Australian Journal of General Practice最新文献

Background: Chemical eye injuries are potentially sight-threatening injuries, representing 10-22% of all ocular trauma presentations. Prompt assessment and management of chemical eye injuries in general practice and urgent care clinic settings can prevent patients from losing vision.

Objective: This article presents a clinically useful guide for general practitioners to support the primary management of chemical-related eye injuries, particularly in rural and regional settings. This article will first discuss the variety of chemical eye irritants found in domestic and commercial settings. It will then describe the steps for assessment of chemical-related eye injuries, methods for irrigation and post-irrigation management.

Discussion: Among chemical eye injuries occurring in rural areas, cleaning agents are the most common cause, followed by injuries from personal products, industrial agents, pesticides and herbicides, and petroleum-based products. General practitioners should conduct an initial assessment and instigate immediate management of chemical eye injuries. Advice about the pH level of substances can be obtained from the Poisons Information Centre. Chemical eye injuries coinciding with an epithelial defect or decreased vision should be reviewed by an ophthalmologist within 24 hours of the initial injury.

Background: Median arcuate ligament syndrome (MALS) occurs due to extrinsic compression of the coeliac plexus, leading to postprandial and exercise-induced epigastric pain, nausea, vomiting, food fear and weight loss. Diagnosis can be challenging as up to 25% of the population have radiological compression. However, only 1% of the population have corresponding symptoms. The duration between the onset of symptoms and diagnosis of MALS can extend up to years. Primary care physicians are commonly the first people to encounter patients with MALS and play a vital role in its assessment, diagnosis and management and the coordination of subspecialty care.

Objective: The aim of this article is to provide general practitioners with a review of the current literature, summarise a diagnostic pathway and propose a treatment algorithm for MALS.

Discussion: MALS is a rare cause of debilitating abdominal pain with no single 'rule in test'. It often affects young patients and leads to significant morbidity and poor quality of life. Increased awareness of MALS in the primary care setting allows for earlier consideration and investigation as part of the diagnostic work-up for patients with symptoms of abdominal pain not attributable to more common conditions.

Background and objectives: Burnout is common in primary care doctors. The aim of this study was to explore burnout, self-care and retention in general practice supervision in Australia.

Method: The sample comprised 267 general practice supervisors from all Australian states and territories. Respondents completed an anonymous online survey.

Results: Respondents reported high levels of disengagement (n=189; 71%) and exhaustion (n=212; 79%). Factors associated with burnout included being younger; working while unwell; holding the belief that workplace support for self-care was inadequate; and lower daily balance and/or professional development self-care. Exhaustion was negatively associated with general practice supervisor retention via its negative effect on self-care (β=-0.379; 95% CI: -0.777 to -0.050).

Discussion: Burnout is common in general practice supervisors and is associated with attrition, possibly via a negative effect on self-care. Greater investment in workplace initiatives to address burnout and sector-wide strategies to reduce workforce shortages are needed.

Background: Australia is undergoing general practice funding reform, with recent changes to Medicare and the introduction of MyMedicare voluntary patient registration.

Objective: Within this context, we provide general practitioners (GPs) with an explainer on health economic concepts relevant to current funding reform debates. This article outlines different funding model types, discusses the theoretical advantages and disadvantages of each funding model, and reflects on past experiences of reform.

Discussion: Common GP funding models across the world include fee for service, capitation, pay for performance and bundled payments. Each funding model has its potential advantages and disadvantages. Blended funding models can minimise undesired consequences of individual funding models but can introduce additional complexity. The challenge remains to design funding models that enable access to quality care, adequately pay providers and are sustainable into the future.

Background and objectives: Obesity contributes to the onset and progression of osteoarthritis. This study assesses the influence of baseline body mass index (BMI) and baseline knee pain on improvements observed in patients undertaking a community-based weight loss program for knee osteoarthritis.

Method: This study is a retrospective analysis of data from 9004 patients who took part in the Osteoarthritis Healthy Weight For Life program between January 2014 and July 2022.

Results: The greater the weight loss achieved, the greater the improvement in knee pain and function, with baseline weight having no effect on the magnitude of the outcome. All patients with a starting Knee Injury and Osteoarthritis Outcome Score of <75 experienced significant improvement in their symptoms. Patients with more severe starting pain saw greater improvements.

Discussion: Baseline BMI has no effect on the amount of weight loss required to produce a meaningful improvement in osteoarthritis symptoms. Patients with more severe baseline knee pain see more improvement than those with milder symptoms for the same weight loss.

Background: The management of uncertainty is a core general practice skill best learnt in clinical practice.

Objective: This article outlines strategies a general practice supervisor can implement to help registrars acquire the skills of managing and coping with uncertainty.

Discussion: The medical education literature recommends supervisors being explicit about the different paradigm operating in primary care and normalising the existence and tolerance of uncertainty. Fundamental consultation skills used in the management of uncertainty should be demonstrated. These include shared decision making, safety netting and arranging follow-up. During teaching sessions, problem cases can be explored using Murtagh's diagnostic model to develop clinical reasoning and avoid missing important diagnoses. This paper introduces a model to explore uncertainty by considering management options, easily remembered as the '3Rs': review; refer; and Rx (treat). This model complements the diagnostic model and reflects that a general practitioner must still decide what to do when a diagnosis cannot be made.

Background and objectives: General practitioner (GP) training in Australia relies on accredited GP supervisors facilitating workplace-based training for GP registrars. There is a shortage of supervisors that is likely to worsen. This research aimed to elucidate the perspectives of early-career GPs and rural generalists (RGs) about the barriers, motivators and enablers to becoming a GP supervisor.

Method: Qualitative descriptive methodology was used in the study. Transcripts from three focus groups and six semistructured interviews with 11 RGs (four registrars and seven new Fellows) and 13 GPs (all new Fellows) were analysed thematically.

Results: The following key themes were identified: being a good supervisor; motivated by past experiences of supervision; financial implications of being a supervisor; factors unique to rural settings; new models of supervision; and becoming a supervisor - how and when?

Discussion: The findings highlighted personal and professional barriers to becoming a GP supervisor and some enabling strategies to mitigate these barriers.

Background and objectives: The COVID-19 pandemic changed the way education was delivered. In Australian general practice training, external clinical teaching visits (ECTVs) had to be done remotely. This research explored that phenomenon from the point of view of the participants to answer questions about feasibility, acceptability and effectiveness.

Method: The experiences of ECTV visitors, registrars, supervisors and practice managers were invited initially by survey and then through interview and focus groups. Data were analysed using a constant comparative method giving four major themes and several subthemes.

Results: Remote ECTVs were well accepted by all participants. They are different to ECTVs done face to face, with both advantages and disadvantages.

Discussion: Remote ECTVs are feasible and effective and are likely to become part of the ongoing Australian general practice teaching program.