Digital Commons Network^™

Effectiveness Of Quality Incentive Payments In General Practice (Equip-Gp): A Study Protocol For A Cluster-Randomised Trial Of An Outcomes-Based Funding Model In Australian General Practice To Improve Patient Care, Gregory Peterson, Grant Russell, Jan Radford, Nicholas Arnold Zwar, Danielle Mazza, Simon Eckermann, Judy Mullan, Marijka Batterham, Athena Hammond, Andrew D. Bonney

Illawarra Health and Medical Research Institute

Background There is international interest in whether improved primary care, in particular for patients with chronic or complex conditions, can lead to decreased use of health resources and whether financial incentives help achieve this goal. This trial (EQuIP-GP) will investigate whether a funding model based upon targeted, continuous quality incentive payments for Australian general practices increases relational continuity of care, and lessens health-service utilisation, for high-risk patients and children. Methods We will use a mixed methods approach incorporating a two-arm pragmatic cluster randomised control trial with nested qualitative case studies. We aim to recruit 36 general practices from Practice-Based Research …

The Development Of Professional Practice Standards For Australian General Practice Nurses, Elizabeth J. Halcomb, Moira Stephens, Julianne Bryce, Elizabeth Foley, Christine Ashley

Faculty of Science, Medicine and Health - Papers: part A

Aims The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses.

Background Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting.

Design …

Patients' Attitudes Towards Chaperone Use For Intimate Physical Examinations In General Practice, Lucie C. Stanford, Andrew D. Bonney, Rowena G. Ivers, Judy Mullan, Warren C. Rich, Bridget R. Dijkmans-Hadley

Faculty of Science, Medicine and Health - Papers: part A

BACKGROUND: The objective of this article is to investigate patients' attitudes to the use of chaperones for intimate physical examinations (IPEs) in a sample of Australian general practices. METHODS: A cross-sectional survey of adult patients from 13 randomly selected general practices in regional New South Wales was conducted between September and November 2012. Generalised linear mixed models were used for analysis. RESULTS: Of 780 surveys distributed, 687 (88%) were returned; the age range was 18-91 years and 356 (52%) were from female patients. Most women had never had a chaperone present for a Papanicolaou (Pap) smear (82.6%). Between 23% and …

Evaluating Women's Knowledge Of The Combined Oral Contraceptive Pill In An Australian Rural General Practice Setting, Sharna Kulhavy, Teresa M. Treweek

Faculty of Science, Medicine and Health - Papers: part A

Background: In addition to the contraceptive action of the combined oral contraceptive pill (COCP), there are a number of other benefits to its use such as menstrual cycle regulation. However, COCP use is also associated with a higher risk of thromboembolism. Despite the prevalence of COCP use, studies have indicated that overall women have poor knowledge of the COCP.

Aim: To evaluate women's knowledge of the COCP in a rural general practice setting. The extent of knowledge was assessed in several domains including: COCP use and effectiveness, mechanism of action, and the risks and benefits of COCP use. …

Many People In Scotland Now Benefit From Anticipatory Care Before They Die: An After Death Analysis And Interviews With General Practitioners, Julia Tapsfield, Charlie Hall, Carey Lunan, Hazel Mccutcheon, Peter Mcloughlin, Joel J. Rhee, Alfonso Leiva, Juliet Spiller, Anne Finucane, Scott Murray

Faculty of Science, Medicine and Health - Papers: part A

Background Key Information Summaries (KIS) were introduced throughout Scotland in 2013 so that anticipatory care plans written by general practitioners (GPs) could be routinely shared electronically and updated in real time, between GPs and providers of unscheduled and secondary care. Aims We aimed to describe the current reach of anticipatory and palliative care, and to explore GPs' views on using KIS. Methods We studied the primary care records of all patients who died in 2014 in 9 diverse Lothian practices. We identified if anticipatory or palliative care had been started, and if so how many weeks before death and which …

Analysis Of The Psychological Impact Of A Vascular Risk Factor Intervention: Results From A Cluster Randomized Controlled Trial In Australian General Practice, Suzanne Helen Mckenzie, Upali W. Jayasinghe, Mahnaz Fanaian, Megan Passey, Mark Fort Harris

Illawarra Health and Medical Research Institute

Background Screening for vascular disease, risk assessment and management are encouraged in general practice however there is limited evidence about the emotional impact on patients. The Health Improvement and Prevention Study evaluated the impact of a general practice-based vascular risk factor intervention on behavioural and physiological risk factors in 30 Australian practices. The primary aim of this analysis is to investigate the psychological impact of participating in the intervention arm of the trial. The secondary aim is to identify the mediating effects of changes in behavioural risk factors or BMI. Methods This study is an analysis of a secondary outcome …

Culturally And Linguistically Diverse General Practitioners' Utilisation Of Practice Nurses, Elizabeth J. Halcomb, Yenna Salamonson, Melissa Cooper, Jennifer L. Clauson, Lien Lombardo

Faculty of Science, Medicine and Health - Papers: part A

Background Practice nurses are primarily employed by general practitioners, however little is known about the barriers to practice nurse employment from the perspective of general practitioners (GPs). Aim This paper seeks to explore solo, culturally and linguistically diverse (CALD) general practitioners' perceptions of the practice nurse role, and to identify the barriers and facilitators of these doctors employing nurses within their practice. Methods A descriptive study, using semi-structured interviews, was conducted from July to August 2010. Participants were CALD GPs working as solo practitioners who were members of a Division of General Practice in South Western Sydney. Quantitative data were …

A Qualitative Evaluation Of New Zealand Consumers Perceptions Of General Practice Nurses, Elizabeth J. Halcomb, Kath Peters, Deborah Davies

Faculty of Science, Medicine and Health - Papers: part A

Background An important consideration in health service delivery is ensuring that services meet consumer needs and that consumers are satisfied with service delivery. Patient satisfaction can impact on compliance with suggested treatments and therefore impact on health outcomes. Comparatively few studies have explored consumer satisfaction with nurses in general practice. Methods A sub-group of 18 consumers from a larger quantitative evaluation of consumer satisfaction with New Zealand general practice nurses participated in semi-structured telephone interviews. Interview data was analysed using thematic analysis. Results Four major themes emerged from the data. These themes highlighted that, despite confusion experienced by some consumers …

Clinical Placements In General Practice: Relationships Between Practice Nurses And Tertiary Institutions, Kath Peters, Elizabeth J. Halcomb, Susan Mcinnes

Faculty of Science, Medicine and Health - Papers: part A

As a practice-based discipline a key component of undergraduate nurse education is clinical practice experience. The quality of clinical experiences has a significant impact on the students' ability to function competently post graduation. The relationship between higher education institutions (HEIs) and health service placement providers impacts upon the quality of clinical placements. In Australia, the growth of primary care nursing and the shortage of acute clinical places has prompted HEIs to explore the placement of students in general practice. Given the increasing attention being paid to non-traditional clinical placements, it is timely to explore how universities are establishing relationships and …

Connectgpr: Implementing A Virtual Community Of Practice For General Practice Training, Stephen Barnett

Faculty of Science, Medicine and Health - Papers: part A

Abstract of paper the presented at the 2013 Medicine 2.0: World Congress on Social Media, Mobile Apps, Internet/Web 2.0, 25 September, London.

Australian General Practitioner Perceptions Of The Detection And Screening Of At-Risk Drinking, And The Role Of The Audit-C: A Qualitative Study, Chun Wah Michael Tam, Nicholas Arnold Zwar, Roslyn Markham

Faculty of Science, Medicine and Health - Papers: part A

Background: At-risk drinking is common in Australia. Validated screening tools such as the AUDIT-C have been promoted to general practitioners (GPs), but appear rarely used and detection of at-risk drinking in primary care remains low. We sought to describe Australian GP perceptions of the detection and screening of at-risk drinking; to understand their low uptake of alcohol screening questionnaires, and in particular, their attitude to the adoption of the AUDIT-C. Methods. Semi-structured focus group interviews of four groups of GPs and GP trainees were conducted in metropolitan Sydney between August and October 2011. Audio recordings were transcribed and analysed using …

Preventive Evidence Into Practice (Pep) Study: Implementation Of Guidelines To Prevent Primary Vascular Disease In General Practice Protocol For A Cluster Randomised Controlled Trial, Mark Fort Harris, Jane Lloyd, John Litt, Mieke Van Driel, Danielle Mazza, Grant Russell, Jane Smith, Chris Del Mar, Elizabeth Denney-Wilson, Sharon M. Parker, Yordanka Krastev, Upali W. Jayasinghe, Richard J. Taylor, Nicholas Zwar, Jinty Wilson, Helen Bolger-Harris, Justine Waters

Faculty of Science, Medicine and Health - Papers: part A

Background: There are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD) and diabetes in Australian general practice. This study protocol describes the methodology for a cluster randomised trial to evaluate the effectiveness of a model that aims to improve the implementation of these guidelines in Australian general practice developed by a collaboration between researchers, non-government organisations, and the profession.Methods: We hypothesise that the intervention will alter the behaviour of clinicians and patients resulting in improvements of recording of lifestyle and physiological risk factors (by 20%) and increased adherence to guideline recommendations for: the …

Streptococcal Collagen-Like Protein A And General Stress Protein 24 Are Immunomodulating Virulence Factors Of Group A Streptococcus, James A. Tsatsaronis, Andrew Hollands, Jason N. Cole, Peter G. Maamary, Christine M. Gillen, Nouri L. Ben Zakour, Malak Kotb, Victor Nizet, Scott A. Beatson, Mark J. Walker, Martina L. Sanderson-Smith

Illawarra Health and Medical Research Institute

In Western countries, invasive infections caused by M1T1 serotype group A Streptococcus (GAS) are epidemiologically linked to mutations in the control of virulence regulatory 2-component operon (covRS). In indigenous communities and developing countries, severe GAS disease is associated with genetically diverse non-M1T1 GAS serotypes. Hypervirulent M1T1 covRS mutant strains arise through selection by human polymorphonuclear cells for increased expression of GAS virulence factors such as the DNase Sda1, which promotes neutrophil resistance. The GAS bacteremia isolate NS88.2 (emm 98.1) is a covS mutant that exhibits a hypervirulent phenotype and neutrophil resistance yet lacks the phage-encoded Sda1. Here, we have employed …

Dementia And Driving: An Approach For General Practice, John Carmody, Victoria Traynor, Donald C. Iverson

Faculty of Health and Behavioural Sciences - Papers (Archive)

Background As our population ages, the proportion of drivers with dementia will continue to rise. Increasingly, health professionals are faced with the clinical dilemma of determining fitness to drive. Unfortunately, the management of drivers with dementia is fraught with hazards.

Objective This article attempts to provide an overview of the complex issue of driving and dementia as it relates to general practitioners in Australia. In addition, an evidence based management strategy is proposed.

Discussion When determining an individual’s fitness to drive, a clinician’s input may have legal, ethical, emotional and social ramifications. At present, a clear consistent national protocol detailing …

Adapting General Practice Training To Meet The Evolving Health Care Needs Of Our Communities, Andrew Bonney, Simon Morgan, Parker Magin

Faculty of Science, Medicine and Health - Papers: part A

Abstract of workshop held at General Practice Education and Training Convention 2013, 11-12 September 2013, Perth.

General Practice Training And Virtual Communities Of Practice - A Review Of The Literature, Stephen Barnett, Sandra C. Jones, Sue Bennett, Donald C. Iverson, Andrew D. Bonney

Graduate School of Medicine - Papers (Archive)

Background: Good General Practice is essential for an effective health system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs) in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence …

A Scholarly Spin On Practice: The Impact Of Longitudinal Integrated Clerkships On The Development Of Academic Scholarship In General Clinical Practice, Judith N. Hudson, Kathryn M. Weston

Graduate School of Medicine - Papers (Archive)

All senior medical students at the University of Wollongong in Australia undertake a longitudinal integrated community-based clerkship in a regional or rural community. In addition to continuity of patient care and curriculum, the clerkship offers each student individualized professional development by experienced generalist practitioners. These practitioners predicted outcomes from their relationship with the long-term students, including a more scholarly approach to clinical practice (1). In 1990, Boyer outlined the concept of four domains of scholarship: discovery, integration, application and teaching (2). More recently, a working definition of clinical scholarship in academic medicine has been proposed 930. This paper describes the …

Access To Same Day, Next Day And After-Hours Appointments: The Views Of Australian General Practitioners, Mark Fort Harris, Patrick Davies, Mahnaz Fanaian, Nicholas Zwar, Siaw-Teng Liaw

Faculty of Science, Medicine and Health - Papers: part A

Objective. To evaluate factors associated with the availability of same or next day appointments and after-hours access reported by Australian general practitioners (GPs). Methods. Secondary analysis of a survey of primary care practitioners conducted by the Commonwealth Fund in 2009 in 11 countries. Analysis of factors likely to be associated with reported availability of same or next day appointments and after-hours access. Findings. Of 1016 Australian GPs, 78.8% reported that most patients in their practice had access to an appointment on the same or next day and 50% that their practice had arrangements for after-hours access. Access to same or …

Practice Nurses Experiences Of Mentoring Undergraduate Nursing Students In Australian General Practice, Elizabeth J. Halcomb, Kathleen Peters, Susan Mcinnes

Faculty of Science, Medicine and Health - Papers: part A

Internationally, the delivery of health services has shifted from secondary to primary care, necessitating an exponential growth of the nursing workforce and expansion of the nursing role in general practice. This growth, and the subsequent need to develop this workforce, has created a need to expose undergraduate nurses to general practice nursing as a viable career option. Concurrently, universities are struggling to find sufficient clinical places for their undergraduate students to gain clinical experience. It is logical, therefore, to increase the number of undergraduate nursing student placements in general practice. Through qualitative research methods, this paper seeks to explore the …

Factors Influencing General Practitioner Referral Patterns To Orthopaedic Surgeons In The Australian Health Care Setting: An On-Line Survey, David Loxton, Stephen Barnett, Patricia J. Knight, Andrew D. Bonney

Graduate School of Medicine - Papers (Archive)

Aim:

To use the member database of e-healthspace.com.au to identify and quantify the factors that influence General Practitioners when referring patients to a particular Orthopaedic Surgeon

Method:

On line Survey of 9495 General practitioners who are registered on www.ehealthspace.com.au Seven point Likert scale used to rank responses from extremely positive to extremely negative to various factors that influence decisions to refer patients to an Orthopaedic Surgeon

Questions: 5 Broad Categories

Professional and personal reputation / Communication / Style of practice / Promotional activities / Access and cost

Results:

476 respondents.

407 proceeded beyond the demographic questions.

Demographic Questions:

Practice location …

General Practice Training, Web 2.0 And Virtual Communities Of Practice: An Interview Study, Stephen Barnett, Sandra C. Jones, Lance R. Barrie, Andrew D. Bonney, Donald C. Iverson

Graduate School of Medicine - Papers (Archive)

Aims and Rationale

General Practice training faces geographic barriers to efficient knowledge sharing, collaboration and professional and social support amongst its participants. In industry, large companies use internet tools to create Virtual Communities of Practice which improve collaboration, information sharing and support amongst staff. This study examined the feasibility of using Web 2.0 tools to create a Virtual Community of Practice for GP training.

Methods

Following a previous quantitative survey study, a qualitative telephone interview study was undertaken with GP Registrars and Supervisors in a Regional Training Provider. Participants were selected on the basis of highest internet usage in the …

Different Needs, Same Solution: The Effect Of Visible Supervision On Older Patients' Attitudes To General Practice Trainee Chronic/Complex Care, Andrew D. Bonney, Sandra C. Jones, Donald Iverson, Christopher Magee

Graduate School of Medicine - Papers (Archive)

Abstract presented at The 2010 38th NAPCRG Annual Meeting, 13-17 Nov 2010, Seattle, USA

What Do Older Patients Want? Understanding Older Patients' Attitudes Towards General Practice Trainees, Andrew D. Bonney, Sandra C. Jones, Donald Iverson, Christopher Magee

Graduate School of Medicine - Papers (Archive)

Context: Older patients constitute an increasing proportion of the caseloads in general practice (GP) training practices, but are relatively reluctant to consult trainees. Understanding their attitudes is a first step in improving older patient-trainee interaction. Objectives: Characterise the attitudes of older patients to GP trainees. Design: Cross-sectional survey; exploratory factor analysis; logistic regression. Setting: Randomised, stratified sample of 38 training practices across five Australian states. Participants: Patients aged 60 years and over (N=911; response rate 47.9%). Instrument: Questionnaire for self-completion: previously piloted and subjected to factor analysis. Main and secondary outcome measures: Identification of attitude factors; patient characteristics predicting high …

Measuring Older Patients’ Attitudes To General Practice Registrars: Exploratory Factor Analysis Of A Survey Instrument, Andrew D. Bonney, Christopher A. Magee, Peter Caputi

Graduate School of Medicine - Papers (Archive)

Introduction: Training general practice registrars (GPRs) to meet the challenges of an ageing population is hampered by their relatively reduced contact with older patients and a paucity of suitable research to inform training models. This paper describes an exploratory factor analysis of a survey instrument assessing the attitudes of older patients to GPRs, as part of a project to address these concerns. Methods: The instrument was developed on the basis of a qualitative study and a literature review and distributed to 500 patients aged 60 years and over from 10 training practices in regional Australia. Responses to 22 of the …

How Generalisable Are Results Of Studies Conducted In Practicebased Research Networks? A Cross-Sectional Study Of General Practitioner Demographics In Two New South Wales Networks, Parker Magin, Melanie Marshall, Susan Goode, Georgina Cotter, C Dimity Pond, Nicholas Zwar

Faculty of Science, Medicine and Health - Papers: part A

Objective: To compare the demographics of general practitioners in two practice-based research networks (PBRNs) and to explore the generalisability of research findings from these PBRNs. Design, setting and participants: Cross-sectional questionnaire-based study of two geographically-based PBRNs - Hunter New England Central Coast Network of Research General Practices (NRGP) and Primary Healthcare Research Network-General Practice (PHReNet-GP) - during August-September 2010. All 183 GP members of both PBRNs were invited to participate; of these, 140 (77%) participated. Main outcome measures: GPs' demographics, use of languages other than English in consultations, and previous participation in research. Practices' use of practice nurses. Socioeconomic status …

General Practice Training, Web 2.0 And Virtual Communities Of Practice : A Survey Study, Stephen Barnett, Sandra C. Jones, Lance R. Barrie, Andrew D. Bonney, D C. Iverson

Graduate School of Medicine - Papers (Archive)

Aims & rationale/Objectives

General Practice training faces geographic barriers to efficient knowledge sharing, collaboration and professional and social support amongst its participants. In industry, large companies use internet tools to create Virtual Communities of Practice which improve collaboration, information sharing and support amongst staff. This study examined the feasibility of using Web 2.0 tools to create a Virtual Community of Practice for GP training.

Methods

A crossectional online survey was conducted in a Regional GP Training Provider (RTP). The instrument contained categorical and 5-point ascending Likert response format items and was sent to all registrars and supervisors in the RTP. …

Preparing For An Ageing Population: A Survey Of Older Patients' Attitudes To General Practice Registrars, Andrew D. Bonney, Sandra C. Jones, Lyn Phillipson, Donald C. Iverson

Faculty of Health and Behavioural Sciences - Papers (Archive)

The ageing population makes it imperative to provide appropriate training for general practice registrars (GPRs) in the community-based care of older patients. However, data suggest that older patients may be less willing to consult GPRs for chronic/complex care; adversely affecting training opportunities and potentially the satisfaction of older patients in training practices. This cross-sectional study was undertaken to investigate this concern in the Australian context and develop models of older patient-GPR interaction that are acceptable to patients.

Development Of A Clinician-Led Research Agenda For General Practice Nurses, Elizabeth J. Halcomb, Louise Hickman

Faculty of Science, Medicine and Health - Papers: part A

Objective: This study sought to identify and prioritise research issues as perceived by Australian general practice nurses. In this context, a research priority refers to the most pressing research problems that necessitate exploration to improve clinical practice. Design: This paper reports the findings of a two-round Delphi study. Initially, focus groups identified research issues. Subsequently, an online survey facilitated ranking of these issues on a 5-point Likert scale. Setting: Australian general practices. Subjects: Twenty-five practice nurses participated in the focus groups and 145 practice nurses responded to an online survey. Main outcome measure(s): The main outcome measure was the prioritisation …

Development And Early Experience From An Intervention To Facilitate Teamwork Between General Practices And Allied Health Providers: The Team-Link Study, Mark Fort Harris, Bibiana Chan, Christopher Daniel, Qing Wan, Nicholas Zwar, Gawaine Powell Davies

Faculty of Science, Medicine and Health - Papers: part A

Abstract. Background. This paper describes the development and implementation of an intervention to facilitate teamwork between general practice and outside allied and community health services and providers. Methods. A review of organizational theory and a qualitative study of 9 practices was used to design an intervention which was applied in four Divisions of General Practice and 26 urban practices. Clinical record review and qualitative interviews with participants were used to determine the key lessons from its implementation. Results. Facilitating teamwork across organizational boundaries was very challenging. The quality of the relationship between professionals was of key importance. This was enabled …

General Practice Registrars: Attitudes Of Older Patients, Andrew D. Bonney, Sandra C. Jones, Lyn Phillipson, Donald C. Iverson

Faculty of Health and Behavioural Sciences - Papers (Archive)

Previous research indicates that older patients may be less willing to consult general practice registrars (GPRs), reducing training opportunities in chronic/complex care. This survey explores older patients’ attitudes in order to inform models of interaction that would be acceptable to patients. METHODS Ten training general practices distributed questionnaires for self completion to 50 patients aged 60 years and over. Chi-square, Spearman’s rho and logistic regression were used for analysis. RESULTS The response rate was 47%. Ninetysix percent wanted ongoing contact with their general practitioner if they saw a GPR. Twenty-four percent were comfortable with GPR chronic/complex care, increasing to 73% …