Allan Pollack

Antibiotics for acute respiratory infections in general practice: Comparison of prescribing rates with guideline recommendations

Objective: To compare the current rate of antibiotic prescribing for acute respiratory infections (ARIs) in Australian general practice with the recommendations in the most widely consulted therapeutic guidelines in Australia (Therapeutic Guidelines).

Respiratory tract infections among children younger than 5 years: Current management in Australian general practice

Objective: To explore the current management in Australian general practice of common respiratory tract infections (RTIs) in children younger than 5 years.

Management rates of sexually transmissible infections by Australian general practitioners, 2000-2012.

UNLABELLED Background In Australia, general practitioners (GPs) manage the majority of sexually transmissible infections (STIs). Most STIs are diagnosed and treated by GPs as a result of symptom recognition or risk identification. We aimed to determine how frequently six common STIs were managed by GPs, the characteristics of the GPs and patients, and any changes over time. METHODS Data from the Bettering the Evaluation and Care of Health (BEACH) program for April 2000-March 2012 were analysed. BEACH is a national study of GP activity. The overall management rates of genital herpes (herpes simplex virus, HSV), genital warts, HIV, chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae) and syphilis were calculated. RESULTS In total, 11784 GPs recorded details of 1178400 patient encounters. These included: 115 cases of genital HSV per 100000 encounters, 92 of genital warts, 67 of HIV, 39 of chlamydia, 6 of gonorrhoea and 7 of syphilis. Higher management rates occurred among patients who were male, 15-24 years old, more socially advantaged, Aboriginal or Torres Strait Islander, resident in a major city or of English-speaking background. GPs who were female and those aged under 60 years had higher STI management rates than their counterparts. CONCLUSIONS HSV and warts were the most common STIs managed. Lower management rates for the other STIs may reflect lower incidence or lower testing rates, because these other STIs are frequently asymptomatic. It is important to determine whether existing approaches effectively target the most at-risk communities and what barriers to presentation exist.

General practice encounters for young patients with autism spectrum disorder in Australia

This study compared the patient demographics and reasons for encounter in general practice for patients <25 years with and without an autism spectrum disorder identified as a reason for encounter and/or problem managed. The Bettering the Evaluation and Care of Health programme collected information about clinical activities in Australian general practice. Each year, the programme recruited a random sample of 1000 general practitioners, each of whom collected data for 100 consecutive consultations (encounters). Encounters with patients <25 years, where at least one autism spectrum disorder was recorded as a reason for encounter and/or a problem managed (n = 579), were compared with all other encounters (n = 281,473) from April 2000 to March 2014 inclusive. Data were age–sex standardised. Patients at autism spectrum disorder encounters (compared to non-autism spectrum disorder encounters) were more likely to be younger and male. There was a dramatic rise in the number of general practitioner consultations at autism spectrum disorder encounters from 2000 to 2013. More reasons for encounter were recorded at autism spectrum disorder encounters than at non-autism spectrum disorder encounters (156.4 (95% confidence interval: 144.0–168.8) and 140.5 (95% confidence interval: 140.0–141.0), respectively). At autism spectrum disorder (vs non-autism spectrum disorder) encounters, there were more psychological, general and unspecified, and social reasons for encounter and fewer preventive and acute health reasons for encounter. People with an autism spectrum disorder have complex health care needs that require a skilled general practice workforce.

Primary health care for people with an intellectual disability: an exploration of consultations, problems identified, and their management in Australia

Background People with an intellectual disability (ID) have more complex and different patterns of health care needs than the general population. They experience a greater burden of multi‐morbidity, high levels of undetected and unmanaged health issues, and premature mortality than the general population. Primary care has a key role in the health care of people with an ID. Currently, very little is known about the consultation type and length, problems managed, and how general practitioners (GPs) manage these problems for people with an ID compared with the general population. This information would provide valuable insights into how GPs are achieving the health guidelines and facilitating people with an ID to achieve the highest attainable standard of health. Methods A secondary analysis of data was collected from January 2003 to December 2012 from the Bettering the Evaluation and Care of Health (BEACH) programme. Consultation type, consultation length in minutes, problem(s) managed during the consultation, medications, treatments provided, and referrals made, pre and post age‐sex standardisation, at all GP encounters with people identified in the encounter record as having an ID (‘ID’ encounters, n = 690) were compared with those at ‘non‐ID’ encounters (n = 970 641). Statistical significance was tested with 95% confidence intervals. Results This study identified significant differences in consultation types, consultation length, problem(s) managed during the consultation, medications, treatments provided, and referrals made at ‘ID’ encounters compared with ‘non‐ID’ encounters. ‘ID’ encounters had more indirect encounters, longer consultations, more problems managed, but an under management of common health conditions in people with an ID. Administrative rather than medically related actions dominated clinical treatments for people at ‘ID’ encounters, and they received fewer procedural treatments, referrals to specialists, and medications compared with those at ‘non‐ID’ encounters. Conclusion The significant differences in consultations, problems identified and managed suggest that GPs may require additional support to (1) identify and manage common medical conditions experienced by people with an ID; (2) manage the increased time required for consultations; and (3) directly consult with people with an ID. Further research is required to determine why GPs managed problems in a significantly different way for people with an ID.

Problems managed and medications prescribed during encounters with people with autism spectrum disorder in Australian general practice

Autism spectrum disorder is associated with high rates of co-occurring health conditions. While elevated prescription rates of psychotropic medications have been reported in the United Kingdom and the United States, there is a paucity of research investigating clinical and prescribing practices in Australia. This study describes the problems managed and medications prescribed by general practitioners in Australia during encounters where an autism spectrum disorder was recorded. Information was collected from 2000 to 2014 as part of the Bettering the Evaluation and Care of Health programme. Encounters where patients were aged less than 25 years and autism spectrum disorder was recorded as one of the reasons for encounter and/or problems managed (n = 579) were compared to all other Bettering the Evaluation and Care of Health programme encounters with patients aged less than 25 years (n = 281,473). At ‘autism spectrum disorder’ encounters, there was a significantly higher management rate of psychological problems, and significantly lower management rates of skin, respiratory and general/unspecified problems, than at ‘non-autism spectrum disorder’ encounters. The rate of psychological medication prescription was significantly higher at ‘autism spectrum disorder’ encounters than at ‘non-autism spectrum disorder’ encounters. The most common medications prescribed at ‘autism spectrum disorder’ encounters were antipsychotics and antidepressants. Primary healthcare providers need adequate support and training to identify and manage physical and mental health concerns among individuals with autism spectrum disorder.

No abatement of steroid injections for tennis elbow in Australian General Practice: A 15-year observational study with random general practitioner sampling

Objective Evaluate general practitioner (GP) management of tennis elbow (TE) in Australia. Methods Data about the management of TE by GPs from 2000 to 2015 were extracted from the Bettering the Evaluation of Care of Health program database. Patient and GP characteristics and encounter management data were classified by the International Classification of Primary Care, version 2, and reported using descriptive statistics with point estimates and 95% confidence intervals. Results TE was managed by GPs 242,000 times per year on average. Patients were mainly female (52.3%), aged between 35 and 64 years (mean: 49.3 yrs), had higher relative risks of concomitant disorders (e.g. carpal tunnel syndrome and other tendonitis) and their TE was 10 times more likely to be work related than problems managed for patients who did not have TE. Use of diagnostic tests was low, implying a clinical examination based diagnosis of TE. Management was by procedural treatments (36 per 100 TE problems), advice, education or counselling (25 per 100), and referral to other health care providers (14 per 100, mainly to physiotherapy). The rate of local injection did not change over the 15 years and was performed at similar rates as physiotherapy referral. Conclusion The high risk of comorbidities and work relatedness and no abatement in the reasonably high rate of local injections (which is contrary to the evidence from clinical trials) provides support for the development and dissemination of TE clinical guidelines for GPs.

Management of vertebral compression fracture in general practice: BEACH program.

Importance The pain associated with vertebral compression fractures can cause significant loss of function and quality of life for older adults. Despite this, there is little consensus on how best to manage this condition. Objective To describe usual care provided by general practitioners (GPs) in Australia for the management of vertebral compression fractures. Design, setting and participants Data from the Bettering the Evaluation And Care of Health (BEACH) program collected between April 2005 and March 2015 was used for this study. Each year, a random sample of approximately 1,000 GPs each recorded information on 100 consecutive encounters. We selected those encounters at which vertebral compression fracture was managed. Analyses of management options were limited to encounters with patients aged 50 years or over. Main outcome(s) and measure(s) i) patient demographics; ii) diagnoses/problems managed; iii) the management provided for vertebral compression fracture during the encounter. Robust 95% confidence intervals, adjusted for the cluster survey design, were used to assess significant differences between group means. Results Vertebral compression fractures were managed in 211 (0.022%; 95% CI: 0.018–0.025) of the 977,300 BEACH encounters recorded April 2005– March 2015. That provides a national annual estimate of 26,000 (95% CI: 22,000–29,000) encounters at which vertebral fractures were managed. At encounters with patients aged 50 years or over (those at higher risk of primary osteoporosis), prescription of analgesics was the most common management action, particularly opioids analgesics (47.1 per 100 vertebral fractures; 95% CI: 38.4–55.7). Prescriptions of paracetamol (8.2; 95% CI: 4–12.4) or non-steroidal anti-inflammatory drugs (4.1; 95% CI: 1.1–7.1) were less frequent. Non-pharmacological treatment was provided at a rate of 22.4 per 100 vertebral fractures (95% CI: 14.6–30.1). At least one referral (to hospital, specialist, allied health care or other) was given for 12.3 per 100 vertebral fractures (95% CI: 7.8–16.8). Conclusions and relevance The prescription of oral opioid analgesics remains the common general practice approach for vertebral compression fractures management, despite the lack of evidence to support this. Clinical trials addressing management of these fractures are urgently needed to improve the quality of care patients receive.

Who provides primary health care for people with an intellectual disability: General practitioner and general practice characteristics from the BEACH dataset

ABSTRACT Background People with an intellectual disability (ID) have complex healthcare needs yet experience barriers to participation in primary care. Further research is required to examine if the characteristics of general practitioners (GPs) and their practices influence their delivery of care to people with ID. Methods Data from the Bettering the Evaluation and Care of Health program was used to determine if there are significant differences in the ID-GP and Non ID-GP group. Analysis included characteristic-specific rates, chi-square, and odds ratios. Results This study found that GPs who were Australian medical graduates, practising in rural areas, in accredited practices, and in some states of Australia were significantly more likely to be classified to the ID-GP than the Non ID-GP group. Conclusions This research suggests that certain GP and practice characteristics may present barriers to primary care participation for people with ID and supports the need for a comprehensive national action framework.

General practitioners' prescribing of lipid-lowering medications for Indigenous and non-Indigenous Australians, 2001-2013.

Objective: To examine the prescribing of lipid‐lowering medications during general practitioner encounters with Indigenous and non‐Indigenous Australians from 2001 to 2013.