Danielle L. Penn

Quality of diabetes care and coronary heart disease absolute risk in patients with type 2 diabetes mellitus in Australian general practice

Objective: To examine the quality of diabetes care and prevention of cardiovascular disease (CVD) in Australian general practice patients with type 2 diabetes and to investigate its relationship with coronary heart disease absolute risk (CHDAR). Methods: A total of 3286 patient records were extracted from registers of patients with type 2 diabetes held by 16 divisions of general practice (250 practices) across Australia for the year 2002. CHDAR was estimated using the United Kingdom Prospective Diabetes Study algorithm with higher CHDAR set at a 10 year risk of >15%. Multivariate multilevel logistic regression investigated the association between CHDAR and diabetes care. Results: 47.9% of diabetic patient records had glycosylated haemoglobin (HbA1c) >7%, 87.6% had total cholesterol ⩾4.0 mmol/l, and 73.8% had blood pressure (BP) ⩾130/85 mm Hg. 57.6% of patients were at a higher CHDAR, 76.8% of whom were not on lipid modifying medication and 66.2% were not on antihypertensive medication. After adjusting for clustering at the general practice level and age, lipid modifying medication was negatively related to CHDAR (odds ratio (OR) 0.84) and total cholesterol. Antihypertensive medication was positively related to systolic BP but negatively related to CHDAR (OR 0.88). Referral to ophthalmologists/optometrists and attendance at other health professionals were not related to CHDAR. Conclusions: At the time of the study the diabetes and CVD preventive care in Australian general practice was suboptimal, even after a number of national initiatives. The Australian Pharmaceutical Benefits Scheme (PBS) guidelines need to be modified to improve CVD preventive care in patients with type 2 diabetes.

Development of ACROSSnet: an online support system for rural and remote community suicide prevention workers in Queensland, Australia

Communication and information technologies can reduce the barriers of distance and space that disadvantage communities in Australias underserved rural areas, where the health status of residents is often worse than that of their urban counterparts. ACROSSnet (Australians Creating Rural Online Support Systems) is a 3 year collaborative action research project that aims to design and develop an online support system that will assist rural communities in accessing information, education and support regarding suicide and its prevention, whilst considering the challenges of Internet speed, cost and availability that can impede the delivery of online services. The site provides three distinct levels of access: one level for community members, and two further levels for appropriately credentialled mental health workers. In creating this environment, the ACROSSnet team hopes that online communities of practice will develop, engaging participants of different ages, income and education levels, location, and socioeconomic backgrounds.

Cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes in urban and rural areas

Objective:  To investigate the cardiovascular disease (CVD) risk management and its impact on Australian general practice patients with type 2 diabetes in urban and rural areas between 2000 and 2002, and to compare trends over time and differences between urban and rural areas.

Evolution of a register recall system to enable the delivery of better quality of care in general practice

Australian Divisions of General Practice have a key role to play in supporting general practitioners (GPs) to provide proactive, preventive care for their patients with cardiovascular disease (CVD) and diabetes. They can achieve this by providing them with quality improvement information generated by population health monitoring tools such as CARDIAB®™. CARDIAB®™ has prompted the development of standard minimum clinical datasets, enabled recording, monitoring and audit of quality of care and health outcomes for diabetes and cardiovascular patients who are locally enrolled in Division programs. It has also supported the improvement of services within general practice and local secondary care services. GPs have been able to audit their clinical performance and monitor quality of care and health outcomes in diabetes and cardiovascular disease. This article describes the evolution of the CARDIAB®™ database from the grass roots level to a nationally accepted database.

Register-recall systems: tools for chronic disease management in general practice

The Divisions Diabetes and Cardiovascular Disease Quality Improvement Project (DDCQIP) is a national project that aims to promote quality improvement initiatives among Divisions of General Practice. DDCQIP has investigated the growth of Division-based diabetes and cardiovascular disease register–recall systems and the role they play in promoting evidence-based structured care within general practice. In the period 2000–2002, an increase in the number of GPs using register–recall systems and the rise in the number of active registered patients have made it possible to monitor quality of care and health outcome indicators, and contributed to the growth of a Division-based population health program.

The development of a Web site to promote the mental and physical health of sons and daughters of Vietnam Veterans of Australia

Abstract There are estimated to be approximately 85,000 Australian Sons and Daughters of Australian Vietnam Veterans,1 a group recognized as having a substantially higher rate of suicide than the general Australian population.2 The Sons and Daughters of Vietnam Veterans of Australia (SDVVA) Web site http://www.sonsanddaughters.net.au was developed to harness the computer literacy of this age group by featuring an online support group that enables discussions, access to information and resources about Australias involvement in the Vietnam War, and provides the ability of Sons and Daughters to share experiences with each other. The conceptualization and early development of the Web site was well received by the SDVVA during state-based focus groups, particularly given the complete lack of targeted Web-based information and online support groups. This project is an example of participatory action research (PAR) methodology that was successful in developing the early stages of a community of practice (CoP). This paper discusses how online technologies can be implemented to build a sense of community, trust, and shared values in individuals at higher risk of suicide. It also describes why PAR was chosen as a methodology to meet the challenges and needs of this particular project.

ACROSSnet: A suicide prevention and mental health website for rural and remote workers in Queensland

This study was undertaken to develop and evaluate the efficacy of an early intervention for children who had been injured in an accident. The aim of the intervention was to prevent the development of longterm psychological consequences. Brochures were developed for children, adolescents, and their parents. These brochures detailed common responses to trauma (and normalized such responses), and suggestions for minimizing any post-trauma distress. Participants were children aged 7-15 admitted to hospital for traumatic injury. The intervention was delivered to one of two hospitals, within 72 hours of the trauma. 103 children and parents participated in the study. The parents and children completed structured interviews and questionnaires 2 weeks, 4-6 weeks and 6 months post-trauma. Outcome analyses also indicated that the intervention reduced parental distress at 4-6 weeks post-trauma. The intervention did not impact significantly on child adjustment over this time period. Results of the 6 month follow-up suggested that the intervention resulted in an amelioration of child anxiety from one to six months post-trauma, whereas the controls exhibited an increase in anxiety over this time period. Overall, it was concluded that the early intervention is a simple, practical, and cost-effective method of reducing child and parent distress post-trauma.