Australian Journal of General Practice最新文献

Background and objectives: Smoking, poor diabetic control and excessive body mass index (BMI) increase the risk of infection following joint replacement. This study investigated Australian general practitioners' (GPs) perception of these modifiable risk factors in patients with end-stage osteoarthritis.

Method: A structured online survey tool was developed and widely distributed to Australian GPs.

Results: Responses were received from 131 GPs. Most attempted to address current smoking (90%), poor diabetic control (94%) and excessive BMI (89%) prior to referral. The majority felt that joint replacement should be delayed until these risk factors had been modified (57%, 84% and 74%, respectively). However, many respondents did not believe that these risk factors were contraindications to joint replacement (76%, 46% and 43%, respectively).

Discussion: This study suggests that Australian GPs are mindful of modifiable risk factors in patients with hip and knee osteoarthritis; however, many do not support restricting access to joint replacement.

Background and objectives: Otitis externa (OE) is a very common disease in Australia. It is associated with swimming and exposure to water. Typically, treatment consists of aural toileting and the use of topical antimicrobial drops. Antimicrobial treatment is empiric, and most Australian guidelines advise the use of dexamethasone/framycetin/gramicidin as first-line therapy. This study aimed to identify the most prevalent pathogens implicated in OE in Queensland, Australia, and determine if there was any variability with the season, proximity to a coastline, age, gender and First Nations status.

Method: The primary pathogen cultured, the specimen type, the date of collection and the patient demographics were retrieved from microbiology swabs sent from hospitals to Pathology Queensland. Multivariate analysis was performed on the swabs.

Results: Pseudomonas aeruginosa was the most prevalent pathogen cultured in the external ear in Queensland, at 37.9%. In inland regions, Staphylococcus aureus was the most prevalent organism. Children were three-fold less likely to have OE resulting from a fungal pathogen.

Discussion: The use of targeted antimicrobials against Pseudomonas aeruginosa in coastal regions during summer is sensible. Due to the low burden of fungal disease in children, there should be a high threshold for the commencement of antifungal ear drops.

Background: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency requiring urgent medical attention and care.

Objective: This article, based on up-to-date evidence and clinical guidelines, aims to equip general practitioner (GP) specialists with a structured and practical approach to SSNHL management, emphasising the need for prompt evaluation and appropriate interventions. From initial evaluation to treatment strategies and follow-up, this guide offers a step-by-step framework to optimise patient care and improve outcomes in patients suffering SSNHL.

Discussion: Distinguishing SSNHL from conductive hearing loss (CHL), with early identification and prompt initiation of high-dose corticosteroid therapy, are key considerations for the management of SSNHL. Appropriate referrals when indicated for audiometric evaluation, emergency and/or otolaryngology services are also essential. Furthermore, this study aims to outline emerging therapies including intratympanic steroid administration, hyperbaric oxygen therapy and their potential roles in augmenting standard treatment approaches.

Background and objectives: Australian general practices are highly involved with accreditation programs; however, there is evidence to suggest variability in their levels of performance. The aim of the current study was to determine the association with between several metrics of preparation with accreditation performance outcomes.

Method: Several metrics were synthesised that measured preparation time to general practice accreditation. Performance outcomes were: (1) conformity to 124 indicators of the standards; (2) time to remediate indicator non-conformities; and (3) level of assistance required.

Results: A greater number of months between registration with the accrediting agency and practice accreditation expiry date was associated with higher indicator conformity at the site visit (OR=1.04, P=0.001), as well as less time (β=-0.02, P=0.002) and less assistance (β=-0.66, P=0.02) to remediate non-conformant indicators post site visit.

Discussion: Adequate preparation time for several components within the accreditation framework for general practices were associated with small-to-moderate improvements in key performance outcomes.

Background and objectives: Despite increasing urbanisation, little is known about skin health for urban-living Aboriginal children and young people (CYP, aged <18 years). This study aimed to investigate the primary care burden and clinical characteristics of skin conditions in this cohort.

Method: A one-year retrospective cohort study of urban-living Aboriginal CYP presenting for general practitioner (GP) consultation at an Aboriginal Community Controlled Health Organisation (ACCHO) was conducted.

Results: At least one dermatological diagnosis was made in 27% (253/939) of GP face-to-face consultations for the 585 urban-living Aboriginal CYP included. Infections and dermatitis accounted for 54% (152/284) and 18% (50/284) of all dermatological diagnoses, respectively. Bacterial skin infection (BSI) cumulative incidence was 13% (74/585; 95% CI 10-16%), with recurrent BSI affecting <1% (5/585; 95% CI 0.3-2%) and hospitalisation required in 1% (1/82; 95% CI 0.06-7%) of incident BSI cases.

Discussion: We present a culturally secure, multidisciplinary skin health assessment model within an urban ACCHO, where dermatological conditions account for a significant proportion of GP workload.

Background: Allergic rhinitis (AR) is a common condition that affects 19% of Australians in the community, accounting for approximately 0.6% of all general practitioner presentations. Recent years have seen the emergence of new treatment options, many of which can be delivered in the primary care setting.

Objective: The aim of this paper is to provide a contemporary and accessible framework for the clinical assessment, investigation and management of AR in the primary care setting, and to establish appropriate referral criteria for ear, nose and throat and/or allergist/immunologist referral.

Discussion: AR is common, and can have a significant effect on both quality of life and function. The diagnosis can be made based on history, examination and appropriate investigations, including serum specific allergen IgE (immunoglobulin E) and/or skin prick testing. Radiological imaging is not part of the work-up for AR. Management consists of four main aspects: allergen avoidance, pharmacotherapy, immunotherapy and procedural interventions. Biological pharmacotherapies are on the horizon.

Background: The widespread use of cross-sectional imaging has led to the increased detection of urological incidentalomas. Incidental renal and adrenal masses are the most commonly detected urological incidentalomas and are often encountered by general practitioners.

Objective: This review aims to provide an evidence-based approach to managing renal and adrenal masses.

Discussion: Renal lesions occur in 14% of computed tomography (CT) scans. Differentials include cysts (benign or malignant), angiomyolipomas, oncocytomas and renal cell carcinomas (RCCs). The Bosniak classification should be used for cystic renal lesions. Active treatment should be considered for RCCs that are >4 cm, symptomatic or rapidly growing. Patients with adrenal lesions should undergo functional work-up. If clinically concerned, screening tests include 1 mg overnight dexamethasone suppression test and plasma or urinary metanephrines. In the presence of hypertension or hypokalaemia, screening for hyperaldosteronism with the plasma aldosterone-to-plasma renin ratio should be considered. Benign adrenal adenomas on CT are <4 cm, homogenous and hypodense (Hounsfield unit <10).

Background: Chronic limb-threatening ischaemia (CLTI) is an advanced and severe form of lower limb peripheral arterial disease (PAD) and can pose significant challenges in clinical management. Not all patients are able to undergo surgical intervention due to patient-related and disease-related factors.

Objective: This review article aims to provide general practitioners with an overview of conservative management of patients with end-stage CLTI in the community.

Discussion: The review aims to provide an overview of end-stage CLTI and approaches that are required to preserve patients' quality of life. It outlines symptom control, wound care, psychosocial support and end-of-life considerations to preserve the quality of life for patients facing this challenging condition.

Background and objectives: Chronic breathlessness is a frequent diagnostic challenge in primary care. Our aim is to evaluate the feasibility of a stepwise breathlessness diagnostic algorithm for primary care.

Method: This mixed-methods study included: (1) a general practitioner (GP) nominal group technique study; (2) focus groups on GPs' views on the algorithm; and (3) analysis of algorithm alignment against patterns of diagnostic referrals and diagnoses of breathlessness presentations (2014-19) from the MedicineInsight primary care electronic health record (EHR) dataset of 1,961,264 patients (405 general practice sites).

Results: All the tests in our algorithm, except for echocardiography, were ranked in the top 10 tests used by most GPs for patients presenting with chronic breathlessness. Themes from the focus group include similarity with current practice and test accessibility. Analysis of EHR diagnostic referrals revealed that all tests in the algorithm are regularly utilised and covered the major tests needed for breathlessness diagnoses recorded.

Discussion: The results of the three studies support the acceptability and feasibility of the clinical algorithm in primary care.

Background and objectives: This study describes the prevalence of risky alcohol consumption in Australian women aged 40-45 years. It explores the relationship between demographic factors and access to and usage of primary healthcare services.

Method: Data were obtained from the Australian Longitudinal Study on Women's Health, Survey 8 (1973-78 cohort). Descriptive statistics and univariate logistic regression were used to assess associations of specific factors with risky alcohol consumption.

Results: Eleven per cent of respondents reported drinking >10 standard drinks per week. These 'risky alcohol drinkers' attend general practice as frequently as low-risk drinkers despite perceived poorer health. They reported 'rarely or never' seeing the same general practitioner (GP) and described themselves as having 'poor' access to a GP that bulk bills.

Discussion: This study provides unique insight into the primary healthcare attendance patterns and health status of early middle-aged Australian women who are 'risky alcohol drinkers'. They do not consistently see the same GP, which might present challenges in identifying them in primary care.