Australian Journal of General Practice最新文献

Background and objectives: Tuberculosis infection (TBI) screening and treatment delivered from primary care could hold the key to achieving tuberculosis (TB) elimination in low TB burden countries. This scoping review was undertaken to understand how elements of the cascade of care for TBI screening and treatment have been implemented in primary care settings globally.

Method: For this review, eight databases were searched, including PubMed, Embase, CINAHL, Global Index Medicus, Scopus, Web of Science, ProQuest Dissertations & Theses Global and the Cochrane Library, to examine models of care for TBI screening and treatment in primary care.

Results: Eight articles were included from the 7207 articles screened. These eight articles describe models of care that are varied in their aim, design and focus and elements of the TBI cascade of care.

Discussion: Although primary care is well placed to offer TBI screening and treatment, robust referral, community mobilisation and systems support are critical. Further research is necessary for Australia to deliver on the elimination target of the World Health Organization.

Background: Women in their 40s experience significant reproductive health changes, requiring personalised contraception to avoid unintended high-risk pregnancies and adapt to changing health conditions.

Objective: This article examines optimal contraceptive choices for women in their 40s, considering effectiveness, ease of use, non-contraceptive benefits, side effects, contraindications and re-evaluation or discontinuation timings.

Discussion: Contraceptive choices for women in their 40s vary depending on their family planning status, underlying health conditions and risk factors. Long-acting reversible contraceptives, permanent sterilisation and progestogen-only methods (excluding depot medroxyprogesterone acetate) are preferred options for women who have completed their families. Hormonal contraceptives can help manage menstrual disorders and bone health issues while providing endometrial protection during menopause. Regular contraceptive reviews should be conducted, and options adapted as needed.

Background: Treatment for prostate cancer (PC) is associated with adverse effects, especially in patients receiving androgen deprivation therapy (ADT). The Australian Government, non-governmental organisations and pharmaceutical companies responsible for marketing ADT have initiated and sponsored various strategic support programs for patients diagnosed with PC.

Objective: This professional article provides an overview of available PC patient support programs in Australia to assist general practitioners (GPs) to direct patient referrals and optimise clinical care.

Discussion: These PC support programs provide useful assistance on educational materials, decision support, clinical care management and referral to specialised services (eg continence advice, sexual health counselling and psychological support). More concerted efforts and smarter investment in PC survivorship programs are necessary to engage, educate and improve the lives of men living with PC more effectively.

Background: Australian general practitioners encounter a vast array of health issues in their clinical practice. High-quality clinical record keeping is crucial to support continuity of care for patients and decision making for clinicians. Many clinical software programs used in general practice contain shortcut features that allow insertion of pre-stored, editable text into progress notes. These can be used to support documentation of specific health issues.

Objective: Drawing on our experience within a research project seeking to strengthen chlamydia management in general practice, this article describes the co-design, implementation and use of documentation shortcuts for chlamydia management.

Discussion: Shortcuts are useful as a memory prompt and timesaver for general practice clinicians. It is important that they do not replace clinical acumen and judgement. General practices using our chlamydia management shortcuts found them easy to set up, that they acted as a prompt for best practice chlamydia management and that they integrated well with the general practice workflow.

Background and objectives: The UK provided guidance for general practitioners (GPs) to deliver essential care services during the COVID-19 pandemic. Our objective was to describe local GP experiences and approaches to delivering care while similar formal guidance in Australia was unavailable.

Method: Two hundred and ninety-one GPs who practised during the March 2020 to December 2021 COVID-19 lockdowns in Melbourne and Sydney undertook an electronic survey exploring perceptions of essential care service delivery. The provision of care by Australian practices was compared to UK Royal College of General Practitioners' recommendations.

Results: Of 274 completed surveys, Australian GP practices were 60% concordant with UK guideline recommendations. There was a large shift towards telehealth service provision across the board, from diagnosis to follow-up. Most care continued if it was deliverable through telehealth or had urgent or time-sensitive need.

Discussion: Local guidance for delivery of essential care services should be developed for future calamities, informed by GPs' experience practising during the COVID 19 pandemic and considering Australian contextual factors.

Background: A number of respiratory syncytial virus (RSV) prevention products have recently been approved in Australia. These products focus on highest risk groups, aiming to prevent RSV disease in young infants and older adults. While not currently included in the National Immunisation Program (NIP), an RSV vaccine (Arexvy, GlaxoSmithKline [GSK]) is available privately for adults ≥60 years, and some Australian jurisdictions have commenced RSV monoclonal antibody (nirsevimab) programs for infants in 2024.

Objective: This article summarises safety data regarding RSV prevention products approved in Australia, including vaccines for adults ≥60 years, maternal vaccines and monoclonal antibodies for infants.

Discussion: Clinical trial data found these products were largely well tolerated, with most local and systemic reactions being mild-moderate and short-lived. Proportions of serious adverse events were low. While very rare, potential safety signals being further assessed include risk of preterm birth following the maternal vaccine (Abrysvo, Pfizer) and Guillain-Barré syndrome (GBS) following RSV vaccines in older adults (Abrysvo and Arexvy). Close monitoring of these adverse events of special interest via post-licensure surveillance is underway.

Background and objectives: Rapid point-of-care tests (POCT) are likely to assist with the detection of group A streptococci (GAS), but their usefulness is determined by the presence of carriers of GAS. This is insufficiently explored in the wet tropics.

Method: This study included 77 patients attending primary care in the wet tropics complaining of a sore throat, and 49 healthy controls. Carrier rates of GAS and the positive and negative etiological predictive values (P-EPV and N-EPV, respectively) of a POCT were calculated.

Results: The carrier rates were 8.3% among healthy children and 2.7% for adults. The P-EPV for children was 71% (95% confidence interval [CI]: 0.0-100%) and for adults it was 85% (95% CI: 0.0-100%). The corresponding N-EPV was 99% (95% CI: 95-100%) for children and 99% (95% CI: 98-100%) for adults.

Discussion: N-EPV, ruling out GAS, was sufficiently high with narrow CIs to allow for defining a stopping rule to avoid unnecessary antibiotic prescribing.