Gf Gill

General practitioners’ attitudes toward complementary therapies

Attitudes toward complementary therapies were elicited from a postal survey of all identified general practitioners in the state of Tasmania, Australia. Regression analysis of the data indicated that demographic features associated with favourable attitudes were younger age and location in small or single practices. Personal experiences of such therapies or patient endorsement of them were also associated with favourable attitudes. Those who saw the holistic orientation of complementary medicine as an advantage were likely to hold favourable attitudes. Those who saw the cure rate of complementary therapies as problematic and/or had personal knowledge of the harmful effects of such therapies were less likely to have favourable attitudes.

On the right path? Exploring the experiences and opinions of clinicians involved in developing and implementing HealthPathways Barwon

The aims of this paper are to present the findings of a process evaluation exploring the experiences and opinions of clinicians who have been involved in the HealthPathways Barwon clinical workgroups and discuss implications for further development of the program, as well as regional health service initiatives more broadly. HealthPathways Barwon is a web-based program comprising locally agreed-upon evidence-based clinical pathways that assist with assessment, management and region-specific referral for various clinical conditions. Clinical workgroup members participated in focus groups. Coding and thematic analysis were performed and findings were compared with similar evaluations of HealthPathways in other jurisdictions. Five broad themes emerged from the focus group, each with several subthemes: (1) purpose of HealthPathways; (2) workgroup process; (3) barriers and facilitators to HealthPathways use; (4) impact of HealthPathways on clinical practice; and (5) measuring performance. Findings of particular interest were that the perceived drivers for implementation of HealthPathways Barwon are broad, HealthPathways Barwon is viewed positively by clinicians, the workgroup process itself has a positive impact on relationships between primary and secondary care clinicians, existing habits of clinicians are a major barrier to adoption of HealthPathways Barwon, the sustainability of HealthPathways Barwon is a concern and it is difficult to measure the outcomes of HealthPathways. Although HealthPathways Barwon is viewed positively by clinicians and is seen to have the potential to address many issues at the primary-secondary care interface, successful implementation and uptake will depend on buy-in from clinicians, as well as continuous evaluation to inform improved development and implementation. More broadly, health service initiatives like HealthPathways Barwon require longer-term certainty of funding and administration to become established and produce meaningful outcomes.

The Telehealth Skills, Training, and Implementation Project: An Evaluation Protocol

Background Telehealth appears to be an ideal mechanism for assisting rural patients and doctors and medical students/registrars in accessing specialist services. Telehealth is the use of enhanced broadband technology to provide telemedicine and education over distance. It provides accessible support to rural primary care providers and medical educators. A telehealth consultation is where a patient at a general practice, with the assistance of the general practitioner or practice nurse, undertakes a consultation by videoconference with a specialist located elsewhere. Multiple benefits of telehealth consulting have been reported, particularly those relevant to rural patients and health care providers. However there is a paucity of research on the benefits of telehealth to medical education and learning. Objective This protocol explains in depth the process that will be undertaken by a collaborative group of universities and training providers in this unique project. Methods Training sessions in telehealth consulting will be provided for participating practices and students. The trial will then use telehealth consulting as a real-patient learning experience for students, general practitioner trainees, general practitioner preceptors, and trainees. Results Results will be available when the trial has been completed in 2015. Conclusions The protocol has been written to reflect the overarching premise that, by building virtual communities of practice with users of telehealth in medical education, a more sustainable and rigorous model can be developed. The Telehealth Skills Training and Implementation Project will implement and evaluate a theoretically driven model of Internet-facilitated medical education for vertically integrated, community-based learning environments

The Incorporation of a Complementary Therapy by Australian General Practitioners: The Case of Acupuncture

Complementary therapies may be rejected by doctors as quackery or incorporated as part of their practice, although such incorporation may be limited. In Australia acupuncture has been incorporated as a normal part of general practice, although it is not accepted as an orthodox technique. This incorporation is demonstrated through analysis of national data on acupuncture usage and through analysis of two surveys of general practitioners undertaken independently in the states of Tasmania and Victoria, Australia. Further, it is argued, from examination of interview and focus group responses, that experienced doctors turn to acupuncture to deal with patients who do not respond to orthodox therapies. This move is possible because the valuing of clinical judgement allows practitioners to suspend their scientific judgement of the therapy although they are uneasy about doing so.

Prioritising general practice research

Cuts to federal funding put us in grave danger of wasting the investment made to achieve current gains in research capacity.

HOSPEX in the antipodes

The Australian Army recently adopted the British concept of hospital exercise (HOSPEX) as a means of evaluating the capabilities of its deployable NATO Role 2E hospital, the 2nd General Health Battalion. The Australian approach to HOSPEX differs from the original UK model. This article describes the reasons why the Australian Army needed to adopt the HOSPEX concept, how it was adapted to suit local circumstances and how the concept may evolve to meet the needs of the wider Australian Defence Force and our allies.

The impact of residential socio-economic profile on medical service utilisation and nursing home attendance claims by older Australians

In other developed countries, older persons in deprived personal circumstances make increased use of primary care and nursing homes compared with those less disadvantaged. The influence of living in a more deprived area on the use of these services by older residents has not been so well studied. This study appraises if older Australians living in more disadvantaged locations have similar increased service usage. Retrospective analyses of fee-for-service data from 1 October 2001 to 30 September 2002 for all Medicare and Department of Veterans? Affairs claimants aged 77 years and over, not admitted to residential aged care, were undertaken. Data were analysed by age, gender and quartile of disadvantage of postcode of residence as categorised by the Australian Bureau of Statistics 1996 Census Index of Relative Socio-economic Disadvantage. The main outcome measures were: mean number of claims for general practitioner primary medical care (GP) services; longer GP consultations; specialist consultations; rate of GP health assessments; and, first claims for GP nursing home attendances. Mean number of claims for GP primary medical care services generally decreased as the disadvantage of postcode increased. Men aged 77-79 years were an exception, with no difference in the mean across quartiles of disadvantage. The mean number of claims for longer primary care consultations and all specialist consultations also decreased as the disadvantage of postcode increased. Claims for GP health assessments were more frequent as the disadvantage of the residential postcode increased. Claim rates for first nursing home attendance items by men did not differ across the range of disadvantage. This lack of difference was also seen for women aged 77-79 years. Claims for first nursing home attendance items by women aged 80 or more years decreased as the disadvantage of postcode increased. This study concluded that there are fewer claims for medical and nursing home services by older Australians living in more disadvantaged postcodes. Whether this represents under-provision of medical care leading to sub-optimal health outcomes needs further examination.

Reply : prioritising general practice research

1 GAbout 85% of the Australian population claim at least one general practice service from Medicare per year. Over 137 million such consultations were delivered by 33 279 general practitioners in 2014e15. In 2011e12, PHC spending was

Acupuncture in Australian general practice: practitioner characteristics

50.6 billion (36.1% of total health expenditure), with

Normal medical practice of referring patients for complementary therapies among Australian general practitioners

28.6 billion spent on predominantly general practice-based medical services and medications. Multiple studies have shown that a strong PHC system is associated with greater efficiency, lower rates of hospitalisation, fewer health inequalities and better health outcomes, including lower mortality. Thus, ensuring that the cornerstone of PHC delivery, general practice, has a robust evidence base is of paramount importance. Despite this, there are major gaps in the evidence supporting clinical practice and health service delivery in general practice.