scholarly journals General Practice Registrars’ Management of and Specialist Referral Patterns for Atopic Dermatitis

2021 ◽  
pp. e2021118
Author(s):  
Anneliese Willems ◽  
Amanda Tapley ◽  
Alison Fielding ◽  
Vivian Tng ◽  
Elizabeth Holliday ◽  
...  
Keyword(s):  
General Practice ◽  
Atopic Dermatitis ◽  
Patient Care ◽  
Significant Proportion ◽  
Female Gender ◽  
Learning Goals ◽  
Cross Sectional ◽  
Referral Patterns ◽  
Clinical Encounters ◽  
Recent Project

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 female gender, patient age, longer consultation duration; an established (rather than new) AD diagnosis; supervisor advice being sought; and learning goals being generated.  Conclusions: Both registrar and patient factors influence AD referral patterns. Registrars referred established rather than newly diagnosed AD, suggesting a level of comfort in initial management. Referral was associated with longer consultations, seeking supervisor advice, and generation of learning goals—suggesting these are more complex presentations and, possibly, registrar learning opportunities. A significant proportion of referrals were to non-dermatologist specialists. The implication of this for optimal patient care is a subject for further study.  

scholarly journals Prevalence and Associations of General Practice Registrars’ Management of Atopic Dermatitis: A Cross-Sectional Analysis from the Registrar Clinical Encounters in Training Study

2021 ◽  
pp. e2021128
Author(s):  
Anneliese Willems ◽  
Amanda Tapley ◽  
Alison Fielding ◽  
Er Tsing Vivian Tng ◽  
Elizabeth Holliday ◽  
...  
Keyword(s):  
General Practice ◽  
Atopic Dermatitis ◽  
Response Rate ◽  
Learning Goals ◽  
Cross Sectional ◽  
Clinical Encounters ◽  
Chronic Inflammatory Condition ◽  
English Speaking ◽  
Recent Project ◽  
Sectional Analysis

Introduction: Atopic dermatitis (AD) is a chronic inflammatory condition which imposes substantial burden upon patients and their families. As a frequent primary care presentation, general practice (GP) trainees must develop adequate skills in AD diagnosis and management. Objectives: We aimed to explore the prevalence and associations of GP registrars’ management of patients with AD. Methods: This study used data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study of the clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors were independent variables in multivariable logistic regression with outcome factor ‘diagnosis/problem being AD’. Results: From 2010-2019, 2,783 registrars (96% response rate) provided data from 381,180 consultations. AD was encountered in 0.6% of consults. AD was more likely to be seen in patients aged 0-1 years and patients from a non-English speaking background. AD was less likely to be seen in Aboriginal or Torres Strait Islander patients. Learning goals were more likely to be generated for AD and these consultations were associated with registrars seeking information or assistance. AD was strongly associated with a medication being prescribed, of which the most prescribed medications were mild or moderate potency topical corticosteroids.  Conclusions: Our findings suggest that, similar to other dermatological presentations, registrars find AD challenging to manage. There may be some gaps in AD management knowledge and application.

scholarly journals Australian general practice trainees’ exposure to ophthalmic problems and implications for training: a cross-sectional analysis

2016 ◽  
Vol 8 (4) ◽  
pp. 295 ◽  
Author(s):  
Simon Morgan ◽  
Amanda Tapley ◽  
Kim M Henderson ◽  
Neil A Spike ◽  
Lawrie A McArthur ◽  
...  
Keyword(s):  
General Practice ◽  
Information Seeking ◽  
Learning Goals ◽  
Training Methods ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Australian General Practice ◽  
Simple Logistic ◽  
Sectional Analysis

ABSTRACT 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 diagnoses from 118,541 encounters. There were 2649 ophthalmology-related problems, equating to 1.4% (95% CI: 1.38–1.49) of all problems managed. The most common eye presentations were conjunctivitis (32.5% of total problems), eyelid problems (14.9%), foreign body (5.3%) and dry eye (4.7%). Statistically significant associations were male trainee; male patient and patient aged 14 years or under; the problem being new and the patient being new to both trainee and practice; urban and of higher socioeconomic status practice location; the practice nurse not being involved; planned follow up not arranged; referral made; in-consultation information sought; and learning goals generated. DISCUSSION Trainees have comparable ophthalmology exposure to established GPs. However, associations with referral and information-seeking suggest GP trainees find ophthalmic problems challenging, reinforcing the critical importance of appropriate training.

scholarly journals Chronic headache among general practice out patients in a tertiary care hospital, Eastern Nepal

2017 ◽  
Vol 13 (2) ◽  
pp. 22-29
Author(s):  
Rabin Bhandari ◽  
R Bhandari ◽  
DR Shakya ◽  
R Maskey ◽  
M Paudel ◽  
...  
Keyword(s):  
General Practice ◽  
Chronic Headache ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Cross Sectional Study ◽  
Tension Type Headache ◽  
Ethical Review ◽  
Care Hospital ◽  
Research Committee ◽  
Cross Sectional

Background: The term chronic headache is commonly taken as headache lasting for more than three months. It is common in general practice with minimal research on the topic in Nepal. Objective: To sort out the common diagnoses of chronic headache and to study the clinical features and demographic profile of patients presenting with chronic headache.Method: A descriptive cross sectional study was conducted (2012 August to 2013 August) at General Practice outpatients in BP Koirala Institute of Health Sciences, a medical university in eastern Nepal. Approval and ethical clearance was taken from Research Committee and Institutional Ethical Review Board. Descriptive statistical analysis was done.Result: 168 patients constituting 1% of outpatient visits presented due to chronic headache. Mean age was 29.57 years (SD 10.53) and female to male ratio was 3.67. Mean number of days of headache was 19.46 days (SD 4.62). Numerical pain score was reported at 7.1/10 (SD 1.85). The mean duration of presentation was 22 months (SD 11). 40% reported impaired activity of more than one week. Headache was classified as chronic migraine in 20.2%, chronic tension type headache in 16.7%, and chronic daily persistent headache in 11.9%. The diagnosis did not fit into any diagnostic criteria in 51.2% cases. Conclusion: Chronic headache is common in females and young age group. Patients present late despite significant pain scores. Significant proportion is still unclassified.Health Renaissance 2015;13(2): 22-29

Prevalence and associations of prescribing of long-acting reversible contraception by general practitioner registrars: a secondary analysis of ReCEnT data

2020 ◽  
Vol 46 (3) ◽  
pp. 218-225
Author(s):  
Rachel Turner ◽  
Amanda Tapley ◽  
Sally Sweeney ◽  
Andrew Davey ◽  
Elizabeth Holliday ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Secondary Analysis ◽  
Early Career ◽  
Learning Goals ◽  
Cross Sectional ◽  
Clinical Encounters ◽  
Effective Form ◽  
Prescribing Practice ◽  
Health Related ◽  
Long Acting

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 years in which contraception was prescribed. 1356 (25%) involved LARC. Significant multivariable associations of prescribing LARC included patient age (OR 2.85, 95% CI 3.17 to 3.74, for age 36–45 years compared with age 12–18 years), practice rurality - inner-regional (OR 1.47, 95% CI 1.22 to 1.79) and outer-regional/remote/very remote (OR 1.47 95% CI 1.15 to 1.87) compared with major cities, practices in areas of lower socioeconomic status (SES) (OR 0.93, 95% CI 0.91 to 0.96 for SES by decile), generating learning goals (OR 1.37, 95% CI 1.04 to 1.79), in-consultation assistance-seeking (OR 1.58, 95% CI 1.24 to 2.01), and the registrar having reproductive health-related postgraduate qualifications (OR 1.33, 95% CI 1.01 to 1.76).ConclusionsThe prevalence of LARC prescribing by Australian GP registrars is higher than has been previously estimated in established GPs. Postgraduate qualifications in reproductive health are associated with prescribing LARC. Prescribing practice differs according to rurality and relative socioeconomic disadvantage.

scholarly journals CHARACTERISTICS OF ATOPIC DERMATITIS IN PUSKESMAS (PUBLIC HEALTH CENTER) MASARAN 1 SRAGEN REGENCY

2021 ◽  
Vol 10 (1) ◽  
pp. 27-34
Author(s):  
Muhammad Ilham Arifin Munthaha ◽  
Retno Indar Widayati ◽  
Liza Afriliana ◽  
Aryu Candra
Keyword(s):  
Public Health ◽  
Atopic Dermatitis ◽  
Medical Records ◽  
Secondary Data ◽  
Female Gender ◽  
Age Group ◽  
Inflammatory Skin Disease ◽  
Cross Sectional ◽  
Adult Age ◽  
Cross Sectional Design

Background: Atopic dermatitis is a chronic and residive inflammatory skin disease with mild to severe itching and occurs mostly in infant and children. The cause not certainty known and multifactorial.Objective: This study aims to Know the Characteristics of Atopic Dermatitis in Puskesmas Masaran 1, Sragen Regency.Method: This study is descriptive with a retrospective cross-sectional design. Secondary data retrieved from medical records atopic dermatitis patients at Puskesmas Masaran 1 in the period 1 January-31 December 2019 with a sample 248 people then analyze using a computer program.Result: The most atopic dermatitis sufferers were the adult age group (151 people), female gender (139 people),  not working (96 people), atopic history disease found in 112 patients, site of the most lesions was lower extremities (71 patients), and the choice therapy is polytherapy with three types of drugs in 103 patients. Types of drugs are corticosteroids (224 patients), antihistamines (212 patients), and vitamins/minerals (200 patients).Conclusion: Characteristics of atopic dermatitis in Puskesmas Masaran 1 are the most age group is adults, gender is female, types of work is not working, atopic history is atopic dermatitis, and therapeutic options are corticosteroids, antihistamines, and vitamins/minerals.

scholarly journals Management of transient ischemic attacks diagnosed by early-career general practitioners: A cross-sectional study

2017 ◽  
Vol 13 (3) ◽  
pp. 313-320
Author(s):  
Andrew R Davey ◽  
Daniel S Lasserson ◽  
Christopher R Levi ◽  
Amanda Tapley ◽  
Simon Morgan ◽  
...  
Keyword(s):  
General Practice ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Cross Sectional Study ◽  
Early Career ◽  
Learning Goals ◽  
Transient Ischemic Attacks ◽  
Cross Sectional ◽  
Antiplatelet Medication ◽  
Ischemic Attack

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 A total 1331 general practice registrars contributed data (response rate 95.8%). Of the 250,625 problems, there were 65 new transient ischemic attacks diagnosed (0.03% [95% confidence interval: 0.02–0.03%]). General practice registrars were more likely to seek help, generate learning goals, and spend more time for a new transient ischemic attack compared to other problems. Compliance with management guidelines was modest: 15.4% ordered brain and arterial imaging, 36.9% prescribed antiplatelet medication, and 3.1% prescribed antihypertensive medication. Conclusions Transient ischemic attack is a very infrequent presentation for general practice registrars, giving little clinical opportunity to reinforce training program education regarding guideline-recommended management. General practice registrars found transient ischemic attacks challenging and management was not ideal. Since most transient ischemic attacks first present to general practice and urgent management is essential, an enhanced model of care utilizing rapid access to specialist transient ischemic attack support and follow-up could improve guideline compliance.

scholarly journals Emergency department referral patterns of Australian general practitioner registrars: a cross-sectional analysis of prevalence, nature and associations

2019 ◽  
Vol 43 (1) ◽  
pp. 21 ◽  
Author(s):  
Nigel Catzikiris ◽  
Amanda Tapley ◽  
Simon Morgan ◽  
Mieke van Driel ◽  
Neil Spike ◽  
...  
Keyword(s):  
Emergency Department ◽  
General Practice ◽  
Cohort Study ◽  
Continuity Of Care ◽  
Cross Sectional ◽  
Referral Patterns ◽  
International Evidence ◽  
Cross Sectional Analysis ◽  
Included Patient ◽  
Sectional Analysis

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 < 0.05) associations of ED referral included patient age <15 and >34 years, the patient being new to the registrar, one particular regional training provider (RTP), in-consultation information or assistance being sought and learning goals being generated. Outer regional-, remote- or very remote-based registrars made significantly fewer ED referrals than more urban registrars. Of the problems referred to the ED, 45.5% involved the seeking of in-consultation information or assistance, predominantly from supervisors. Conclusions Registrars’ ED referral rates are nearly twice those of established GPs. The findings of the present study suggest acute illnesses or injuries present registrars with clinical challenges and real learning opportunities, and highlight the importance of continuity of care, even for acute presentations. What is known about the topic? A GP’s decision concerning continued community- versus hospital-based management of acute presentations demands careful consideration of a suite of factors, including implications for patient care and resource expenditure. General practice vocational training is a critical period for the development of GP registrars’ long-term patterns of practice. Although limited international evidence suggests GP registrars and early career GPs refer patients to the ED at a higher rate than their more experienced peers, these studies involved small subject numbers and did not investigate associations of registrars making an ED referral. Relevant Australian studies focusing on GP registrars’ ED referral patterns are lacking. What does this paper add? The present ongoing cohort study is the first to establish the patterns of ED referrals made by Australian GP registrars, encompassing five general practice RTPs across five states, with participating registrars practising in urban, rural, remote and very remote practices. Several significant associations were found with GP registrars making ED referrals, including patient age, continuity of care, the registrar’s RTP, assistance sought by the registrar and rurality of the registrar’s practice. What are the implications for practitioners? The higher likelihood of GP registrars seeing acute presentations than their more established practice colleagues, coupled with a demonstrated association of registrars seeking in-consultation assistance for such presentations, highlights the importance of GP supervisor accessibility in facilitating ED referral appropriateness and in the development of registrars’ safe clinical practice.

scholarly journals Prevalence and Associations of General Practice Registrars’ Management of Impetigo: A Cross-Sectional Analysis From the Registrar Clinical Encounters in Training (ReCEnT) Study

2020 ◽  
pp. e2020043
Author(s):  
Hilary Gorges ◽  
Clare Heal ◽  
Mieke Van Driel ◽  
Amanda Tapley ◽  
Joshua Davis ◽  
...  
Keyword(s):  
General Practice ◽  
Information Seeking ◽  
Study Data ◽  
Health Seeking ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Clinical Encounters ◽  
Seeking Behavior ◽  
Patient Variables ◽  
Sectional Analysis

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 consultations in Australia. Association with outer regional/remote areas may reflect climate and socioeconomic factors that predispose to impetigo. Associated pathology requests may reflect a lack of confidence in GP registrars’ management of impetigo. Cultural differences may exist regarding health-seeking behavior relating to impetigo.

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