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

Practice

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Full-Text Articles in Social and Behavioral Sciences

Development Of Advanced Practice Competency Standards For Dietetics In Australia, Claire Palermo, Sandra Capra, Eleanor J. Beck, Janeane Dart, J Conway, Susan Ash Jan 2017

Development Of Advanced Practice Competency Standards For Dietetics In Australia, Claire Palermo, Sandra Capra, Eleanor J. Beck, Janeane Dart, J Conway, Susan Ash

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

Aim: This study aimed to explore the work roles, major tasks and core activities of advanced practice dietitians in Australia to define the Competency Standards for advanced practice. Methods: A qualitative approach was used to review advanced dietetic practice in Australia involving experienced professionals, mostly dietitians. Four focus groups were conducted with a total of 17 participants and an average of 20 years experience: 15 dietitian practitioners plus 2 employers (1 dietitian and 1 non-dietitian). The focus groups explored the key purpose, roles and outcomes of these practitioners. Data from the focus groups were confirmed with in-depth interviews about their ...


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 Jan 2017

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 ...


The Development Of Professional Practice Standards For Australian General Practice Nurses, Elizabeth J. Halcomb, Moira Stephens, Julianne Bryce, Elizabeth Foley, Christine Ashley Jan 2017

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 ...


A Self-Reported Survey On The Confidence Levels And Motivation Of New South Wales Practice Nurses On Conducting Advance-Care Planning (Acp) Initiatives In The General-Practice Setting, Emilia Fan, Joel J. Rhee Jan 2017

A Self-Reported Survey On The Confidence Levels And Motivation Of New South Wales Practice Nurses On Conducting Advance-Care Planning (Acp) Initiatives In The General-Practice Setting, Emilia Fan, Joel J. Rhee

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

Nurses are well positioned to initiate and conduct advance-care planning (ACP) conversations; however, there has been limited research on practice nurses performing this role in Australia. The aim of the present study was to understand the beliefs, attitudes, perceptions, confidence, training and educational needs of New South Wales practice nurses with regards to involvement in ACP. A cross-sectional online survey was conducted in August to October 2014. Nurses were recruited through nursing organisations and Medicare Locals. There were 147 completed surveys (n = 147). Participants were mostly female registered nurses, with a median age of 50, and 6 years of practice-nurse ...


Wildfire Survival Plans In Theory And Practice, Christine Eriksen, Trent D. Penman, Bronwyn L. Horsey, Ross A. Bradstock Jan 2016

Wildfire Survival Plans In Theory And Practice, Christine Eriksen, Trent D. Penman, Bronwyn L. Horsey, Ross A. Bradstock

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

Bushfire survival plans are a valuable tool for residents living in fire-prone landscapes. Plans include assigning trigger points for action, roles for all household members, and alternate approaches should the original plan fail. Fire agencies advocate that residents write, practise and discuss these plans before the fire season. In this study we use a multiple-methods approach to examine the theoretical and actual application of bushfire survival plans in south-east Australia. First, we review agency advice regarding survival plans to determine the consistency, clarity and specificity of the advice. Second, an online survey of residents examines the relationships between types of ...


Evaluating Women's Knowledge Of The Combined Oral Contraceptive Pill In An Australian Rural General Practice Setting, Sharna Kulhavy, Teresa M. Treweek Jan 2016

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.

Methods ...


Evaluation Of Assessment In The Context Of Work-Based Learning: Qualitative Perspectives Of New Graduates, Claire Palermo, Alexandra Chung, Eleanor Beck, Susan Ash, Sandra Capra, Helen Truby, Brian Jolly Jan 2015

Evaluation Of Assessment In The Context Of Work-Based Learning: Qualitative Perspectives Of New Graduates, Claire Palermo, Alexandra Chung, Eleanor Beck, Susan Ash, Sandra Capra, Helen Truby, Brian Jolly

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

Aim Evaluation or assessment of competence is an important step to ensure the safety and efficacy of health professionals, including dietitians. Most competency-based assessment studies are focused on valid and reliable methods of assessment for the preparation of entry-level dietitians, few papers have explored student dietitians' perceptions of these evaluations. The present study aimed to explore the perceptions of recent graduates from accredited nutrition and dietetics training programs in Australia. It also aimed to establish the relevance of competency-based assessment to adequately prepare them for entry-level work roles. Methods A purposive sample of newly graduated dietitians with a range of ...


Connectgpr: Implementing A Virtual Community Of Practice For General Practice Training, Stephen Barnett Jan 2013

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.


Practice Based Evidence: What Determines Clozpapine Prescribing Practice?, N B. Pai, S C. Vella Jan 2013

Practice Based Evidence: What Determines Clozpapine Prescribing Practice?, N B. Pai, S C. Vella

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

Abstract of poster that presented at the 15th ISAM Annual Meeting: Managing Addiction through Evidence-Based Medical and Psychosocial Interventions, 21-23 November 2013, Kuala Lumpur, Malaysia.


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 Jan 2013

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 ...


Addressing The Deficiencies In The Evidence-Base For Primary Practice In Regional Australia - Sentinel Practices Data Sourcing (Spds) Project: A Pilot Study, Abhijeet Ghosh, Karen E. Charlton, Lisa Girdo, Marijka J. Batterham, Keith Mcdonald Jan 2013

Addressing The Deficiencies In The Evidence-Base For Primary Practice In Regional Australia - Sentinel Practices Data Sourcing (Spds) Project: A Pilot Study, Abhijeet Ghosh, Karen E. Charlton, Lisa Girdo, Marijka J. Batterham, Keith Mcdonald

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

Background Chronic disease risk on a population level can be quantified through health surveys, either continuous or periodic. To date, information gathered from primary care interactions, using sentinel sites, has not been investigated as a potentially valuable surveillance system in Australia.

Methods A pilot study was conducted in a single General Practice in a regional area of New South Wales, Australia to assess the feasibility of accessing data obtained through a computerised chronic disease management program that has been designed for desktop application (Pen Computer Systems (PCS) Clinical Audit Tool: ™ PCS CAT). Collated patient data included information on chronic disease ...


Culturally And Linguistically Diverse General Practitioners' Utilisation Of Practice Nurses, Elizabeth J. Halcomb, Yenna Salamonson, Melissa Cooper, Jennifer L. Clauson, Lien Lombardo Jan 2013

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 ...


Using Formative Feedback To Identify And Support First Year Chemistry Students With Missing Or Misconceptions. A Practice Report, Gwen Lawrie, Anthony Wright, Madeleine Schultz, Timothy Dargaville, Glennys O'Brien, Simon B. Bedford, Mark Williams, Roy Tasker, Hayden Dickson, Christopher Thompson Jan 2013

Using Formative Feedback To Identify And Support First Year Chemistry Students With Missing Or Misconceptions. A Practice Report, Gwen Lawrie, Anthony Wright, Madeleine Schultz, Timothy Dargaville, Glennys O'Brien, Simon B. Bedford, Mark Williams, Roy Tasker, Hayden Dickson, Christopher Thompson

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

Students entering tertiary studies possess a diverse range of prior experiences in their academic preparation for tertiary chemistry so academics need tools to enable them to respond to issues in diversity in conceptual models possessed by entering students. Concept inventories can be used to provide formative feedback to help students identify concepts that they need to address to improve construction of subsequent understanding enabling their learning. Modular, formative learning activities that can be administered inside or outside of class in first year chemistry courses have been developed. These activities address key missing and mis-conceptions possessed by incoming student. Engagement in ...


A Qualitative Evaluation Of New Zealand Consumers Perceptions Of General Practice Nurses, Elizabeth J. Halcomb, Kath Peters, Deborah Davies Jan 2013

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 ...


Social Media Experiments: Scholarly Practice And Collegiality, Chris Gibson, Leah Gibbs Jan 2013

Social Media Experiments: Scholarly Practice And Collegiality, Chris Gibson, Leah Gibbs

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

We draw out and seek to build on two key insights in Kitchin et al. (2013), namely the possibilities of social media for transforming knowledge production practices and for generating new spaces of collegiality and communality. Most promising are capacities to shape the terms of academic labour and to disrupt binaries of core/periphery, research/impact and academic/public.


The Influence Of Longitudinal Integrated Clerkships On Clinical Scholarship In Regional And Rural Communities Of Practice, Kathryn M. Weston, Judith Nicky Hudson Jan 2013

The Influence Of Longitudinal Integrated Clerkships On Clinical Scholarship In Regional And Rural Communities Of Practice, Kathryn M. Weston, Judith Nicky Hudson

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

All senior medical students at the University of Wollongong undertake a longitudinal integrated community-based cle rkship, supervised by experienced generalist practitioners (GPs) in a regional or ru ral community. Prior to the first clerkship, GP preceptors predicted outcomes from their relationship with the long-term students, including a more scholarly approach to clinical pract ice. This prompted exploration of preceptor post·clerkship perceptions In the light of Grigsby and Tl10rndykes (2011) recent working definition of dlnical scholarship in academic medicine.


Clinical Placements In General Practice: Relationships Between Practice Nurses And Tertiary Institutions, Kath Peters, Elizabeth J. Halcomb, Susan Mcinnes Jan 2013

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 ...


What Is Different In Psychiatric Practice In Developing And Developed World? An Experiential Account From Australia And India, Nagesh Pai, Naveen Chandra Jan 2013

What Is Different In Psychiatric Practice In Developing And Developed World? An Experiential Account From Australia And India, Nagesh Pai, Naveen Chandra

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

Abstract of a paper presented at the 65th Annual National Conference of Indian Psychiatric Society, Bangalor, 10-13 Jan, 2013. This is a narrative account of two psychiatrists (from Wollongong, NSW and Mangalore, India) who swapped their location or practice and reviewed their experiences.


Electronic Discharge Summary Driving Advice: Current Practice And Future Directions, John Carmody, Michael Carey, Victoria Traynor, Don Iverson Jan 2013

Electronic Discharge Summary Driving Advice: Current Practice And Future Directions, John Carmody, Michael Carey, Victoria Traynor, Don Iverson

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

Background Driving is a complex task. Many older drivers are unaware of their obligation to inform authorities of conditions which may impact upon their driving safety. Aims This study sought to establish the adequacy of driving advice in electronic discharge summaries from an Australian stroke unit. Method One month of in-patient electronic discharge summaries were reviewed. A predetermined list of items was used to assess each electronic discharge summary: age; gender; diagnosis; relevant co-morbidities; deficit at time of discharge; driving advice; length of stay; and discharge destination. Results Of 41 participants, the mean age was 72 years. Twenty patients had ...


Risky Business: Do Private Practice And Clinical Placement Make A Happy Partnership?, Angela Douglas Jan 2013

Risky Business: Do Private Practice And Clinical Placement Make A Happy Partnership?, Angela Douglas

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

Abstract of paper presented at the 2013 Exercise & Sports Science Australia Business Forum, 18-19 May, Wollongong, Australia.


Exercise Counselling: When Undergraduate Practice-Based Learning And Community Outreach Combine, Everyone Appears To Be A Winner, Angela Douglas, Jennifer Wilkie, Herbert Groeller Jan 2012

Exercise Counselling: When Undergraduate Practice-Based Learning And Community Outreach Combine, Everyone Appears To Be A Winner, Angela Douglas, Jennifer Wilkie, Herbert Groeller

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

Abstract of paper presented at the 5th Exercise & Sports Science Australia Conference 2012.


Will Climate Severity Ever Lead To Climate Action? Implications For Adaptation Policy And Practice, Bastian Seidel, Erica Bell Jan 2012

Will Climate Severity Ever Lead To Climate Action? Implications For Adaptation Policy And Practice, Bastian Seidel, Erica Bell

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

No abstract provided.


Using Research To Identify Teaching And Learning Innovations That Will Better Prepare Nursing Students For Professional Practice, Dominique Parrish, Kay Crookes, Patrick A. Crookes Jan 2012

Using Research To Identify Teaching And Learning Innovations That Will Better Prepare Nursing Students For Professional Practice, Dominique Parrish, Kay Crookes, Patrick A. Crookes

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

In Australia, data is collected by universities across students' institutional tenure to measure and monitor student learning, engagement and experience (DEEWR 2009). This data is often used to assess the performance of a subject, course, faculty or university and also to inform potential marketing materials and campaigns. However, there is very little data (if any) collected to enable universities to assess how well their educational programmes are preparing students for professional practice. This paper is based on a pilot study that aimed to address this gap by asking recent university graduates to provide some feedback on how their undergraduate nursing ...


Practice Nurses Experiences Of Mentoring Undergraduate Nursing Students In Australian General Practice, Elizabeth J. Halcomb, Kathleen Peters, Susan Mcinnes Jan 2012

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 ...


Adapting General Practice Training To Meet The Evolving Health Care Needs Of Our Communities, Andrew Bonney, Simon Morgan, Parker Magin Jan 2012

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.


How Does An Awareness Of Emotional Intelligence Impact On Practice: Developing Emotional Intelligence In An Education Setting, Dominique Parrish Jan 2011

How Does An Awareness Of Emotional Intelligence Impact On Practice: Developing Emotional Intelligence In An Education Setting, Dominique Parrish

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

No abstract provided.


The Relevance Of Emotional Intelligence For Effective Leadership Practice In A Higher Education Context, Dominique Parrish Jan 2011

The Relevance Of Emotional Intelligence For Effective Leadership Practice In A Higher Education Context, Dominique Parrish

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

No abstract provided.


Cardiovascular Absolute Risk Assessment And Management Engagement And Outcomes In General Practice Patients, Qing Wan, Nicholas Zwar, Sanjyot Vagholkar, Terry Campbell, Mark Fort Harris Jan 2010

Cardiovascular Absolute Risk Assessment And Management Engagement And Outcomes In General Practice Patients, Qing Wan, Nicholas Zwar, Sanjyot Vagholkar, Terry Campbell, Mark Fort Harris

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

Despite a decline in recent decades, cardiovascular disease (CVD) remains the major cause of death and disability in Australia.1,2 To improve primary prevention of CVD, many clinical guidelines recommend using cardiovascular absolute risk (CVAR) assessment to guide risk factor management.3-6 Cardiovascular absolute risk assessment predicts the overall risk of a cardiovascular event over a given time period (usually 5 or 10 years). However, use of CVAR is limited and has not been incorporated well in routine general practice.7-9 There has been little research on CVAR implementation and an effective implementation strategy has been lacking.10


Quit In General Practice: A Cluster Randomised Trial Of Enhanced In-Practice Support For Smoking Cessation, Nicholas Arnold Zwar, Robyn Richmond, Elizabeth Halcomb, John Furler, Julie Smith, Oshana Hermiz, Irene Blackberry, Ron Borland Jan 2010

Quit In General Practice: A Cluster Randomised Trial Of Enhanced In-Practice Support For Smoking Cessation, Nicholas Arnold Zwar, Robyn Richmond, Elizabeth Halcomb, John Furler, Julie Smith, Oshana Hermiz, Irene Blackberry, Ron Borland

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

Background This study will test the uptake and effectiveness of a flexible package of smoking cessation support provided primarily by the practice nurse (PN) and tailored to meet the needs of a diversity of patients. Methods/Design This study is a cluster randomised trial, with practices allocated to one of three groups 1) Quit with Practice Nurse 2) Quitline referral 3) GP usual care. PNs from practices randomised to the intervention group will receive a training course in smoking cessation followed by access to mentoring. GPs from practices randomised to the Quitline referral group will receive information about the study ...


Uptake Of Medicare Chronic Disease Items In Australia By General Practice Nurses And Aboriginal Health Workers, Elizabeth J. Halcomb, Patricia M. Davidson, Nicola Brown Jan 2010

Uptake Of Medicare Chronic Disease Items In Australia By General Practice Nurses And Aboriginal Health Workers, Elizabeth J. Halcomb, Patricia M. Davidson, Nicola Brown

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

The Australian health care system is currently in a state of reform and there is increasing pressure to provide care in community settings. Rising costs, demands and population ageing underscore the importance of adopting models of health care delivery to address changing epidemiological patterns. Population ageing and the increase of chronic conditions challenge models based on acute care. Changes to the Medicare benefits schedule have facilitated the development of a range of expanded nursing services in the general practice setting. In particular, item number 10997 was introduced to reimburse practice nurses and Aboriginal health workers (AHWs) for providing monitoring and ...