Royal Australian College Of General Practitioners Research Articles

Attitudes, beliefs, behaviours and perspectives on barriers and enablers of Australian general practitioners towards non-drug interventions: a national survey

BackgroundMany guidelines recommend non-drug interventions (NDIs) for managing common conditions in primary care. However, compared with drug interventions, NDIs are less widely known, promoted and used. We aim to (1)...

Models of care for intrauterine device provision in Australian general practice.

Intrauterine devices (IUDs) are safe and effective forms of long-acting reversible contraception. However, uptake in Australia is low. Although general practitioners (GPs) manage contraceptive provision, little is known about IUD service delivery. This study aims to describe themodels of care (MoC) used in the provision of IUDs by Australian GPs. Semistructured telephone interviews were conducted with 20 GP IUD providers nationwide. Data were deidentified, transcribed, thematically analysed and evaluated using The RoyalAustralian College of General Practitioners' Quality framework for Australian general practice. Three MoC were described: common, streamlined and same-day insertion. Thecommon model involved three to fourappointments but was of the lowest quality. The streamlined MoC had a maximum of two appointments. Few GPs delivered same-day insertion. Task-sharing and adaptable MoC were identified. The quality of current MoC for IUD provision is non-standardised and largely inadequate. Increased GP awareness about and operation of high-quality MoCwill enhance IUD access.

The new Diploma of Rural Generalist Anaesthesia: Supporting Australian rural and remote communities.

In 2023, a Diploma of Rural Generalist Anaesthesia (DipRGA) was implemented across Australia. Developed collaboratively by the Australian and New Zealand College of Anaesthetists (ANZCA), the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP), the 12-month qualification is completed during or following ACRRM or RACGP Rural Generalist Fellowship training. Focused on the needs of rural and remote communities for elective and emergency surgery, maternity care, resuscitative care for medical illness or injury, and stabilisation for retrieval, the DipRGA supports rural generalist anaesthetists working within collaborative teams in geographically isolated settings. The goal is a graduate who can anaesthetise American Society of Anesthesiologists physical status class 1, 2 and stable 3 patients for elective surgery, provide obstetric anaesthesia and analgesia, anaesthetise paediatric patients and undertake advanced crisis care within their scope of practice. Crucially, they also recognise both limitations of their skills and local resources available when considering whether to provide care, defer, refer or transfer patients. DipRGA curriculum design commenced by adapting the ANZCA specialist training curriculum with consideration of the training approach of both the ACRRM and the RACGP, particularly the rural and remote context. Curriculum content is addressed in seven entrustable professional activities supported by workplace-based assessments and multisource feedback. Trainees are supervised by rural generalist anaesthetists and specialist anaesthetists, and complete flexible learning activities to accommodate geographical dispersion. Standardised summative assessments include an early test of knowledge and an examination, adapted from the ACRRM structured assessment using multiple patient scenarios.

Exam prediction and the general Practice Registrar Competency Assessment Grid (GPR-CAG)

ABSTRACT Background In GP training, identifying early predictors of poor summative examination performance can be challenging. We aimed to establish whether external clinical teaching visit (ECTV) performance, measured using a validated instrument (GP Registrar Competency Assessment Grid, GPR-CAG) is predictive of Royal Australian College of General Practitioners (RACGP) Fellowship examination performance. Methods A retrospective cohort study including GP registrars in New South Wales/Australian Capital Territory with ECTV data recorded during their first training term (GPT1), between 2014 and 2018, who attempted at least one Fellowship examination. Independent variables of interest included the four GPR-CAG factors assessed in GPT1 (‘patient-centredness/caring’, ‘formulating hypotheses/management plans’, ‘professional responsibilities’, ‘physical examination skills’). Outcomes of interest included individual scores of the three summative examinations (Applied Knowledge Test (AKT); Key Feature Problem (KFP); and the Objective Structured Clinical Examination (OSCE)) and overall Pass/Fail status. Univariable and multivariable regression analyses were performed. Results Univariably, there were statistically significant associations (p < 0.01) between all four GPR-CAG factors and all four summative examination outcomes, except for ‘formulating hypotheses/management plans’ and OSCE score (p = 0.07). On multivariable analysis, each factor was significantly associated (p < 0.05) with at least one exam outcome, and ‘physical examination skills’ was significantly associated (p < 0.05) with all four exam outcomes. Discussion ECTV performance, via GPR-CAG scores, is predictive of RACGP Fellowship exam performance. The univariable findings highlight the pragmatic utility of ECTVs in flagging registrars who are at-risk of poor exam performance, facilitating early intervention. The multivariable associations of GPR-CAG scores and examination performance suggest that these scores provide predictive ability beyond that of other known predictors.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Impact of Australian general practice alcohol and other drugs education: a qualitative evaluation.

Many GPs are challenged to deliver safe and effective care for patients who use alcohol and other drugs (AOD). The Royal Australian College of General Practitioners (RACGP) developed the AOD GP Education Programme to support Australian GPs and optimise AOD care in the community. How the programme impacted GP participants is not yet fully understood. To explore the views and experiences of GP participants who completed the AOD GP Education Programme, and AOD experts who were involved in the programme as a presenter or mentor. Situated in the constructivist paradigm, this qualitive descriptive study engaged GPs across Australia. This study employed semi-structured, online, focus groups interviews. Data were analysed thematically. Five focus groups were held with a total of 35 GP participants. Five themes developed, which illustrated that the study participants viewed the programme design as comprehensive and flexible. It has also been shown that participants' individual learning needs were addressed. Impacts of the programme on clinical practice included the following: confidence to care for patients who use AOD; confidence to collaborate with colleagues in delivery of AOD care; confidence to develop AOD professional networks in their community setting; and confidence to manage complex AOD presentations. Participants described the AOD programme as a high quality and positive educational experience. The prioritisation of core treatment skills (whole-person care and structured approaches to behavioural change) was a feature of the professional development programme. The AOD programme design is a practical model to implement for future AOD GP education and continuing professional development.

How colleges should lead on climate.

How colleges should lead on climate.

Assessment of cultural safety in a post-Objective Structured Clinical Examination (OSCE) era.

As The Royal Australian College ofGeneral Practitioners (RACGP) introduces alternatives to the Objective Structured Clinical Examination, it is imperative that standards are continually set for a culturally safe general practice workforce. Assessments have many functions and should be continually reviewed to ensure that they require general practitioners (GPs) to demonstrate genuine cultural safety. The aim of this article is to highlight thecomplexities in assessing the cultural safety of GPs when consulting with Aboriginal and Torres Strait Islander peoples. Presently there is a lack of validated approaches for assessing cultural safety of GPs. This creates challenges for the RACGP in redesigning fellowship examinations. Yet in this challenge is an opportunity to consider assessment design that is not competency based, amplifies Aboriginal and Torres Strait Islander peoples' voices and reflects the complexity of cultural safety.

General practitioners' knowledge, preparedness, and experiences of managing COVID-19 in Australia.

BackgroundCOVID-19 has brought unprecedented demands to general practitioners (GPs) worldwide. We examined their knowledge, preparedness, and experiences managing COVID-19 in Australia.MethodsA cross-sectional online survey of GPs members of the Royal Australian College of General Practitioners (RACGP) was conducted between June and September 2020.ResultsOut of 244 survey responses, a majority of GPs (76.6%) indicated having good knowledge of COVID-19, relying mostly on state/territory department of health (84.4%) and the RACGP (76.2%) websites to source up-to-date information. Most felt prepared to manage patients with COVID-19 (75.7%), yet over half reported not receiving training in the use of PPE. The majority were concerned about contracting SARS-CoV-2, more stressed than usual, and have heavier workloads. Their greatest challenges included scarcity of PPE, personal distress, and information overload.ConclusionAccess to PPE, training, accurate information, and preparedness are fundamental for the successful role of general practices during outbreaks.

Role of formative assessment in predicting academic success among GP registrars: a retrospective longitudinal study

ObjectivesThe James Cook University General Practice Training (JCU GPT) programme’s internal formative exams were compared with the Royal Australian College of General Practitioners (RACGP) pre-entry exams to determine ability to...

General practitioner and obstetrician views on system changes to improve smoking cessation care in pregnancy in Australia: a cross-sectional survey

AbstractIntroductionSystemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training.AimAssess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses.MethodsNational cross-sectional survey with two samples: (1) online survey emailed to a random sample of 500 GPs from Royal Australian College of General Practitioners (RACGP); (2) paper survey posted to 5571 GPs and obstetricians from Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Percentages agreeing that specified changes would improve the management of smoking in pregnancy were calculated. Pairwise comparisons used Kruskal–Wallis tests (RACGP/RANZCOG GPs/obstetricians).ResultsN = 378 participated. Response rates 8.4% (N = 42; online survey) and 6% (N = 335; paper survey), respectively. Total percentages agreeing with system-based changes: 79% training, 64% oral NRT subsidy, 62% Medicare item for smoking cessation, 54% improved access to NRT patches. Within RANZCOG, more GPs (73.1%) agreed that oral NRT should be subsidised (P = 0.001) than obstetricians (53.7%).ConclusionGPs and obstetricians agreed that system changes would improve their management of smoking in pregnancy. Oral NRT subsidy was the only pairwise group difference. Subsequently, oral NRT has been subsidised; in time, this may influence prescribing and quit rates.

Impact of NPS MedicineWise general practitioner education programs and Choosing Wisely Australia recommendations on prescribing of proton pump inhibitors in Australia

BackgroundThis study evaluated the impact of multifaceted NPS MedicineWise programs that targeted all general practitioners (GPs) in Australia in 2009 and 2015 with the aim of reducing unnecessary prescribing of proton pump inhibitors (PPIs) and encouraged stepping down to a lower strength PPI or to discontinue treatment. The 2015 intervention coincided with the release of Choosing Wisely Australia recommendations from the Royal Australian College of General Practitioners (RACGP).MethodsOutcome measures included monthly dispensing rates of different strength PPIs prescribed by GPs to concessional patients in Australia. All PPIs were categorized according to the May 2019 revised classifications for standard and low strength PPIs except for esomeprazole 40 mg which was classified as a standard strength and esomeprazole 20 mg as low strength for this analysis. Time series analyses was conducted of the dispensing rates of PPI prescriptions for concessional patients between January 2006 and June 2016 using the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) databases in Australia. Participants were GPs with dispensed PPI prescriptions to concessional patients between January 2006 and June 2016.ResultsFollowing the 2009 NPS MedicineWise program we observed a 6.7% reduction in the expected dispensing rate of standard strength PPIs for concessional patients between April 2006 and March 2015, and an 8.6% reduction between April 2009 and June 2016 following the 2015 program launch. We observed a significant increase of 5.6% in the dispensing rate of low strength PPIs for concessional patients between April 2009 and March 2015, and no significant change in trend following the 2015 program.ConclusionsThe NPS MedicineWise programs were associated with reductions in the dispensing rate of standard strength PPIs by June 2016 and an increase in the dispensing rate of low-strength PPIs by March 2015 although this trend did not continue following the 2015 program. This suggests that GPs are stepping down patients to lower strength PPIs following the educational programs. However, lower strength PPIs are still not the majority of PPIs dispensed in Australian and regular interventions to sustain and improve PPI management by GPs may be warranted.

Welcome to The Lucky Country: the Royal Australian College of General Practitioners deters overseas-trained academic general practitioners.

In assessing overseas-trained general practitioners (GPs) applying for specialist recognition in Australia, the Royal Australian College of General Practitioners (RACGP) sets a minimum requirement of 2 days per week 'undertaking general practice activities' over the 3 years prior to application. The RACGP does not consider academic practice (i.e. relevant teaching and research) to be a 'general practice activity', thereby blocking overseas-trained full-time academic GPs from specialist recognition in Australia. The actions of the RACGP have implications for access to quality primary health care in Australia.

Improving the delivery of primary care for older people.

Improving the delivery of primary care for older people.

Current Knowledge and Adoption of Mobile Health Apps Among Australian General Practitioners: Survey Study.

BackgroundMobile health (mHealth) apps can be prescribed as an effective self-management tool for patients. However, it is challenging for doctors to navigate 350,000 mHealth apps to find the right ones to recommend. Although medical professionals from many countries are using mHealth apps to varying degrees, current mHealth app use by Australian general practitioners (GPs) and the barriers and facilitators they encounter when integrating mHealth apps in their clinical practice have not been reported comprehensively.ObjectiveThe objectives of this study were to (1) evaluate current knowledge and use of mHealth apps by GPs in Australia, (2) determine the barriers and facilitators to their use of mHealth apps in consultations, and (3) explore potential solutions to the barriers.MethodsWe helped the Royal Australian College of General Practitioners (RACGP) to expand the mHealth section of their annual technology survey for 2017 based on the findings of our semistructured interviews with GPs to further explore barriers to using mHealth apps in clinical practice. The survey was distributed to the RACGP members nationwide between October 26 and December 3, 2017 using Qualtrics Web-based survey tool.ResultsA total of 1014 RACGP members responded (response rate 4.6% [1014/21,884], completion rate 61.2% [621/1014]). The median years practiced was 20.7 years. Two-thirds of the GPs used apps professionally in the forms of medical calculators and point-of-care references. A little over half of the GPs recommended apps for patients either daily (12.9%, 80/621), weekly (25.9%, 161/621), or monthly (13.4%, 83/621). Mindfulness and mental health apps were recommended most often (32.5%, 337/1036), followed by diet and nutrition (13.9%, 144/1036), exercise and fitness (12.7%, 132/1036), and women’s health (10%, 104/1036) related apps. Knowledge and usage of evidence-based apps from the Handbook of Non-Drug Interventions were low. The prevailing barriers to app prescription were the lack of knowledge of effective apps (59.9%, 372/621) and the lack of trustworthy source to access them (15.5%, 96/621). GPs expressed their need for a list of safe and effective apps from a trustworthy source, such as the RACGP, to overcome these barriers. They reported a preference for online video training material or webinar to learn more about mHealth apps.ConclusionsMost GPs are using apps professionally but recommending apps to patients sparingly. The main barriers to app prescription were the lack of knowledge of effective apps and the lack of trustworthy source to access them. A curated compilation of effective mHealth apps or an app library specifically aimed at GPs and health professionals would help solve both barriers.

A truly 'HANDI' resource.

GPs and patients have an increasing interest in the use of non-drug interventions to treat common conditions seen in primary care. Nearly half the thousands of clinical trials conducted each year are for evaluating non-drug treatments, such as diet, exercise, procedures, and devices. Advances in such treatments in the past few decades have been substantial and diverse — for example, exercise for heart failure and COPD, the Epley manoeuvre for benign paroxysmal positional vertigo, and CBT for depression. However, effective non-drug methods are less well known, less promoted, and less used than their pharmaceutical cousins. There are well-established drugs/medications formularies such as the British National Formulary . However, no such formulary or resource for non-drug treatments (interventions) currently exists in the UK. The Handbook of Non-Drug Interventions — HANDI — project was launched by the Royal Australian College of General Practitioners (RACGP) in 2013 to promote effective non-drug treatments. HANDI is an online formulary of …

PREDIABETES AND THE NEED FOR CARDIOVASCULAR RISK ASSESSMENT IN AVIATION

ABSTRACT Obesity, the disease of the twenty-first century, has a range of serious consequences to health. These are related in part to abnormal glucose levels, resulting in inflammatory and atherogenic response, hypertension and abnormal lipid profile. This increases the risk of cardiovascular disease significantly besides developing diabetes later. Hyperglycaemia is diagnosed with impaired fasting glucose and/or impaired glucose tolerance or elevated glycated haemoglobin (HbA1c). The Royal Australian College of General Practitioners (RACGP) guidelines for diagnosis using oral glucose tolerance test (or HbA1c) recognise the importance of extending diagnosis beyond simply identifying diabetes. This is relevant in view of the risk of composite cardiovascular events, coronary heart disease, stroke, and all-cause mortality associated with abnormal blood glucose. Since the pilot population mirrors this morbidity, the aviation regulator has an obligation to consider the impact in terms of aviation safety. Furthermore, although primary care literature predominantly focusses on the importance of diagnosing diabetes, from a regulator’s perspective there are incapacitation risks originating outside that narrow diagnosis. They arise once the control of glucose has begun to deteriorate. This article considers the regulatory importance of pilots and controllers who present with hyperglycaemia, or what is sometimes termed “prediabetes”. This includes the evidence for the risk assessment to help minimise the likelihood of an adverse event due to atherosclerotic cardiovascular disease among those holding aviation medical certificates, in turn promoting aviation safety.

Supporting Patient Outcomes through Organised Networks (SPOT ON)

Introduction: In 2014-15 the Sunshine Coast Hospital & Health Service (SCHHS) has 113,029 Emergency Department (ED) presentations, of which 55,729 were triaged as a category 4 or 5 (Australasian Triage Scale). SPOT ON aimed to find a solution to this issue which presented a significant risk to patients and clinicians within the ED. Many of these low acuity patients were self-presenters however a significant number were brought in by ambulance. SPOT ON is a new and innovative integrated care strategy targeting lower acuity patients in the Sunshine Coast community who call the Queensland Ambulance Service (QAS) for assistance. A six month pilot commenced March 2016 to demonstrate the benefits of the strategy which aimed to ensure that each patient is transported or referred to the right place based on clinical decision making by the paramedic at the point of care. SPOT ON provides clinical pathways to assist the paramedic and General Practice (GP) to provide evidence based care that will continue along each point of the patient journey, avoiding duplication of tests and procedures should the patient require escalation to an Emergency Department. Consideration has also been given to supporting the Royal Australian College of General Practitioners (RACGP) ‘medical home’ concept[1] and avoiding fragmentation of care by the provision of a two tier GP model. Tier 1 GPs are the patient’s usual GP (where one exists) and is the first option of care for patients who meet the SPOT ON criteria. Where no relationship exists or the usual GP is not in a position to accept the patient, a number of Tier 2 GPs have been contracted by the HHS to provide care to these patients, avoiding an unnecessary trip to the Emergency Department. The collaboration by these key groups: SCHHS, QAS, the PHN, General Practice, Healthcare Improvement Unit, University of the Sunshine Coast and Silverchain (Hospital in the Home) as well as a consumer representative ensures that each group involved in the SPOT ON project is supported to provide quality health care to the Sunshine Coast community resulting in enhanced patient journey and benefits to each of the health care groups involved. The involvement of a consumer representative ensured the model considered person centred care and the needs and wishes of the patient. Involvement of the University assisted in initial and ongoing research requirements for the project. An initial literature search was unable to identify any similar models of care. Ethics approval and Public Health Act approvals were obtained as part of the project to ensure our research results could be published to inform others about the structure and benefits of this project. Methods and Target Group: QAS patients are the primary target of the project, and clinical pathways have been developed to identify appropriate patients to have their care met by GPs rather than the ED. GPs are identified as either Tier 1 or Tier 2, and clinically suitable patients are referred to or transported to one of these clinics rather than an ED. QAS will first attempt transport to a Tier 1 GP where one exists and if unsuccessful then transport will occur to a Tier 2 clinic in the area. Tier 2 clinics have been contracted by the HHS (through a rigorous selection process) to accept these additional patients and have KPI that must be met. Data is being collected from QAS, Tier 2 GPs, SCHHS and patients (through a post care survey). Results: Full results are pending however interim results are showing a positive trend. Measurements include: patient experience; clinician experience; clinical outcomes (measured through re-presentations); and value for money (to SCHHS, GPs, and QAS). Initial results: >90% positive patient experience 25% reduction in Category 5 patients to SCHHS EDs 30 minute reduction in median case time for QAS 500% increase in patients transported to GPs by QAS on the previous year’s figures Conclusions: The project will aim to conclude that through a collaborative approach and specific guidelines the health sector can provide quality health care options for the low acuity patient that will better suit their specific health needs, and avoid an unnecessary visit to the ED. This patient centred model of care encourages the development of a ‘patient-GP’ relationship for continuity of ongoing health needs that is close to where the patient lives and avoids long waiting times that are often experienced in an ED. This same concept is transferable to other Health services as it is based on the collaborative and supportive approach between the key health providers within an area.

Subspecialisation in emergency medicine: A specialty at the crossroads.

Subspecialisation in emergency medicine: A specialty at the crossroads.

The predictive validity of a situational judgement test and multiple-mini interview for entry into postgraduate training in Australia.

BackgroundEvidence for the predictive validity of situational judgement tests (SJTs) and multiple-mini interviews (MMIs) is well-established in undergraduate selection contexts, however at present there is less evidence to support the validity of their use in postgraduate settings. More research is also required to assess the extent to which SJTs and MMIs are complementary for predicting performance in practice. This study represents the first longitudinal evaluation of the complementary roles and predictive validity of an SJT and an MMI for selection for entry into postgraduate General Practice (GP) specialty training in Australia.MethodsLongitudinal data was collected from 443 GP registrars in Australia who were selected into GP training in 2010 or 2011. All 17 Regional Training Providers in Australia were asked to participate; performance data were received from 13 of these. Data was collected for participants’ end-of-training assessment performance. Outcome measures include GP registrars’ performance on the Royal Australian College of General Practitioners (RACGP) applied knowledge test, key feature problems and an objective structured clinical exam.ResultsPerformance on the SJT, MMI and the overall selection score significantly predicted all three end-of-training assessments (r = .12 to .54), indicating that both of the selection methods, as well the overall selection score, have good predictive validity. The SJT and MMI provide incremental validity over each other for two of the three end-of-training assessments.ConclusionsThe SJT and MMI were both significant positive predictors of all end-of-training assessments. Results provide evidence that they are complementary in predicting end-of-training assessment scores. This research adds to the limited literature at present regarding the predictive validity of postgraduate medical selection methods, and their comparable effectiveness when used in a single selection system. A future research agenda is proposed.