the need and possibility to improve their own antibiotic prescribing, and in doing so, they welcome engagement from the municipality. MCMOs should be involved in quality improvement and AMS in general practice.

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Attitudes to, and Use of, Evidence-based Medicine in two Sydney Divisions of General Practice

Australian Journal of Primary Health ◽

10.1071/py06007 ◽

2006 ◽

Vol 12 (1) ◽

pp. 40 ◽

Cited By ~ 5

Author(s):

Joanne L Callen ◽

Kate Fennell ◽

Jean H McIntosh

Keyword(s):

General Practice ◽

Evidence Based Medicine ◽

Time Pressure ◽

Response Rate ◽

Postal Survey ◽

Cochrane Library ◽

Evidence Based ◽

Royal Australian College ◽

Australian General Practice ◽

Based Medicine

Previous surveys suggested Australian GPs felt positive towards evidence-based medicine (EBM) but had reservations about practising it. Strategies to promote EBM in Australian general practice were implemented by the Royal Australian College of General Practitioners (RACGP) and published online in 1998. The aim of this study was to explore attitudes to and use of EBM in a population of Sydney GPs four years after publication of the strategies. A postal survey was conducted in 2003 among a group of GPs in Sydney (n=135) with a response rate of 31%. The survey assessed: attitudes to and barriers to practising EBM; preferred methods in moving from opinion-based medicine to EBM; awareness and use of EBM resources; and ability to interpret research evidence. Two- thirds of respondents felt positive towards EBM. Time pressure was the most commonly perceived barrier to practising EBM and use of evidence-based guidelines was the most popular method in moving towards EBM. Among 70% of respondents, at least 40% of clinical practice was evidence-based. Awareness of the databases The Cochrane Library and Medline was high, but use of database information was rare. There was partial understanding of technical terms used in EBM. While overall these GPs had a positive attitude towards EBM, they indicated some reluctance to applying it. Thus it is probable that in this GP group EBM was used less than optimally. The evidence provided by this study suggests that the RACGP strategies to promote appropriate use of EBM in general practice need heightened emphasis among the GPs surveyed. The study's low response rate prevents any generalisation of findings to the Australian general practice workforce.

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