Australian family physician最新文献

Background: The pattern of menstrual bleeding seen in women during their reproductive years is the result of a finely tuned balance be-tween endogenous oestrogens, which stimulate the endometrial lining, and progesterone, which temporarily maintains that lining in anticipation of a pregnancy. Many women have expectations of a 'normal monthly' cycle, and may be wary of any-thing that has the potential to disrupt its regularity. From a clinical perspective, any alteration in vaginal bleeding may indicate underlying pathology, and lead to further investigation and management.

Objective: The aim of this article is to provide a practical approach to the investigation and management of altered vaginal bleeding patterns in women using various methods of contraception.

Discussion: Around 70% of Australian women of reproductive age use some form of contraception. Any discussion of 'normal bleeding' becomes even more complex given that modern contraceptive methods almost inevitably modify the pattern of bleeding experienced by the user.

Background: Active transport (ie walking, cycling, using public transport) can play a part in reducing non-communicable diseases (NCDs). Very little is known about how general practitioners (GPs) can contribute to promoting active transport. We explored GPs' ideas around active transport, and potential barriers and facilitators to its promotion in the clinical setting.

Methods: Using a maximal variation sample, we conducted 10 semi-structured interviews with GPs in Victoria, Australia. The socioecological model informed data collection and analysis.

Results: The idea of active transport resonated with GPs. Limited awareness around active transport and safety concerns regarding commuter cycling were barriers to clinical promotion. GPs believed patients' health, cultural norms, socioeconomic position and access to supportive environments could facilitate participation.

Discussion: Future efforts should prioritise awareness of active transport among GPs. The perspectives of GPs would be valuable to policymakers, particularly in designing programs to mitigate inequalities around active transport access and use.

Background: The objective of this study was to examine prevalence rates of lifestyle risk factors in the Western Victorian Primary Health Network (WV PHN) general practice patient population and the corresponding levels of clinical advice and counselling.

Methods: Analysed data from the Bettering the Evaluation and Care of Health (BEACH) program from April 2011 to March 2015 were examined, providing a comparison of three geographical areas of general practice patients: WV PHN, Victoria and Australia.

Results: Rates of clinical advice and counselling for diet and exercise provided by general practitioners (GPs) in the WV PHN network were significantly lower than Victorian and Australian rates, despite the region's higher obesity rates. Smoking rates were higher in the WV PHN compared with Australia, but there was no difference in the levels of smoking cessation advice disseminated. Across all regions, one in four patients drank alcohol at hazardous levels.

Discussion: GPs in rural practice require further support, encouragement and resources to provide diet and exercise advice to their patients more frequently.

Background: Cardiovascular disease (CVD) is a major cause of death in Australia. Electronic medical record (EMR)-based clinical decision support (CDS) tools have the potential to support absolute CVD risk (ACVDR) evaluation and management. The objective of this study was to test the acceptability and feasibility of the Treat to Target CVD (T3CVD), an EMR-based CDS tool, for the evaluation of ACVDR in general practice.

Methods: Five general practitioners (GPs) piloted the T3CVD tool in their clinic. Interviews with the clinicians explored the acceptability and feasibility of the T3CVD tool.

Results: The T3CVD tool was acceptable and, in the small pilot, was shown to have the capacity to support GPs in ACVDR assessment and management, and to encourage patient participation and motivation. Technical and structural factors important to ensure feasibility of the tool were identified.

Discussion: With further development, the T3CVD tool has the potential to improve ACVDR assessment and management in primary care.

Background: Morphine is widely prescribed for patients with cancer, although a number of attitudes have been cited as barriers to its use, including fear, addiction and associations with death. The aim of this study was to explore the nature of these beliefs, and assess the extent to which these attitudes exist in a general practice patient population that may require morphine in the future.

Methods: A 30-item survey was distributed through general practices in Victoria, Australia.

Results: Of the 379 questionnaires distributed, 290 were collected (76.5%). Participants were predominantly neutral on questions regarding the effect of morphine on the duration of life. Morphine was seen to be prescribed responsibly (73.5%), even while most perceived its potential for addiction (69.7%). Participants with experience of morphine use had more negative perceptions regarding its efficacy.

Discussion: Conversations regarding morphine use should include a discussion about the beliefs and experiences of the individual, many of which may reinforce the utility of morphine.

Background: The aim of this study was to explore the experiences of Australian general practitioners (GPs) with a Doctor of Philosophy (PhD) about their choice to abandon or pursue an academic career.

Methods: A qualitative study of 18 GPs (PhD obtained between 2006 and 2016) was conducted. Semi-structured telephone interviews were transcribed and analysed using concurrent thematic analysis.

Results: General practice researchers faced insecure career pathways. They often work in isolation, there is a lack of critical mass, and research was often described as a hobby (ie unfunded, done from home). Solutions included expanding academic general practice registrar positions to include advanced research training, building professional networks, mentoring, and better marketing of general practice research.

Discussion: Focused investment in developing clear and sustainable career pathways is essential to nurture and retain general practice researchers and research leaders. The research culture and professional standing of general practice researchers also need to improve. Support from professional bodies and colleagues, and enabling research collaborations, are key.

Background: The use of long-acting reversible contraceptives (LARCs) is globally accepted as a strategy that is successful in decreasing rates of unintended pregnancy, especially in very young women. Currently, Australia has very low uptake rates of LARC.

Objective: The aim of this paper is to explore the latest information on using LARCs as first-line contraception in young women.

Discussion: Low uptake of LARCs may be related to Australia's prevailing cultural norm of oral contraception, and practitioner and patient misperceptions of the safety and efficacy of LARC, which have been dispelled in recent years. LARCs are widely recommended by professional bodies and the World Health Organization (WHO) as first-line contraception for young women as they are safe, effective and reversible. Young women should be offered the choice of a LARC as part of a fully informed decision for their first form of contraception.