Australian Journal of General Practice最新文献

Background: Patients with cancer often experience nausea. In some cases, a specific cause such as chemotherapeutic adverse effects, raised intracranial pressure or malignant bowel obstruction is identified. In other cases, no specific cause is apparent.

Objective: This article summarises the evidence-based management of nausea in advanced cancer. It includes the nausea of select, specific contexts such as raised intracranial pressure and bowel obstruction.

Discussion: It is not commonly appreciated that low-dose oral haloperidol is the standard of care arm for many trials looking to reduce nausea in advanced cancer. It is available cheaply through the Pharmaceutical Benefits Scheme. The relative merits of other medications are discussed, as are the merits of an empiric versus a mechanistic approach to treatment.

Background: Epiphora, or the watery eye, is a common presenting complaint seen by general practitioners and can have significant quality-of-life implications.

Objective: This article aims to review epiphora, its many causes and a systematic approach to its assessment, management and escalation in the primary care setting.

Discussion: Many causes of epiphora can be managed in the primary care setting. A clear and structured approach to work-up is essential in narrowing down the broad range of differential diagnoses, and might help clinicians recognise when involvement of the appropriate specialist service is required.

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 and objectives: Little is known about the views of service providers currently working in telehealth early medical abortion (EMA) provision in Victoria, Australia. This study aims to contextualise the enablers and barriers to telehealth EMA provision, providing insight for healthcare policy and practice to improve the accessibility of this service.

Method: This was a qualitative descriptive study involving semi-structured interviews with 14 Victorian stakeholders with expertise and knowledge on telehealth EMA provision. Data were analysed using conventional content analysis.

Results: This study presents perceived enablers and barriers across four different contexts of the Victorian abortion system: (1) perceived patient context; (2) perceived provider context; (3) health organisation-system context; and (4) sociopolitical context. The COVID-19 pandemic's disruption of healthcare services led to greater patient and provider acceptance of telehealth EMA. However, barriers within the patient context included the inability to ensure safety and confidentiality, digital access and literacy issues, language barriers, and the importance of trusting provider-patient relationships. Providers encountered challenges in delivering holistic care via telehealth, including time and workload issues and working with interpreters. Shortcomings within the organisational context encompassed structural barriers for culturally and linguistically diverse population groups, the absence of standard telehealth guidelines and varying interpretations of telehealth. Although temporary Medicare item number changes improved access, they presented financial challenges for mixed and private billing practices.

Discussion: The application of these findings by relevant health services and policymakers has the potential to improve the quality of, and increase accessibility to, telehealth EMA, better meeting the needs of individuals seeking this service.

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: 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.