Practitioners In Queensland Research Articles

Effects of inadequate hospital clinical handover on metropolitan general practitioners in Queensland: A qualitative study.

Transition from hospital to community care is well established as a high-risk time for patients. Inadequate clinical handover to general practice puts patients at risk of medical error, adverse events and rehospitalisation. We sought to understand the effects on general practitioners (GPs) of poor clinical handover from the inpatient, outpatient and emergency department settings. Qualitative methodology was used through conducting semi-structured interviews with purposively selected GPs. Interviews were undertaken until data reached saturation and no new themes emerged. The interviews were thematically analysed and coded. Key themes emerging included poor communication leading to patient safety concerns, time taken away from patient care and GPs experiencing a lack of professional respect. Clinical handover from the hospital sector remains a source of frustration for GPs. Poor handover demonstrates a lack of appreciation for the important role of the GP in continuing the care of patients and puts patients at risk of poor outcomes.

Defining sustainable practice in community‐based health promotion: A Delphi study of practitioner perspectives

Sustainability of practice must be a central imperative in the practice of community-based health promotion to achieve population health and attract a greater share of public health spending. Although there has been some consideration of sustainability at the project or program levels, often understood as intervention longevity, very limited attention has been given to understanding sustainable practice. The present study develops a definition and features of sustainable practice in community-based health promotion through a Delphi method with health promotion practitioners in Queensland, Australia. The study presents a consensus definition and features of sustainable practice. The definition highlights the importance of collaboration, health determinants and aspirations, processes and outcomes. The four features of sustainable practice identified in the study are: (1) effective relationships and partnerships; (2) evidence-based decision making and practice; (3) emphasis on building community capacity; and (4) supportive context for practice. The definition and features are, to a large extent, consistent with the limited literature around sustainability at the project and program levels of health promotion. Together, they provide insight into a form of community-based health promotion that will be both viable and productive. So what? This consensus understanding of sustainable practice articulates the foundations of working effectively with local communities in achieving improved population health within global limits.

Recommendations by Queensland GPs to be more physically active: which patients were recommended which activities and what action they took

To ascertain the extent to which general practitioners in Queensland recommend physical activity to their patients, the types of patients they target, types of activities they suggest and how patients respond to the recommendations. Questions designed to answer the research objectives were included in the Queensland Social Survey. Univariate, bivariate and logistic regression analyses were employed linking relevant variables with demographic data from the survey. The survey was completed by 1,261 (35.2%) people. In the previous year, 225 (18%) of them were recommended by a general practitioner to do more physical activity. These people were more likely to have a higher body mass index and rate their general health as fair or poor. Walking was the most common activity recommended (75%). Only 18% of people were not pleased to be recommended to take more exercise and most (67%) reported following the advice. Blue-collar workers and older people were less likely to follow the recommendations. General practitioners in Queensland are recommending increased physical activity to patients with weight problems and with medical problems. Patients are usually pleased to receive the advice and act upon it. General practitioners should be aware that physical activity recommendations are received favourably by most patients and there is potential to improve public health by giving physical activity advice to sedentary and/or overweight patients when appropriate.

Reliability of collecting colorectal cancer stage information from pathology reports and general practitioners in Queensland

To investigate the reliability of collecting colorectal stage information from pathology reports and general practitioners in Queensland, Australia. A longitudinal study of colorectal cancer survivors conducted in 2003 and 2004 (n=1966, response rate=57%) obtained stage information from clinical specialists (n=1334), general practitioners (GP) (n=1417) and by extracting stage from pathology reports (n=1484). Reliability of stage information was determined by comparing stage from GPs and pathology reports with that reported by the clinical specialists, using a weighted kappa. GPs and pathology reports each had a similar level of agreement with clinical specialists, with kappa scores of 0.77 (0.75-0.80) (n=1042) and 0.78 (0.75-0.81) (n=1152), respectively. Results were similar when restricting to records staged by all three methods (n=847). GPs had similar levels of agreement with clinical specialists within each stage, although pathology reports tended to under-stage patients in Stage D (0.37). Collapsing stage into two categories (A or B, C or D) increased the reliability estimates from the pathology reports to 0.91 (0.88-0.93), but there was little change in GP estimates 0.79 (0.75-0.83). Extractions from pathology reports are a valid source of broad stage information for colorectal cancer. In the absence of clinical stage data, access to pathology records by population-based cancer registries enables a more accurate assessment of survival inequalities in colorectal cancer survival.

Should Mental Health Issues be Addressed in Primary Care, and can it be Done? Views of Rural General Practitioners in Queensland

The aim of this paper was to examine self-efficacy and perceived appropriateness among rural general practitioners (GPs) in regards to screening and intervention for physical, lifestyle and mental health issues. Fifty GPs from 25 practices in eight rural Queensland towns completed a written survey designed for the study. General practitioners rated opportunistic screening or assessment for smoking and for detection of relapse of mental disorders as the most appropriate, with even cardiovascular and diabetes risk falling behind these. Self-efficacy was highest for medical disorders for smoking assessment. It was significantly lower for alcohol, mental health issues, and addressing risks of physical disorder in people with mental disorders. High appropriateness ratings suggest that current strategies to boost self-efficacy of GPs in addressing mental health issues are timely.

The mismanagement of the assets of older people: the concerns and actions of aged care practitioners in Queensland

Objective: To explore the types of financial abuse coming to their attention of aged care workers, the practice responses and the barriers to effective responses.Method: A mailed survey of 159 ACAT members, allied health professionals and other aged care workers across metropolitan, regional and remote Queensland.Results: Financial abuse is coming to the attention of a broad range of aged care workers. It takes a variety of forms with a consistent pattern reported across urbanlregionallrural locations and differing ethnic groups. Although a range of resources exists, one third of respondents reported limitations in their capacity to intervene appropriately.Conclusions: This complex area requires a greater understanding of the dimensions of financial abuse, further evaluation of the effectiveness of current mechanisms, professional and community education and additional support for workers seeking to intervene.

Contact lens prescribing in the Australian states and territories 2001

Background: This study was conducted to ascertain current preferences for contact lens prescribing in the Australian states and territories. Methods: One thousand questionnaires were randomly distributed to proportionate samples of optometrists in each state of Australia. We requested details of the first 10 patients fitted with contact lenses after receipt of the questionnaire. Results: One hundred and seventy‐eight completed questionnaires were returned, detailing contact lens fits to 1,611 patients. The mean age of the patient group was 32.1 $pL 13.0 yrs (65 per cent female). For Australia as a whole: 53 per cent of patients were existing wearers, the remainder were new fits; 93 per cent of new fits were with soft lenses, of which seven per cent were for extended wear. Of the refits, 89 per cent were soft lenses and 18 per cent for extended wear. The lens material of first choice was mid‐water‐content (62 per cent of all soft lens fits). Only eight per cent of all soft fits were for lenses that were not replaced on a planned basis, with two weeks being the replacement interval of choice in all states and territories. The majority of rigid lenses were prescribed using mid‐Dk materials (50 per cent). Analysis of solution prescribing indicates that multi‐purpose products were the most common regimens for planned replacement soft lenses. The percentage of hydrogen peroxide prescribed increased as lens replacement became less frequent. By state or territory: practitioners in Tasmania prescribed more extended wear than those in any other state (p = 0.007) and practitioners in Queensland prescribed more daily disposable contact lenses than those in any other state (p = 0.009). Conclusions: Non‐planned replacement lenses are now rarely prescribed to patients. Extended‐wear lenses and rigid lenses continue to be prescribed more to existing contact lens wearers than to new patients. The impact of soft multifocal lens designs on contact lens prescribing is very small, ranging from 2.6 per cent in Queensland to 4.7 per cent in Victoria, despite 20 per cent of patients being more than 45 years of age.

Patterns of computer usage among medical practitioners in rural and remote Queensland.

As part of a more detailed needs analysis, patterns of computer usage among medical practitioners in rural and remote Queensland were investigated. Utilising a questionnaire approach, a response rate of 23.82% (n = 131) was obtained. Results suggest that medical practitioners in rural and remote Queensland are relatively sophisticated in their use of computer and information technologies and have embraced computerisation to a substantially higher extent compared with their urban counterparts and previously published estimates. Findings also indicate that a substantial number of rural and remote practitioners are utilising computer and information technologies for clinical purposes such as pathology, patient information sheets, prescribing, education, patient records and patient recalls. Despite barriers such as bandwidth limitations, cost and the sometimes unreliable quality of Internet service providers, a majority of rural and remote respondents rated an Internet site with continuing medical education information and services as being important or very important. Suggestions that "rural doctors are slow to adapt to new technologies" are questioned, with findings indicating that rural and remote medical practitioners in Queensland have adapted to, and utilise, information technology to a far higher extent than has been previously documented.

PATTERNS OF COMPUTER USAGE AMONG MEDICAL PRACTITIONERS IN RURAL AND REMOTE QUEENSLAND

ABSTRACT: As part of a more detailed needs analysis, patterns of computer usage among medical practitioners in rural and remote Queensland were investigated. Utilising a questionnaire approach, a response rate of 23.82% (n = 131) was obtained. Results suggest that medical practitioners in rural and remote Queensland are relatively sophisticated in their use of computer and information technologies and have embraced computerisation to a substantially higher extent compared with their urban counterparts and previously published estimates. Findings also indicate that a substantial number of rural and remote practitioners are utilising computer and information technologies for clinical purposes such as pathology, patient information sheets, prescribing, education, patient records and patient recalls. Despite barriers such as bandwidth limitations, cost and the sometimes unreliable quality of Internet service providers, a majority of rural and remote respondents rated an Internet site with continuing medical education information and services as being important or very important. Suggestions that ‘rural doctors are slow to adapt to new technologies’ are questioned, with findings indicating that rural and remote medical practitioners in Queensland have adapted to, and utilise, information technology to a far higher extent than has been previously documented.

End-of-life decision-making: community and medical practitioners' perspectives.

To examine current attitudes and knowledge of the community and medical practitioners in Queensland to end-of-life decisions. Cross-sectional survey by postal questionnaire. 387 general practitioners and medical specialists and 910 community members from the Queensland electoral roll. Responses to five questions about end-of-life decision-making, and to legislative changes relating to such decisions. The overall response rate for medical practitioners was 67% and for community members was 53%. 78% of community members (age adjusted) and 54% of doctors thought that a doctor should comply with a patient's request to turn off a life-support system; 68% of doctors through people would still ask to have their life ended even if pain were controlled, compared with 54% of community members; 70% of community members thought the law should be changed to allow active voluntary euthanasia, compared with 33% of doctors; and 65% of community members thought that a doctor should be allowed by law to assist a terminally ill person to die, but only 36% of doctors agreed. 79% of doctors and 75% of community members agreed that people would still ask for assistance to end their lives even if optimal palliative care were freely available. Community members supported greater choice and control over end-of-life decisions, while doctors were less supportive of some of the options canvassed. In a climate of community participation in health care decisions, it is important to better understand the basis and meaning of these different views. Further detailed research is recommended.

A survey of the pattern of private general dental practice in Queensland, 1992.

In 1987 all non-specialist ADA member private practitioners in Queensland were invited to participate in a survey to determine the number of the various types of permanent restorations placed in one week and the percentage breakdown of the time they devoted to the various areas of dentistry. Results of that survey were published in 1989. The survey with a few minor changes was repeated in 1992. Results show that there has been little change in the pattern of practice over the five years with restorative dentistry still taking a very large proportion of respondents' time and similar materials being used. The dental workforce appears to be relatively stable with low rates of overseas and interstate migration. There is evidence of an increasing number of women dentists in the workforce and this is emphasized by a breakdown of the current undergraduate enrolment.

A comparison of country and metropolitan general practice

To provide a description of country general practice in Australia, and to determine the extent to which country and metropolitan general practice differ in terms of the characteristics of the practitioners, the morbidity managed, treatments provided and the availability of support services. A survey requiring the recording of details of all direct and indirect patient encounters on encounter forms by a sample of general practitioners (GPs). Each GP recorded for two one-week periods separated by an interval of six months, between October 1990 and October 1991. The recording weeks were spread as evenly as possible throughout the year. Participants were drawn from a list of medical practitioners in Queensland, NSW and Victoria who provided more than 1500 general practice Medicare items of service during the previous year. The sample was stratified within States by population of postcode, into metropolitan areas and three country strata: "small country towns" (population less than 5000); "medium country towns" (5000-15,000); and "large country towns" (more than 15,000). The total country sample is referred to as "country areas". Planned sample size was 180 country GPs (20 in each stratum in each State) and 60 metropolitan GPs (20 in each of the three State capital cities). The final data set was weighted to be representative of the distribution of the source population. The variables studied included: GP characteristics; practice isolation factors; patient age, sex and status to the practice; patient reasons for encounter (up to three per encounter); problems managed (up to four); drugs prescribed and other treatments provided (up to four per problem); tests and investigations ordered and referrals made at these encounters; and planned follow-up. Data were centrally coded. Participation rate: The final sample of 231 GPs (177 country and 54 metropolitan) recorded information during 435 recording weeks (336 country and 99 metropolitan). These practitioners represented 50.7% of those contacted and available, the response rate being better in country (57.5%) than in metropolitan (36.5%) areas. A practice profile questionnaire which included questions regarding the doctor and the practice was completed by 97.4% of participants, while a questionnaire on distance from support services was completed by 93.8% of country participants. The final weighted data set included 51,741 encounters with country GPs and 11,351 with metropolitan GPs. The general practitioners: Country GPs were less likely to be female or to conduct consultations in a language other than English, and were more likely to do some work on a salaried or sessional basis. GPs from small country towns were older, more likely to be in solo practice, and more likely to belong to a professional organisation. "Remoteness" of towns: Nearly all towns were within 25 km of a hospital, but far fewer small and medium country towns were within 50 km of a base hospital than large country towns. X-ray services were almost universally available within 50 km, and with the exception of small country towns so were pathology services. Access to medical specialists and to a lesser degree other health professionals decreased with population size--patients in 30% of small towns had to travel over 100 km to see many specialists and some health professionals. Self-reported procedural work: GPs in small and medium country towns were more likely than those in large towns to report performing procedural work, the largest difference being in the area of em

A survey of the pattern of private general dental practice in Queensland

All non-specialist ADA member private practitioners in Queensland were invited to participate in a survey to determine the number of the various types of permanent restorations placed in one week and the percentage breakdown of the time they devoted to the various areas of dentistry. Final year dentistry students at the University of Queensland were asked to estimate the projected breakdown of their time in future practice. Results showed that amalgam is still by far the most commonly used material followed by composite resin and glass ionomer cement and that restorative dentistry accounts for the bulk of the practitioners' time. Students' estimations of the work mix were in agreement with those of the practitioners.

The use of fluoride preparations in dental practice.

Abstract— A survey of a 10 per cent sample of general practitioners in Queensland showed that topical fluoride therapy was still widely practised and accepted in Queensland and believed by most dentists to be economically worthwhile. In a State where less than five per cent of the population has access to a fluoridated water supply, all of the dentists in the sample advocated the use of fluoride tablets by young children. Since there was an apparent lack of preparedness by most of the dentists to manage acute fluoride poisoning resulting from excessive ingestion of fluoride through these sources, a schedule of treatment has been recorded.

Continuing education in general practice: 2. Impact of educational activities

Should continuing education for doctors be compulsory? Our study of General Practitioners in Queensland evaluated the usefulness of and preference for various types of educational activities. Lectures and consultants' letters were considered the most useful while pharmaceutical company evenings and visiting lecturers were most regularly attended. These latter activities were a useful source of medical knowledge: patient management skills were gained at weekend conferences; and procedural skills were obtained through hospital training courses.

Voluntary attachments of preclinical medical students to rural practitioners in Queensland.

This study evaluates the attachment of preclinical medical students to rural general practitioners in Queensland. The expectations of participating students were assessed before the experience, and compared with their realizations. Perceptions of their own clinical skills, and the type of medicine they want to practise were assessed both before and after. Doctors taking part felt stimulated by the experience, and confimed that the presence of a student is readily accepted by patients, and causes minimal practice disruption. Students saw this attachment as providing motivation for their further studies, and relevance to their preclinical work. Clinical sophistication would not appear to be necessary for considerable benefit to be derived from the experience.

Queensland's rural practitioners: background and motivations.

In view of the continuing maldistribution of medical manpower, this study was undertaken in order to delineate the backgrounds and motivating factors influencing choice of practice by rural practitioners in Queensland. Of those doctors in rural practice 38% had spent more than 10 years of their childhood in a rural environment. Interest of work and variety of practice were most consistently designated as attractions of rural practice, while the factor designated as the greatest attraction of rural practice was the variety of practice. The major disadvantages of rural practice were: (i) restricted opportunities for continuing education; (ii) difficulty obtaining adequate locum assistance for holidays and continuing education; and (iii) professional isolation. The prime reasons doctors had for choosing their present practice were the practice conditions (31.3%), and geographical location (20.9%).