Australian Private Practice Research Articles

Workforce characteristics of privately practicing nurse practitioners in Australia: Results from a national survey.

Australian private practice nurse practitioner (PPNP) services have grown since legislative changes in 2010 enabled eligible nurse practitioners (NPs) to access reimbursement for care delivered through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). This article provides data from a national survey on the workforce characteristics of PPNPs in Australia. PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. There were 73 completed surveys. One of the intentions of expanding access to MBS and PBS for patients treated by NPs was to increase patients' access to health care through greater flexibility in the healthcare workforce. The results of this survey confirm that the workforce characteristics of PPNPs provide a potentially untapped resource to meet current primary healthcare demand. The findings of this study allow us to understand the characteristics of PPNP services, which are significant for workforce planning. The focus of PPNP practice is toward primary health care with PPNPs working predominantly in general practice settings. The largest age group of PPNPs is over 50 years and means a proportion will be retiring in the next 15 years.

Implementation of Continuous Echo Quality Assurance Program: Insights From a 3-Year Experience at a Large, Multi-Site, Australian Private Practice

Implementation of Continuous Echo Quality Assurance Program: Insights From a 3-Year Experience at a Large, Multi-Site, Australian Private Practice

Image Audit as A Part of a Quality Assurance Program is Feasible in a Large, Busy Australian Private Practice Across Multiple Sites, and Produces a Measurable Improvement in Study Quality

Introduction: Echocardiography requires acquisition of standard imaging planes to ensure accuracy and reproducibility. An extensive quality assurance program was established at HeartCare Partners in 2013 including a comprehensive image audit. Method: Quarterly image audits were conducted on 5% of all transthoracic echocardiograms performed at HeartCare Partners’ 7 clinical sites by 2 other randomly selected experienced sonographers. Studies were assessed for completeness of image protocol, on-axis and full cardiac cycle capture. Automated data analysis was presented at quarterly in-house meetings. Result: 977 studies performed from April 2013 and December 2015 were analysed. 6/11 standard views were identified where on-axis imaging was below 80% (average 68±6%) on first audit. Subsequent audits showed an increase to an average of 81±5% (p<0.001). 4 views with values above 80% (average 83±1%) showed no significant change (85±7%, p>0.05). One view (apical 5-chamber) identified as having been obtained in 83% of initial studies rose to 98%. Other views (average 96±3%) were unchanged (1±1% p>0.05). Appropriate capture of at least one full cardiac cycle remained high and relatively unchanged (95±0.02%, p=0.02). Conclusion: Image audit is scalable and practical over a period of years and appears highly effective in improving and maintaining quality. The program has now been extended to 25 GenesisCare locations across 3 states with further expansion ongoing.

THE CARIES MANAGEMENT SYSTEM: UPDATING COST-EFFECTIVENESS WITH 4-YEAR POSTTRIAL DATA.

Long-term follow-up of the Caries Management System (CMS) protocol demonstrated that regular monitoring and noninvasive management of dental caries is effective in reducing the number of caries-related events over a 7-year period. This analysis complements the authors' original economic evaluation of the CMS by re-evaluating the per-protocol cost-effectiveness of the CMS approach. An individual patient-simulation Markov model was developed previously, based on 3-year randomized-controlled trial (RCT) data, to simulate the incidence and progression of dental caries, and resultant interventions, and to evaluate the lifetime cost-effectiveness of the CMS versus standard dental care from the Australian private dental practitioner perspective (in which the baseline age distribution was similar to that of the Australian population). The 4-year posttrial follow-up data are used to re-evaluate the long-term cost-effectiveness of the CMS in a more real-life setting. The reduction in caries risk was maintained among those practices within which the CMS protocols were adhered to. The per-protocol model appears to be reasonably accurate at predicting the risk of restorative events in the posttrial follow-up period. The per-protocol lifetime cost per restorative event avoided is AUD1,980 (USD1,409; 1 AUD = 0.71 USD). The current analysis confirms that the CMS approach is both effective, when the protocols are adhered to appropriately, and cost-effective compared with standard care in the Australian private practice setting.

REASONS FOR DISCONTINUATION OF INTRAVITREAL VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

This study was aimed to identify the reasons for discontinuing intravitreal anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration. This study is a retrospective chart review of a single Australian private practice. Analysis included patients who discontinued treatment from March 2006 to June 2012. Of 248 patients who commenced treatment, 105 (42.3%) had discontinued by June 2012. The reasons for discontinuation were available for 102 of the 105 (97.1%) patients. In 9 (3.6%) patients of the entire cohort, the doctor stopped the treatment as the lesion became inactive, whereas further treatment was thought to be futile in 27 (10.9%) patients. Twenty-six (10.5%) patients declined further treatment with 2 (0.8%) because of excessive treatment visits, 2 (0.8%) because of difficulty in attending, 2 (0.8%) because of the expense, 3 (1.2%) because of pain/discomfort, 6 (2.4%) thought that the treatment was not beneficial, and 11 (4.4%) had other medical conditions that were more severe. Treatment was discontinued in 40 (16.1%) patients for other reasons such as moving to another region in 27 (10.9%) and death in 11 (4.4%). These results indicate that the burden of intravitreal anti-vascular endothelial growth factor injections was a reason for treatment discontinuation in only a small minority of patients.

Increasing dietetic referrals: Perceptions of general practitioners, practice nurses and dietitians

AbstractAim: To examine Australian private practice dietitians' relationships with general practitioners and practice nurses as a factor that influences dietetic referrals.Methods: Semistructured telephone interviews and an online survey were conducted with Australian private practice dietitians (n = 52 and n = 90, respectively) between April and May 2008. Semistructured questionnaires were conducted with general practitioners (n = 11) and practice nurses (n = 12) from the ‘GP Access’ Division of General Practice between March and July 2007.Results: General practitioners' relationships with dietitians were believed to be the primary influencing factor on referral, provided by 81% of survey dietitians and 25% of interview dietitians. The most common means of initially forming relationships with general practitioners were face‐to‐face introduction (48%) and introductory letters (37%). Patient feedback via letter, fax or email was the most popular method of maintaining relationships with general practitioners (77%). Meeting with general practitioners in person was believed to be the most effective activity in building relationships with general practitioners and increasing referral rates (42%). Referral was made easier for general practitioners by providing paper (37%) or electronic (19%) referral forms and contact details (19%). The majority of general practitioners and dietitians believed that the ‘Allied Health Services Under Medicare’ made it easier to refer to a dietitian.Conclusions: Dietetic referrals can be encouraged through good relationships between general practitioners, practice nurses and dietitians. Private practice dietitians would benefit from cultivating relationships with general practitioners and practice nurses through personal contact and providing good patient feedback.

Nutrition advice in general practice: the role of general practitioners and practice nurses

General practice is an ideal setting to be providing nutrition advice; however, it is important that the role of general practitioners (GPs) and practice nurses in providing nutrition advice is acknowledged and defined. This article aims to discuss the role of GPs and practice nurses in the delivery of nutrition advice. Ten general practitioners and 12 practice nurses from a NSW urban Division of General Practice participated in questionnaires and a Lifescripts implementation study, as well as their consenting patients receiving Lifescripts (n=13). An online survey was conducted with 90 Australian private practice dietitians. Semi-structured telephone interviews were conducted with 52 Australian private practice dietitians. The provision of basic nutrition advice is acknowledged to be part of the role of GPs and practice nurses, as they are the first point of contact for patients, allowing them to raise nutrition awareness. However, it is important that this advice is evidence based and able to be delivered in a time-efficient manner. Increased nutrition education and the availability of appropriate resources and nutrition-related best practice guidelines will assist in this process.

Patterns of delivery of dietetic care in private practice for patients referred under Medicare Chronic Disease Management: results of a national survey

A national survey was used to examine patterns of delivery of dietetic care for patients referred to private practitioners under Medicare Chronic Disease Management (CDM). This asked dietitians about referrals from general practitioners, patient management, fees charged and patient billing. There were 356 (47%) Australian private practice dietitians who responded to the questionnaire; 330 (94%) were Medicare providers. They described a counselling-type service and inability to complete initial patient education within funded consultation time. Many provided a longer consultation than was reported as being funded by Medicare. Fees for initial appointments were generally higher than the scheduled Medical Benefit Scheme fee of AU$56.25 (median $80), requiring patients to pay a fee gap. For review appointments, two of every five dietitians bulk-billed or charged an identical fee ($47.85). Providers communicated by written reports (as required under Medicare policy). There was little evidence of team-based chronic care management. The dietetics Medicare CDM process should mirror other counselling-type Medicare services which provide for both longer and more frequent consultations and higher payment. System integration between dietitians and general practitioners is required to achieve true collaboration and team care of chronic disease patients.

Alcoholic liver disease: a clinical series in an Australian private practice.

The published literature on alcoholic liver disease (ALD) in Australia lacks a large clinical series out of private practice as distinct from hospital-based hepatology referral units. This series describes the presentation and clinical features of ALD in a consecutive series out of metropolitan private practice in Australia. A retrospective descriptive study by case-note review found 297 cases of ALD at a Brisbane practice over 20 years. The main outcome measures were: clinical features and stage at presentation, reasons for referral, and the predictive value of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio. Most patients (57.9%) had no symptoms of liver disease and 29 patients (9.8%) had neither symptoms nor signs. Cirrhosis was found in 41% of patients and hepatitis-fibrosis was found in 26% of patients. The male to female (M : F) ratio was 4.7:1. The AST/ALT ratio was not reliably predictive of ALD stage. The average reported daily alcohol intake was 131 g. Females drank less on average and presented a more vigorous clinical picture. This series presents the spectrum of ALD in a metropolitan Australian private practice. Many patients are asymptomatic on presentation. All heavy drinkers should be targeted for early investigation without waiting for volunteered symptoms or abnormal physical signs. The male to female ratio in ALD is higher than hitherto reported. The AST/ALT ratio is not generally applicable in the staging of ALD. The differences from hospital series data suggest the demography and epidemiology of ALD in Australia are incomplete, and further study is warranted.

Service‐mix provided to patients in Australian private practice

Service-mix can reflect changes in demographic factors, oral health, patient demand and treatment philosophies. The aim of this study was to compare service-mix by patient age in 1988 with baseline data from 1983. A weighted, stratified random sample of dentists in Australia was surveyed by mailed questionnaire in 1983 and again in 1988. Service-mix was dominated by restorative, diagnostic and preventive areas. Comparing 1988 with 1983, there were significant increases for diagnostic, preventive, advanced restorative, orthodontic and general areas. Patterns across patient age groups and between years indicated younger patients were being provided with increased preventive services (patients aged 5-11, 25-44 years) and decreased restorative services (patients aged 5-11, 12-17 years), while older patients were being provided with reduced prosthodontic services (patients aged 25-44, 45-64 years), but increased restorative services (patients aged 45-64, 65+ years) and advanced restorative services (patients aged 25-44, 45-64 years). These patterns of service-mix have implications for dental education, research and service delivery.