Australian Journal of General Practice最新文献

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.

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 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.