Australian Journal of General Practice最新文献

Background and objectives: Australians are living and continuing to drive while older because of improved medical care. Queensland drivers aged over 75 years submit to annual mandatory medical examinations, which is often stressful for both general practitioner (GP) and patient. Driving cessation has negative health outcomes, yet impaired driving is dangerous. This study's aim was to elucidate factors that could lead to a more standardised, fair mandatory assessment.

Method: Ten GPs' semi-structured interviews were analysed using reflexive thematic analysis (RTA).

Results: Themes from the data obtained were: relationships; the big worry; and standards, equity and fairness. GPs acknowledged the difficulty conducting these assessments. Focused education was lacking. Senior doctors only saw long-term patients whereas registrars were assigned new patients. Cognitive impairment was difficult to assess and legal-liability was concerning.

Discussion: Current inequities stem from lack of focused GP education; a mismatch of GP skills for new patient assessments; unfunded functional assessment; and ill‑defined legal liability.

Background: Research indicates that education on sun protection and proper sunscreen application is insufficient, leading to widespread under-application of sunscreen. This lack of adherence to recommended practices increases the risk of skin cancers, photoageing and exacerbates conditions like melasma and lupus.

Objective: This review aims to provide clinicians with a practical framework to educate patients on effective sun protection, including sunscreen use, and to address common barriers to adherence.

Discussion: Sunscreen is crucial for preventing melanoma, non-melanoma skin cancers, photoageing and exacerbating conditions like melasma and lupus. Despite its importance, it is often underapplied. Effective patient education is essential, and clinicians are well positioned to guide effective sunscreen use and encourage holistic sun protection behaviours. In addition to sunscreen, this includes wearing protective clothing, broad-brimmed hats, sunglasses and seeking shade.

Background and objectives: Evidence-based prescribing for heavy menstrual bleeding (HMB) can improve quality of life, iron deficiency and anaemia. Tranexamic acid (TXA) is more effective than oral hormonal medications (OHMs). This study aimed to establish temporal trends (2010-23) in TXA prescribing for HMB by Australian general practice registrars.

Method: Cross-sectional analyses were conducted within an ongoing inception cohort study (Registrar Clinical Encounters in Training [ReCEnT]), using multivariable mixed logistic regression models.

Results: In 4717 registrars (response rate 93.4%), adjusted odds of prescribing TXA for HMB increased by 12% annually (odds ratio [OR] 1.12, 95% confidence interval [CI]: 1.04-1.20], P=0.004), and 18% annually when compared to OHMs (OR 1.18, 95% CI: 1.03-1.36, P=0.019). General practice registrars who consulted their supervisor were less likely to prescribe TXA compared to OHMs (OR 0.36, 95% CI: 0.14-0.92, P=0.034).

Discussion: Registrars' increasing TXA prescribing suggests an appropriate response to evidence. Supervisors may be slower to implement this evidence, warranting further investigation to inform evidence-based prescribing strategies.

Background: As there is a large body of evidence confirming its accuracy, human papillomavirus (HPV) self-collection has been introduced to the Australian National Cervical Screening Program (NCSP). Self-collection also offers an opportunity to engage under-screened (including never‑screened) individuals. Under-screening remains a significant risk factor for cervical cancer, with over 70% of Australian cases involving individuals who are under‑screened or have never been screened.

Objective: This article provides an in-depth, evidence-based examination of the clinical accuracy of self-collection in cervical screening and provides recommendations for general practice. The discussion also includes a brief overview of self-collection adoption in under- and never-screened people.

Discussion: Many studies have demonstrated that self-collection is similar to clinician-collection for detecting clinically significant HPV infections. However, some general practitioners (GPs) still have concerns about self‑collection, including holding the misconception that self-collection is less accurate, possibly because of older studies that were undertaken using less sensitive testing technologies. Understanding self-collection accuracy, devices, quality control methods and the implications for general practice can encourage GPs to offer it to eligible patients, potentially engaging more patients in cervical screening, preventing devastating diagnoses, increasing equity and saving lives.

Background: Intimate partner violence (IPV), particularly coercive control by a partner, is prevalent in Australia as well as worldwide, and survivors present commonly with a range of symptoms to general practitioners (GPs). It is recommended for GPs to take a case-finding approach to identify survivors of IPV and it is important for GPs to know how to appropriately respond to disclosures.

Objective: This article outlines how to respond generally to disclosures in general practice using the World Health Organization 'LIVES' framework (Listen, Inquire about needs, Validate, Enhance safety and offer Support). We focus on enhancing safety responses to adult survivors of IPV and children affected by IPV.

Discussion: It is recommended for GPs to inquire about concerns, use validating statements and undertake regular risk assessment and safety planning for survivors and their children. Offers of appropriate referrals and ongoing support should be in the context of providing choice, control and advocacy.

Background: Voluntary assisted dying (VAD) is now an available end-of-life choice everywhere in Australia, except the Northern Territory. Many patients will wish to have conversations about VAD with their general practitioner (GP), as a known and trusted first point of contact for health concerns. However, to date, VAD provision in the general practice setting has been limited.

Objective: This article outlines GPs' legal and professional requirements for engaging in first conversations about VAD with patients. It identifies current barriers to these conversations and offers guidance and advice to support GPs when navigating them.

Discussion: GPs coordinate patient care across the lifespan, including end of life. Early conversations with patients about all end-of-life options, including VAD where legally permitted, can enable more timely access to optimal end-of-life care. VAD is a relatively new form of healthcare, and there can be legal, ethical, professional and therapeutic barriers to conversations about it.