General Practitioners In Australia Research Articles

How are solar keratoses treated by general practitioners in Australia?

This study aimed to obtain clinical and economic information about patterns of treatment of solar keratoses (SKs) by general practitioners in Australia. The study design was a retrospective survey relating to the treatment of patients presenting to their doctor with previously untreated SKs. Data were collected between May and June 2000, from a sample of doctors who were asked to randomly select two SK patients from their medical records and complete a self-administered postal questionnaire. Information about treatment types, number of visits, treatment complications, and specialist referrals were directly extracted from the patient records. A total of 156 patients were recruited to the study (61% male) who had been treated for a total of 251 SKs (average 1.6 lesions/patient). The most common treatment employed was cryotherapy (63%). Excision was also commonly used (18%). Five per cent of patients were treated with a mixture of excision and cryotherapy. Topical agents were not commonly employed. Of those patients who consulted a doctor, 9% were referred to a specialist for diagnosis or treatment, of which 57% were referred to a dermatologist. The typical number of doctor visits varied from 1.9 to 4.6 with a range of cost per patient of 55.13-249.70 Australian dollars depending on complexity of the case and the need for referral.

Association between antidepressant prescribing and suicide in Australia, 1991-2000: trend analysis

Objective: To examine the association between trends in antidepressant prescribing and suicide rates in Australia for 1991-2000.Design: Analysis of databases of suicide and rates of antidepressant prescribing according to age...

The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times

To compare the rate of provision of longer consultations per head of population across practice locations categorised by socioeconomic status. Retrospective analysis of Medicare data for all consultations for all general practitioners in Australia for the 1998-99 and 1999-2000 financial years, grouped by postcode of practice location. Postcodes were categorised by the Socio-Economic Indexes for Areas, Index of Relative Socio-Economic Disadvantage score. Number of consultations and number of brief, standard, long and prolonged consultations per capita in each postcode grouping. The absolute number of long plus prolonged consultations showed no trend across postcode groups, but the rate ratio per person was significantly higher in more advantaged postcode areas. This represents an example of care provision in inverse relationship to need. Despite higher rates of chronic disease and lower rates of preventive care uptake, patients in low socioeconomic status areas receive longer GP consultations at a lower rate than patients in more advantaged areas. Possible strategies to overcome this inverse care provision include increased numbers of GPs in disadvantaged communities, removal of financial disincentives to longer consultations, and strengthening health promotion and community health services in disadvantaged areas.

The balancing act: key issues in the lives of women general practitioners in Australia.

To identify key issues affecting women general practitioners in their professional and non-professional lives. A qualitative study using the Delphi technique, with three rounds of data provision circulated to each participant. Coding was used to ensure anonymity. The participants were a purposive sample of 40 women GPs drawn from all Australian States and Territories. The study was conducted between October 1996 and January 1997. Key issues affecting the professional and non-professional lives of women GPs. Some of the key professional issues for women GPs were job satisfaction, balancing work and personal life, autonomy, availability of flexible and part-time work and training, affordability of professional expenses, fair remuneration, and having a voice in decision-making. Key non-professional issues included self-care; time for relationships with a partner, children, family and friends; and time management to allow pursuit of non-medical interests. The conflicting demands made on women GPs diminish their job satisfaction and lead to stress and imbalance in their lives. Recommendations to ameliorate the problems for women GPs include appropriate training, policy formation, financial and other support, and a change in cultural expectations of women GPs by the community, the profession and governments.

An international taxonomy for errors in general practice: a pilot study.

To develop an international taxonomy describing errors reported by general practitioners in Australia and five other countries. GPs in Australia, Canada, the Netherlands, New Zealand, the United Kingdom and the United States reported errors in an observational pilot study. Anonymous reports were electronically transferred to a central database. Data were analysed by Australian and international investigators. Non-randomly selected GPs: 23 in Australia, and between 8 and 20 in the other participating countries. Error categories, and consequences. In Australia, 17 doctors reported 134 errors, compared with 301 reports by 63 doctors in the other five countries. The final taxonomy was a five-level system encompassing 171 error types. The first-level classification was "process errors" and "knowledge and skills errors". The proportion of errors in each of these primary groups was similar in Australia (79% process; 21% knowledge and skills) and the other countries (80% process; 20% knowledge and skills). Patient harm was reported in 32% of reports from Australia and 30% from other countries. Participants considered the harm "very serious" in 9% of Australian reports and 3% of other countries' reports. This pilot study indicates that errors are likely to affect primary care patients in similar ways in countries with similar primary healthcare systems. Further comparative studies are required to improve our understanding of general practice error differences between Australia and other countries.

Needs assessment study of genetics education for general practitioners in Australia

Purpose: Because of the explosion of genetic information resulting from the Human Genome Project and other developments in genetics and genetic technologies, primary care practitioners in Australia will be expected to have a much greater role in the practice of genetic medicine; however, little is published regarding their knowledge and attitudes to genetics, technologies, or genetics education. This study aimed to determine the genetics knowledge and educational needs of general practitioners (GPs) in Victoria, Australia, and their experiences in dealing with genetics in their practices.Methods: Qualitative research methods were used primarily to obtain data from focus groups, interviews, and a limited survey.Results: GPs believed their knowledge of genetics was poor and they felt inadequately prepared to manage patients with genetic conditions. They identified testing and counseling as areas that particularly needed strengthening.Conclusion: These data, together with GPs' suggestions about educational strategies, are essential for developing appropriate genetics education programs and resources that are relevant for Australian health care.

Medical specialists servicing the New England Health Area of New South Wales.

There is increasing emphasis on research, policy and program activity to recruit and retain rural general practitioners in Australia. In contrast, until recently, there has been less attention paid to specific policies and programs relating to rural medical specialists. The New England Area Health Service experiences a shortage of general practitioners and specialists. This study surveyed this region's specialist workforce in 1998 and aimed to identify recruitment and retention issues affecting specialist rural workforce planning in north-west New South Wales. All 91 medical specialists practising in this rural area were surveyed. Seventy-one completed survey forms were received, representing a response rate of 78%. Positive features of rural specialist practice included the rural lifestyle, professional autonomy and available medical infrastructure. Negative features included professional isolation, long working hours, lack of locum relief and inadequate remuneration. Almost all surveyed specialists believe that there is a shortage of specialists servicing the New England Health Area. The major deficits in specialty areas identified relate to: dermatology; ear, nose and throat; obstetrics and gynaecology; orthopaedics; paediatrics; and urology. Recruiting and retaining medical specialists would be facilitated by improvements in the following areas: specialist resources and facilities, specialist locum scheme, remuneration and professional support. Effective strategies need to take account of local circumstances and be based on discussions involving all local key stakeholders.

Rural and remote Australian general practitioners' educational needs in radiology.

The Australian College of Rural and Remote Medicine (ACRRM) was funded by the Commonwealth Department of Health and Aged Care to set up a quality assurance and continuing medical education program for rural and remote general practitioners in radiology to begin in January 2001. An extensive literature search failed to uncover any previous publications on the specific educational or quality assurance needs for rural general practitioners in radiology. Broader educational needs assessments of rural general practitioners in Australia had identified radiology as an important skill for which improvement was desired. A national steering committee consisting of four rural general practitioners and three radiologists, with the assistance of a program manager, developed and piloted a self-administered postal questionnaire to determine the educational and quality assurance needs of rural and remote general practitioners. The questionnaire was sent to all rural and general practitioners holding a remote radiology exemption using the Health Insurance Commission database. A total of 287 completed questionnaires were returned from all states in the country, except the Australian Capital Territory. The information gave a comprehensive picture of the self-reported radiology education needs of these doctors, who practice in isolation from radiologists and other specialists. The three areas in which the general practitioners were least confident in radiology were chest, cervical spine, and skull radiology. Their highest priority areas of need for education were chest radiology, film interpretation, and spinal radiology. The top preferred quality assurance activity was image review with a radiologist, followed by clinical audit, image review by peers, and measuring practice against guidelines. Local ownership of education is important to successful program development and evaluation. Information obtained from the educational needs assessment was used to develop the Radiology Quality Assurance and Continuing Medical Education Program for Rural and Remote General Practitioners.

Working relationships between practice nurses and general practitioners in Australia: a critical analysis

Working relationships between practice nurses and general practitioners in Australia: a critical analysis This research set out to explore shared care between practice nurses and general practitioners in South Australia. Nine practice nurses (PNs), two nurse practitioners and 10 general practitioners (GPs) were interviewed in urban and rural practices in order to build up a picture of how GPs and PNs worked together. The interviews showed that shared care was not a reality, although practice nurses were very busy, enjoyed their work and were no longer performing as receptionists doing a little nursing on the side, but as highly skilled nurses. Questions that emerged included whether or not practice nurses are specialists or generalists; their relationship to nurse practitioners; the extent to which the doctor–nurse game explains the relationship between practice nurses and general practitioners; and the potential for expanding the practice nurse role.

Health promotion and older people: the role of the general practitioner in Australia in promoting healthy ageing

ObjectiveThe Commonwealth Government's Enhanced Primary Care initiative supports measures to enhance the role of general practitioners (GPs) in promoting healthy ageing as part of a population health approach. This paper comments on how the health assessments can be conducted to best effect, to strengthen the role of GPs in primary care and to promote autonomy and independence in older people. MethodThe relevant literature was collated to produce a review of public health and health promotion approaches and to ascertain the effectiveness of health promotion interventions for older people. A broad definition of health promotion including primary, secondary and tertiary prevention was adopted. ResultsThe evidence base suggests there is scope for greater targeting of health promotion activities towards older people. The rationale fa the Australian GP to assume a major health promotion role with their older patients is provided. Associated barriers and enablers are discussed. ConclusionsPrevention of disability is a key public health issue. The new MBS items may enable systematic evaluation of function and assist healthy ageing for all older people, including the frail aged. An increase in the preventive advice given to older patients has the potential to increase healthy behaviours and alter health outcomes. ImplicationsThe annual health assessment items on the Medicare Benefits Schedule, by enabling the GP to focus on prevention and coordination of care, have the potential to improve the health, physical, psychological and social function of older Australians.

Inequitable distribution of general practitioners in Australia: analysis by state and territory using census data.

The objective of this study was to describe the distribution of general practitioners in each State and Territory, stratified by statistical division and adjusted for estimated community need. The location of general practitioners was obtained from the 1996 Census of Population and Housing. Community need was estimated from crude death rates supplied by the Australian Bureau of Statistics. On average there are 920 people per full-time general practitioner in Australia. Three States are relatively oversupplied by up to 5% (Australian Capital Territory) and the rest are relatively undersupplied by up to 12% (Western Australia). Adjusted for estimated need, the Australian Capital Territory is oversupplied by 71% compared with all of Australia, while Western Australia is undersupplied by 15%. More marked differences occur within the States, with the statistical division containing each capital city in each State that is relatively overserved. The greatest oversupply is in Sydney, where 33% fewer people share a full-time general practitioner than the whole of New South Wales (adjusted for need, oversupply in Sydney is 63%). Relative undersupply is greatest in Queensland, with 133% more people sharing each general practitioner in the north-west statistical division compared with the whole State. The distribution of general practitioners between and within States and Territories is unequal and inequitable. In each State, capital cities tend to be relatively oversupplied compared with more rural areas. While these data do not inform the absolute level of service needed in a community; they do suggest that strategies to redress the inequitable distribution are required.

Consumers as Educators: Implementation of Patient Feedback in General Practice Training

There is growing interest in the adoption of patient-based assessments for the training of general practitioners. Consumers are in a unique position to comment on the quality of the doctor-patient interaction. Involving consumers as partners with general practice (GP) registrars and GP educators in the development of a patient feedback instrument enhances the relevance and acceptability of consumers as educators in GP training. It also demonstrates that social and medical agendas can be harmonized. Two patient feedback instruments on interpersonal skills were trialed in a training program for general practitioners in Australia. It was found that one of the instruments was more discriminating than the other because of its different response scale.

Inequitable distribution of general practitioners in Australia: estimating need through the Robin Hood Index

ObjectiveFrom Census data, to document the distribution of general practitioners in Australia and to estimate the number of general practitioners needed to achieve an equitable distribution accounting for community health need. MethodsData on location of general practitioners, population size and crude mortality by statistical division (SD) were obtained from the Australian Bureau of Statistics. The number of patients per general practitioner by SD was calculated and plotted. Using crude mortality to estimate community health need, a ratio of the number of general practitioners per person mortality was calculated for all Australia and for each SD (the Robin Hood Index). From this, the number of general practitioners needed to achieve equity was calculated. ResultsIn all, 26,290 general practitioners were identified in 57 SDs. The mean number of people per general practitioner is 707, ranging from 551 to 1887. Capital city SDs have most favourable ratios. The Robin Hood Index for Australia is 1, and ranges from 0.32 (relatively under-served) to 2.46 (relatively over-served). Twelve SDs (21%) including all capital cities and 65% of all Australians, have a Robin Hood Index > 1. To achieve equity per capita 2489 more general practitioners (10% of the current workforce) are needed. To achieve equity by the Robin Hood Index 3351 (13% of the current workforce) are needed. ConclusionsThe distribution of general practitioners in Australia is skewed. Non-metropolitan areas are relatively under-served. Census data and the Robin Hood Index could provide a simple means of identifying areas of need in Australia.

Nursing's contribution to general practice: general practitioners' and practice nurses' views

This study was instigated by the paucity of knowledge relating to the work of nurses employed by general practitioners in Australia and the phenomenal development of the practice nurse role in the United Kingdom. A mailed survey of general practitioners and practice nurses within one Division of General Practice in South-East Queensland, sought, among other things, their views about the current and potential contribution of nursing to general practice. Eighty-four out of 164 (51%) general practitioners and 37 out of 67 (55%) practice nurses responded to the survey. Results indicated that both general practitioners and practice nurses appreciated the value of nursing services in general practice and would sanction the employment of more nurses especially for the purpose of preventive care. The majority of nurses were agreeable to the notion that the nurse's role could, and should, be expanded to include autonomous functioning while most of the doctors were amenable to some extension of nursing practice but reticent or opposed to any independent interventions.

Asthma management and morbidity in Australian general practice: the relationship between patient and doctor estimates

The aims of this study were to describe asthma management and morbidity in patients attending general practitioners in Australia, and to assess the relationship between patient reports and those of their general practitioner (GP). The sample comprised consecutive patients attending 46 general practitioners chosen at random in five regions of New South Wales, Australia. A total of 4538 patients were screened, 607 (13.4%) reported ever having diagnosed asthma, and the 501 who reported asthma in the previous 12 months completed a detailed questionnaire. Three hundred and thirty-four patients also had information about their asthma management recorded by their GP. The patient questionnaire asked about asthma symptoms, therapy, lung function measurement, and asthma-related morbidity. The GP questionnaire asked the doctor to record similar information about the patients. Two–thirds of the patients used regular inhaled β 2-agonist medication, and one-half reported using preventive therapy. Only 24% owned a peak flow meter and 9% had a written plan of action for asthma attacks. Although preventive therapy and airway function assessment were more common in those with frequent symptoms (>2–3 times per week), this group were still sub-optimally managed. In the matched sample ( n = 334), doctors reporte prescribing bronchodilator and preventive medication, measuring airway function and recommending peak flow meter use more often than suggested by patient-reported data. The study concludes that many patients do not attend for regular review, and that management remains sub-optimal, particularly in young adults. Data from patient surveys may underestimate clinical practice, as assessed from doctors' records. This should lead to patient-derived estimates of management being interpreted with caution in epidemiological studies. Further attention to patient understanding and compliance with prescribed asthma management advice is needed in order to better manage asthma in the community.

Utilization of the "Smokescreen" smoking-cessation programme by general practitioners and their patients.

General practitioners have been encouraged to be more active in helping their patients to stop smoking. A number of research studies overseas and in Australia has reported that they can be effective in this form of health promotion. The "Smokescreen" programme is an intensive, structured antismoking intervention that was developed for use by general practitioners in Australia. To monitor the effect of this programme, general practitioners who had attended workshops on the use of the programme were contacted 12 months later to find out what use they had made of the programme, and how effective it had been. Only 18 of the 38 doctors who initially agreed to cooperate in the study had recruited smokers to the programme and had kept records of their progress. These 18 doctors had recruited 121 smokers in the 12-month period: only 7% (approximately) of all their patients who smoked. Of these, 29 (24%) patients reported that they had stopped smoking. Reasons that were given by doctors for their inability to use the programme as fully as they had hoped included the difficulty in recruiting smokers, a lack of time, and a low rate of return by the patients for follow-up visits. These results suggest that while general practitioners should be encouraged to give brief antismoking advice, general practice may not be a suitable location for more-intensive antismoking programmes. Limited health-promotional funds may be deployed better in general community awareness and mass-media programmes.

A smoking cessation programme for use in general practice

The effectiveness of a smoking intervention programme based in general practice was evaluated at six months by a randomized controlled trial. In the programme, general practitioners achieved a 33% success rate compared with 3% in a control group. Reported abstinence was checked by blood tests for cotinine, carboxyhaemoglobin and thiocyanate. The majority of patients considered that their chances of success were greater if a doctor administered the programme, and that having the results of lung function and blood tests explained in relation to the risks of cardiovascular and respiratory diseases constituted a strong incentive to stop smoking. Two cases illustrating a successful and a failed outcome of the programme are described. If one quarter of general practitioners in Australia adopted this programme in their practice, approximately 150,000 new abstainers could be expected each year.

A training programme for rural general practitioners in Australia.

A training programme for rural general practitioners in Australia.

PRESCRIPTIONS OF PSYCHOTROPIC DRUGS BY GENERAL PRACTITIONERS: 2. ANTIDEPRESSANTS

A triplicate prescription with a “tab” for relevant information has enabled the Royal Australian College of General Practitioners to study prescriptions by general practitioners in the Australian Morbidity Survey. The survey has revealed that original prescriptions of antidepressant drugs by general practitioners in Australia have reached the number of one and a half million per year. Eighty per cent of these prescriptions were for the treatment of mental disorders, most commonly depressive neurosis. Twenty per cent were for a great variety of diseases other than mental disorders. Tricyclic compounds comprised 99% of these antidepressant prescriptions, and monoamine oxidase inhibitors less than 1%. The drugs were given far more frequently to women than to men and the highest usage was in elderly women over 65 years of age. Many women in the childbearing years received prescriptions for tricyclic antidepressants and many of these women would have been pregnant while taking the drugs.

SHORTAGE OF GENERAL PRACTITIONERS IN AUSTRALIA

Medical Journal of AustraliaVolume 1, Issue 2 p. 85-86 Correspondence SHORTAGE OF GENERAL PRACTITIONERS IN AUSTRALIA First published: 01 January 1973 https://doi.org/10.5694/j.1326-5377.1973.tb119636.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue2January 1973Pages 85-86 RelatedInformation