Primary Care In Australia Research Articles

Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement And Coaching for Health (PEACH) pragmatic cluster randomised controlled trial

Objective To evaluate the effectiveness of goal focused telephone coaching by practice nurses in improving glycaemic control in patients with type 2 diabetes in Australia.Design Prospective, cluster randomised controlled trial,...

Development and validation of a measure and a model of general practitioner attitudes toward collaboration with pharmacists

Collaboration between general practitioners (GPs) and community pharmacists has been shown to be effective in improving patient outcomes. However, little is known about GP attitudes toward collaborating with their pharmacist counterparts and variables that influence this interprofessional collaboration. To develop and validate, in the context of primary care in Australia 1) an instrument to measure GP attitudes toward collaborating with pharmacists and 2) a model that illustrates how GP attitudes (and other variables) influence GP-pharmacist collaborative behavior. The "Attitudes Toward Collaboration Instrument for GPs" (ATCI-GP) was developed to measure GP attitudes toward GP-pharmacist collaboration based on existing literature and qualitative interviews with GPs and community pharmacists. The ATCI-GP and a previously validated behavioral measure "Frequency of Interprofessional Collaboration Instrument for GPs" (FICI-GP) were included in a survey and administered to a sample of 1145 GPs in 12 divisions of general practice across Australia. Principal component analysis (PCA) was used to assess the structure of the ATCI-GP. Structural equation modeling was used to determine how attitudes (measured by the ATCI-GP) and other variables, influence collaborative behavior (measured by the FICI-GP). Three hundred and seventy-six surveys were completed and returned for a response rate of 33%. PCA of the ATCI-GP suggested a two factor ("interactional and practitioner determinants" and "role for pharmacist in medication management") solution accounting for 66.2% of the variance. The model for GP-pharmacist collaboration demonstrated adequate fit (χ(2)/df = 2.27, CFI = .99, RMSEA = .060, 90% CI [.052-.069]). Factors found to predict collaboration included: 1) Interactional and practitioner determinants 2) environmental determinants and 3) GP perception of the pharmacists' role in medication management. The study provides evidence for the validity of the ATCI-GP for measuring GP-pharmacist collaboration from the GPs perspective and supports a model for collaboration in which collaborative behavior is influenced by a number of variables.

Erratum: Insurance Rebates, Incentives and Primary Care in Australia

Erratum: Insurance Rebates, Incentives and Primary Care in Australia

Insurance Rebates, Incentives and Primary Care in Australia

Australia has a universal, compulsory, public health insurance scheme that includes insurance rebates for private fee-for-service medical practitioner services. Recent sweeping changes to the rebates for general practitioner (GP) services provide an opportunity to observe the effects of widespread insurance changes on the behaviour of GPs and aggregate outcomes such as quantities, prices and co-payments. In this paper, we study the effect of two important changes to subsidies for GP services, the first of which increased the rebates payable for services provided to specific patient groups, and the second of which increased rebates payable for all patients. Using economic theory, predictions of the effect of the rebate increase on quantities, prices and co-payments are produced that depend on the structure of the market. Using time-series data, we then present short-run empirical evidence that suggests that the supply curve for GP services is backward-bending.

Improving primary care in Australia through the Australian Primary Care Collaboratives Program: a quality improvement report

ProblemEffective and affordable health systems have good primary care. Access, equity, care of chronic conditions and quality are key priorities in primary care in Australia.DesignA large-scale quality improvement collaborative addressing...

New investments in primary care in Australia

There is a crisis in primary care health workforce shortages in Australia. Its government has attempted to fix this by role-substitution (replacing medical work with nursing instead). This was not completely successful. Obstacles included entrenched social roles (leading to doctors 'checking' their nurse role-substituted work) and structures (nurses subservient to doctors) - both exacerbated by primary care doctors' ageing demographic; doctors owning their own practices; doctors feeling themselves to have primary responsibility for the care delivered; and greater attraction towards independence that may have selected doctors into primary care in the first place.Yet there is much to be optimistic about this social experiment. It was conducted, if not ideally, at least in an environment that the Australian government has enriched with capacity for research and evaluation.

Research output on primary care in Australia, Canada, Germany, the Netherlands, the United Kingdom, and the United States: bibliometric analysis

Objective To compare the volume and quality of original research in primary care published by researchers from primary care in the United Kingdom against five countries with well established academic...

Unravelling the concept of consumer preference: Implications for health policy and optimal planning in primary care

Accounting for consumer preference in health policy and delivery system design makes good economic sense since this is linked to outcomes, quality of care and cost control. Probability trade-off methods are commonly used in policy evaluation, marketing and economics. Increasingly applied to health matters, the trade-off preference model has indicated that consumers of health care discriminate between different attributes of care. However, the complexities of the health decision-making environment raise questions about the inherent assumptions concerning choice and decision-making behavior which frame this view of consumer preference. In this article, we use the example of primary care in Australia as a vehicle to examine the concept of 'consumer preference' from different perspectives within economics and discuss the significance of how we model preferences for health policy makers. In doing so, we question whether mainstream thinking, namely that consumers are capable of deliberating between rival strategies and are willing to make trade-offs, is a reliable way of thinking about preferences given the complexities of the health decision-making environment. Alternative perspectives on preference can assist health policy makers and health providers by generating more precise information about the important attributes of care that are likely to enhance consumer engagement and optimise acceptability of health care.

Early diagnosis of dementia and diagnostic disclosure in primary care in Australia: A qualitative study into the barriers and enablers

Early diagnosis of dementia and diagnostic disclosure in primary care in Australia: A qualitative study into the barriers and enablers

Early diagnosis of dementia in primary care in Australia: a qualitative study into the barriers and enablers

Early diagnosis of dementia in primary care in Australia: a qualitative study into the barriers and enablers

Quality of drug interaction alerts in prescribing and dispensing software

Objective: To investigate the quality of drug interaction decision support in selected prescribing and dispensing software systems, and to compare this information with that found in a range of reference sources. Design and setting: A comparative study, conducted between June 2006 and February 2007, of the support provided for making decisions about 20 major and 20 minor drug interactions in six prescribing and three dispensing software systems used in primary care in Australia. Five electronic reference sources were evaluated for comparison. Main outcome measures: Sensitivity, specificity and quality of information; for major interactions: whether information on clinical effects, timeframe and pharmacological mechanism was included, whether management advice was helpful, and succinctness. Results: Six of the nine software systems had a sensitivity rate 90%, detecting most of the major interactions. Only 3/9 systems had a specificity rate of 80%, with other systems providing inappropriate or unhelpful alerts for many minor interactions. Only 2/9 systems provided adequate information about clinical effects for more than half the major drug interactions, and 1/9 provided useful management advice for more than half of these. The reference sources had high sensitivity and in general provided more comprehensive clinical information than the software systems. Conclusions: Drug interaction decision support in commonly used prescribing and

Characteristics of Patients With Acute Low Back Pain Presenting to Primary Care in Australia

This study aimed to provide a comprehensive profile of a representative sample of patients with acute low back pain drawn from the primary care setting. A secondary aim was to determine whether patient characteristics are associated with pain intensity or disability at the initial consultation. A total of 1172 consecutive patients with acute low back pain presenting to clinics of primary care practitioners (general practitioners, physiotherapists, and chiropractors) in Australia were recruited. Pain intensity and level of disability were measured at the first consultation, and a range of other variables were measured to describe the patient's characteristics. The characteristics were then grouped into 7 distinct factors: demographic, social, cultural, general health, psychologic, past low back pain history, and current low back pain history. Hierarchical linear regression models were used to determine each factor's independent relationship with pain intensity and disability. The majority of patients reported having had a previous episode of low back pain (75.7%), and that the current episode was of sudden onset (76.7%). Only a small proportion (14.3%) had compensable back pain. Pain intensity and disability were associated with each other (P<0.01), current low back pain history (P<0.01), and psychologic (P<0.01) characteristics. In a representative sample of acute low back pain patients in primary care, we found that the profile included only a small proportion of patients with compensable low back pain. Those without compensation were more likely to remain at work despite low back pain. Psychologic and other patient characteristics were associated with pain intensity and level of disability at the initial consultation.

Management of osteoporosis in primary care in Australia

This study reviewed factors influencing osteoporosis management in primary care settings in Australia and examined risk profiles of patients (n = 37,957) for osteoporosis. Only 29.7% of patients with a prior fracture were currently on specific medication for osteoporosis. The results highlight the need for further exploration of barriers to osteoporosis management. Osteoporosis management in primary care is suboptimal even for high-risk people with a history of prior fracture. This study reviewed factors influencing the management of individuals at risk for osteoporosis in primary care settings in Australia and examined risk profiles of patients for osteoporosis. Patients (n = 37,957, mean age 71) were recruited over a 12-month period (February 2006-Jan 2007) and interviewed. With regard to risk factors for osteoporosis, 12.6% of patients reported a history of prior minimal trauma fracture, 7.5% reported a family history of osteoporosis, 7.4% reported they were current smokers, 11.4% reported low dietary calcium intake, 31.8% reported no regular weekly physical exercise and 10.3% reported current use of glucocorticoids. Of those with a prior fracture, only 29.7% were currently on specific medication for osteoporosis. Radiography (n = 17,754) demonstrated a prior vertebral fracture in 30.1%, but only 3.8% of the 17,754 patients reported current use of specific osteoporosis medication. This study has confirmed low rates of treatment in primary care even in individuals who have already suffered a prior fracture or have other risk factors. This study highlights the need for further exploration of barriers to osteoporosis management in the primary care setting.

Partnerships in primary care in Australia: Network structure, dynamics and sustainability

Partnerships represent a prescriptive form of network governance, based on the idea of cooperation. This article has four aims. The first is to describe why network governance and partnerships are important now, and what one particular example – Primary Care Partnerships – is addressing. The second is to analyse the network structure of two of these partnerships, and the third is to examine network dynamics. The fourth aim is to explore relationships and sustainability over the longer term. Two government-funded and steered partnerships, which were established to increase coordination between primary care services in Victoria, Australia, were examined. Annual interviews at three points in time between 2002 and 2005 were used to explore relationships between organizations within these two partnerships. The structure of two different communication networks, based on contacts for work and contacts for strategic information, were examined using social network analysis. Tracing network structures over time highlighted partnership dynamics. The network structures changed over the three years of the study, but an important constant was the continuing centrality of the independent staff employed to manage the partnerships. Over the longer term, it seems to be more important to fund independent partnership staff, rather than people who connect partnerships to the funding agency. If partnerships are seen as valuable in improving service coordination and health outcomes, then long term rather than just start-up funding support is required.

Reforming Primary Care in Australia: A Narrative Review of the Evidence from Five Comparator Countries

The need for reform of primary care is driven by health system inequity, inefficiency, sub-optimal quality of care and outcomes. In Australia, there has been no systematic analysis of the relevance and applicability of international reforms of differing models of primary care delivery and the implications for addressing these issues in the local context. We used a narrative review and synthesis approach to analyse evidence from four English-speaking comparator countries (New Zealand, Canada, United Kingdom, United States of America) and one European country (Netherlands). In this review the term "primary care" refers to the system of health care workers (predominantly general practice, nursing and allied health professionals) who provide locally-based first contact care in the community setting. The existing international evidence does not support the adoption of any specific model of primary care delivery that is suitable to the Australian context. However, the evidence does suggest four key mechanisms that should form the basis of future reform. This includes the funding of GP services, quality and performance frameworks, stronger regional structures to support primary care, and investment in practice infrastructure. This paper provides an overview of the review methods and findings. A full report and in-depth discussion of findings are available from http://www.anu.edu.au/aphcri/Domain/PHCModels/index.php

Australian primary care policy in 2004: two tiers or one for Medicare?

The recent primary care policy debate in Australia has centred on access to primary medical (general practice) services. In Australia, access is heavily influenced by Commonwealth Government patient rebates that provide incentives for general practitioners not to charge copayments to patients (bulk billing). A steady decline in key access indicators (bulk billing) has led the Howard Government to introduce a set of changes that move Medicare from a universal scheme, to one increasingly targeted at providing services to more disadvantaged Australians. In doing so, another scene in the story of the contest between universal health care and selective provision in Australia has been written. This paper explores the immediate antecedents and consequences of the changes and sets them in the broader context of policy development for primary care in Australia.

Editorial

Editorial

Changing clinical practice: evidence-based primary care in Australia.

Evidence-based health care (EBHC) is a concept which in the past decade has gained momentum internationally. Its emphasis on linking practice and policy more closely to evidence from research and literature has challenged many assumptions and established practices in health care, whilst helping the move away from an over-reliance on medical authority and accumulated wisdom. Since the concepts of EBHC were first introduced their relevance for primary care has been examined and there has been active debate over the extent to which primary care should be restructured to accommodate these new concepts. Many argue, for example, that they devalue important but less measurable aspects of primary care. Furthermore, little is known about whether EBHC has changed practice in primary care, despite a range of implementation strategies having been put in place. This paper focuses on the response of primary care practitioners and policy makers to the challenges of EBHC in Australia. Government investment in EBHC infrastructure is detailed, and the implementation of EBHC is described from the perspective of primary care providers, individuals with chronic illnesses and other consumers of primary care services. Current issues facing Australian primary care in implementing EBHC include the relative paucity of direction from a policy framework, the dearth of multi-disciplinary primary care teams and the lack of experience in Australia of primary care health service reform.

The View From the Far Side An International Public Health—Primary Care Interface

In this paper, first-hand experience of a three-year project in Indonesia is used to explore the relationship between public health and primary care—disciplines which are too rarely considered in partnership. The Healthy Start for Child Survival Project in Lombok, Indonesia, which has now been running for two years, has integrated them in a way which utilises the strengths of both approaches. The result is a comprehensive series of practical and appropriate health interventions based on the collection of qualitative and quantitative data. Avenues of intervention revolve around active outreach involving both antenatal and postnatal strategies, including strategies to reduce morbidity and mortality from tetanus, hepatitis and acute respiratory infection. The positive effects of these interventions are now visible in the huge improvements to the health status of the local child population. The final stage of the project is designed to identify ways in which the health of the local population can be further improved, and to ensure the sustainability of these interventions after the project has been completed. The extent to which the knowledge gained could be applied to public health and primary care in Australia is discussed.

Primary care in Australia.

The Australian health care delivery system is reviewed in this article, with special comment on the implications of the financial components of the system and government concerns regarding costs and over-servicing. General practitioners' perception of their role is not significantly different from the expectation of patients, yet the reality may not match the idealized view. There are problems related to availability and there are developments which seem to pose some threat to the continuing care of patients. New developments have occurred in the way in which practice is organized which give an emphasis to continual availability over 24 hour periods, and these developments pose a challenge to the way in which doctors have organized their practices. Population features--Aborigines, migrants, and the elderly--present significant problems that are not always well met, and the concept of total patient care thereby suffers. The general practitioner's apparent failure to fill the expected role in co-ordination of services is discussed, as is the need for general practitioners to become more actively involved in health education and promotion. The hope for the future lies in the Family Medicine Programme of The Royal Australian College of General Practitioners, which represents a major attempt to provide appropriate vocational training for general practice.