Australian Journal of General Practice最新文献

Background and objectives: This study aimed to understand how gout is currently managed in Australian primary care and to assess the level of interest in changing the delivery of care for gout.

Method: This pragmatic qualitative study was conducted among Australian general practitioners (GPs), pharmacists and adults living with gout. Semi-structured interviews were conducted and analysed using thematic analysis.

Results: The key theme identified was that chronic gout has low priority compared to managing other conditions, and management is often responsive to patient action. Lack of confidence was expressed about medication regimens for multimorbidities. Regarding changing care delivery, there was widespread interest in enhancing pharmacists' role in providing medication reviews and guidance, but there were conflicting views between some pharmacists and GPs about clinical decisions and prescribing arrangements.

Discussion: Interpreting findings based on Wagner's chronic care model, it is apparent that there are multiple potential opportunities to change practice that might improve gout management.

Background: Healthcare delivery and excellent health outcomes for teenagers depend on the establishment of effective communication between family physicians and adolescent patients. However, communicating with adolescents can be challenging due to their stage of development and unique needs. By implementing effective communication strategies and fostering a positive environment, family doctors can build trust, enhance patient participation and ultimately improve health outcomes for their adolescent patients.

Objective: This article explores the value of excellent communication in the healthcare of teenagers, identifies potential barriers that family doctors might encounter and provides solutions to overcome these challenges.

Discussion: Adolescence is a critical developmental stage marked by physical, emotional and social changes, making effective communication particularly challenging. During this phase, adolescents might face various health concerns, including mental health issues, substance use, sexual health and chronic diseases. This emphasises the importance of tailoring communication strategies to connect with the adolescent mind. Active listening, using age-appropriate language, incorporating technology, empathy, promoting autonomy and shared decision making are tools to open communication bridges between healthcare providers and their adolescent patients.

Background: In healthcare settings, there can be a fine distinction between genuine performance management and vexatious complaints occurring in the context of bullying. The most common manifestation of such behaviour involves repetitive interpersonal abusive behaviours within the context of a power hierarchy. These interactions might well be experienced as bullying behaviour; however, the interpersonal dynamics underpinning such behaviours remains largely unexplored.

Objective: This paper offers a psychological perspective on bullying and harassment and adopts a psychodynamic case study approach, utilising a case vignette involving a senior and junior doctor within a general practice context. Conflict can be mitigated by understanding the intra- and interpersonal dynamics that interfere with rational performance management.

Discussion: Psychological processes such as projection, displacement and projective identification are useful in understanding the genesis of bullying and harassment within demanding workplaces. Reflecting upon the psychological processes underpinning such conflict might help mitigate coercive workplace behaviour.

Background: Community HealthPathways are clinical decision support tools, combining evidence-based guidelines with local service and referral information, collaboratively developed and collated by primary care and hospital clinicians. HealthPathways is being implemented throughout Australia, New Zealand and the UK, and often plays a role in supporting local service redesign and integrated care.

Objective: This article summarises the background and benefits of community HealthPathways and provides tips to support decision making in the consulting room. The article highlights the influence a community of clinicians can have on service redesign through developing and publishing HealthPathways.

Discussion: Clinical information-seeking is often done during consultations, and having access to evidence-based, decision support tools like HealthPathways can facilitate consistency of best practice clinical care across jurisdictions and streamline referrals to local health services. Through the process of collaboration, HealthPathways supports integration of health services. Knowledge about the structure of HealthPathways and how to find information is useful for busy clinicians to aid decision support at the point of care.

Background and objectives: The research evaluated an introductory‑level training program to improve the readiness of general practices in regional Victoria to identify and support victim-survivors of family and domestic violence (FDV).

Method: Mixed methods research was conducted in parallel with a co-design process to optimise the program over three iterations using a rapid-cycle evaluation approach, with data collected to assess early indicators of the program's effectiveness.

Results: Six practices participated in the training sessions. Post-training surveys demonstrated significant changes in their perceived readiness to respond to FDV, with five main themes emerging from the qualitative analysis, including navigating the multiple layers of complexity, providing victim-centred care, tailoring the program to the needs of practices, the program's influence on staff, and recommendations.

Discussion: The research confirmed that the project achieved its aim of developing a training program that improved the readiness of general practices to identify and support victim-survivors.

Background: An estimated one in five Australians aged 60 years and older have sarcopenia, marked by progressive and accelerated loss in muscle mass, strength and function. Sarcopenia is associated with considerable healthcare costs and a myriad of adverse health outcomes, including increased risk of death. Despite its clinical importance, muscle health is often overlooked in routine clinical practice, hindering diagnosis and treatment.

Objective: In July 2023, eight representatives from Australia's primary care and research communities convened to discuss barriers to sarcopenia screening, assessment and management within routine clinical practice. Solutions were proposed to improve the implementation of muscle health assessment and management in general practice. This article summarises the key discussions and outcomes from this meeting.

Discussion: Strategies to improve the implementation of muscle health assessment and management in general practice include (1) improving public awareness; (2) professional education; (3) provision of tools and resources; (4) advocacy and policy; and (5) increasing collaborative efforts between healthcare professionals, professional societies, universities, electronic medical record software vendors and the government.