Australian Journal of General Practice最新文献

Background and objectives: Type 2 diabetes affects over half a million older Australians. Australian Medicare group exercise and education interventions can support older adults' diabetes management. However, the feasibility and acceptability of accredited exercise physiologist (AEP)-delivered services are yet to be assessed. This study aimed to assess the feasibility, acceptability and preliminary efficacy of a Medicare type 2 diabetes group exercise and education intervention for older adults.

Method: This study was a single-arm feasibility, acceptability and preliminary efficacy trial of an AEP-delivered type 2 diabetes group service for older adults with the condition. Participants attended the diabetes clinic once per week for eight weeks, through Medicare, for a group exercise and education session. Attendance, participation, enjoyment, suitability, usefulness and pre-post clinical health outcomes were assessed.

Results: The intervention was feasible and acceptable, with 40 participants (mean [±standard deviation] age 71.8±4.5 years [range 65-81 years]; 45% female) attending 87% of sessions. Almost all participants (97%) strongly agreed that the program was enjoyable. Participants also improved fitness and cardiometabolic health outcomes.

Discussion: More Australians should be referred to and attend Medicare-subsidised exercise physiologist-delivered group sessions. The potential for additional sessions to achieve greater physical activity engagement and diabetes self-management should be further investigated.

Background: Professional identity formation (PIF) as a general practitioner (GP) enhances the experience of meaning at work, reduces burnout, promotes patient-centred decision making and strengthens advocacy for the unique role of family medicine within the healthcare system. Unfortunately, there is insufficient emphasis on PIF in GP residency programs; it often remains a hidden curriculum. External factors limiting GP trainees' exposure to their own general practice community of practice further impede PIF. Thus, fostering general practice PIF requires deliberate, focused efforts; however, there is little empiric evidence on the GP professional identity or how to foster it.

Objective: The aim of this paper is to discuss strategies for effective GP PIF in family medicine residency.

Discussion: The authors recommend explicit attention to PIF in three key areas: curriculum; teaching and learning; and faculty development. Additionally, the authors encourage GPs to unite as a community to provide continuing and coordinated support for GP residents on their PIF journey.

Background: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is increasingly being diagnosed incidentally on imaging. It has malignant potential, making it vital to establish the correct diagnosis, assess its malignant risk and follow a management strategy to prevent development of invasive carcinoma of the pancreas.

Objective: This review focuses on the epidemiology, natural history, risk factors, diagnosis and management of IPMN of the pancreas, and will provide practical points for general practitioners.

Discussion: IPMN of the pancreas can transform into invasive pancreatic carcinoma at a low rate of approximately 2%/year. Upon diagnosis of IPMN, it is risk stratified based on the presence of worrisome or high-risk stigmata, which guides further management. Management needs to be individualised based on IPMN and patient factors due to limitations with the current diagnostic tools.

Background: Medical certificates communicate the needs and conditions of a person to (often) non-medical entities or other stakeholders. Medical certificates can have a profound effect on patients' access to social and financial support, and therefore wellbeing. However, general practitioners (GPs) are not formally trained in effective completion of medical certificates, leaving opportunity for workforce development.

Objective: This article discusses the significant role of medical certificates in patient care and the challenges GPs face in completing medical certificates.

Discussion: Medical certificates are often the only mode of communication between GPs and non-medical entities. The tone, comprehensiveness and content of medical certificates can influence the document's utility. There are limited guidelines and formal education for GPs on how to write an effective medical certificate. Designing and implementing guidelines along with appropriate training for GPs will likely result in better patient outcomes in line with their support needs.

Background: The recent Intergenerational Report (2023) highlighted that the Australian healthcare system will face increasing economic and logistical challenges, with projected growth in health spending due to an ageing population and an increasing number of chronic diseases. Shared care, a model emphasising collaboration between nursing and allied health, general practice and specialist care providers, has emerged as one solution.

Objective: This paper explores the contemporary shared care landscape in Australia, highlighting the digital transformation of healthcare, the adoption of eHealth technologies, and their impact on improving patient care coordination.

Discussion: The roles of shared electronic health records, secure electronic communication and consultation, electronic patient portals and telehealth in enhancing healthcare accessibility and management of chronic diseases are individually explored. Infrastructure for future inter-electronic medical record integrations are then discussed. Innovative care models combining novel technology and shared care hold promise for more efficient, patient‑centric healthcare systems. Given Australia's unique healthcare challenges, it provides the ideal environment to lead the way in the digital transformation of shared care.

Background: The number of people living with or beyond cancer are expected to rise. General practice-led cancer survivorship plans have been proposed as a way to address ongoing healthcare needs (including physical and psychosocial care) and care coordination, as well as the prevention and management of other chronic illnesses.

Objective: The aim of this paper is to discuss the role of general practice in the long-term care of cancer survivors and provide a summary of recommendations for comprehensive cancer survivorship care planning in general practice.

Discussion: General practice provides cancer survivors with ongoing support within their community from pre-diagnosis onwards. It is recommended that comprehensive cancer survivorship care plans include the cancer treatment summary and follow-up care planning; the management of other comorbid chronic conditions; health promotion and disease prevention with tailoring to shared goals; and the cancer survivor's unique situation.