Australian family physician最新文献

Background: Media reports suggest that growth in urgent, after-hours Medicare Benefits Schedule (MBS) claims has coincided with an increasing number of after-hours medical deputising services (AHMDSs). This article assesses these claims in the context of an increasing presence of AHMDSs.

Methods: Retrospective analysis of MBS claims data for general practitioner (GP) after-hours items from 2010-11 to 2015-16 was conducted. The Tasmanian experience is presented as a case study.

Results: The number of claims was greatest for MBS item number 597 (urgent, sociable after-hours consultations), increasing by 170% over the study period. For jurisdictions with dates identified for the introduction of AHMDSs, dramatic growth in per capita claims were observed: 1270% for the Australian Capital Territory, 485% for Tasmania and 150% for the Northern Territory. For Tasmania, no decrease in emergency department presentations was observed.

Discussion: Rapid increases in after-hours claims for MBS item number 597 have coincided with the introduction of AHMDSs in three jurisdictions. The impact on patient outcomes and equitable resource distribution requires attention.

Background: For research to be ethically acceptable, the potential benefits must justify any risks involved for participants. Dissemination of research findings through publication is one way of creating benefit, but not all researchers intend to publish their research. Other factors, such as lack of size or representativeness, generalisability or innovativeness, or negative findings mean the research is unlikely to be published in a peer-reviewed medical journal.

Objective: This paper discusses ethical considerations in research where peer-reviewed publication is not intended or unlikely.

Discussion: Proposing research that is not intended or unlikely to be published in a peer-reviewed journal does not preclude it from being considered ethical. Additional benefits of such projects may include professional development of investigators, pilot data collection leading to more definitive studies, or developing collaborations with research users that increase relevance and improve utility of findings.

Background: The common use of cross-sectional imaging for the investigation of abdominal and thoracic illness has resulted in the rise of the incidentally identified adrenal mass, or incidentaloma, which presents a diagnostic and management dilemma for the primary care physician.

Objective: This article provides a framework for the investigation and management of incidental adrenal masses.

Discussion: Adrenal incidentalomas are found in approximately 3-4% of abdominal computed tomography (CT) scans. It is important to evaluate these incidental adrenal lesions to determine what treatment, if any, is needed and when specialist referral may be necessary. In particular, incidentalomas must be evaluated in regard to their functional status and malignant potential, as lesions can range from being indolent, benign and non-functioning tumours that can simply be observed, to aggressive and hormonally active malignant lesions that require urgent surgical intervention.

Background: Women who are perimenopausal are at risk of unintended pregnancy despite relatively low fertility at this stage. Contraceptive choice can be limited by increased comorbidities, but the UK Medical Eligibility Criteria (UKMEC) system provides a framework for safe prescribing.

Objective: This article provides evidence-based guidance on contraceptive options, and information to support decision-making about stopping contraception at menopause.

Discussion: Contraceptive choice is determined by several factors, including medical eligibility, side effects and risks, non-contraceptive benefits, cost and personal preference. Long-acting reversible contraceptives (LARCs) are an effective, acceptable and safe choice for many women. For women aged ≥50 years who are using a non-hormonal method, contraception is recommended until after 12 months of amenorrhoea, or 24 months if they are aged 50 years; serial follicle-stimulating hormone (FSH) levels can guide method cessation given amenorrhoea is not a reliable indicator of menopause in this context.

Background: Dispensing data suggest potential issues with the quality use of medicines for airways disease.

Objective: The objective of this article was to describe the management of asthma and chronic obstructive pulmonary disease (COPD) in general practice, and investigate the appropriateness of prescribing.

Methods: The method used for this study consisted of a national cross‑sectional survey of 91 Australian general practitioners (GPs) participating in the Bettering the Evaluation and Care of Health (BEACH) program.

Results: Data were available for 2589 patients (288 asthma; 135 COPD). For the patients with asthma, GPs classified asthma as well controlled in 76.4%; 54.3% were prescribed inhaled corticosteroids (ICS), mostly (84.9%) as combination therapy, and mostly at moderate-high dose; only 26.3% had a written action plan. GPs classified COPD as mild for 42.9%. Most patients with COPD (60.9%) were prescribed combination ICS therapy and 36.7% were prescribed triple therapy.

Discussion: There were substantial differences between guideline-based and GP- recorded assessment and prescription for asthma and COPD. Further research is needed to improve care and optimise patient outcomes with scarce health resources.

Background: Physiotherapy plays an important role in the health of many Australians. The aims of this study were to assess changes in the rate of general practitioner (GP) referral to physiotherapists in Australia from 1998 to 2014, and to determine patient characteristics associated with increased likelihood of such referral.

Methods: Secondary analysis was undertaken of data from the Bettering the Evaluation and Care of Health program using weighted encounter data years 1998-99 to 2014-15 inclusive.

Results: The rate of GP referral to physiotherapists remained steady until 2010, when referrals increased. Patients were more likely to be referred to physiotherapy if they had a Department of Veterans' Affairs card; did not have a Health Care Card; were female aged 45-64 years; or male aged 25-44 years. Musculoskeletal problems accounted for 80% of referrals, but only 6.8% of all musculoskeletal problems managed were referred.

Discussion: Allied health Medicare Benefits Schedule item numbers have increased referrals to physiotherapy. However, there are some population groups who are not referred but might benefit from physiotherapy.

Background: The objective of this article was to alert general practitioners (GPs) to the increase in ocular syphilis in the context of a worsening epidemic of syphilis among men who have sex with men (MSM).

Methods: This study used a retrospective case review of ocular syphilis cases that presented to the Royal Victorian Eye and Ear Hospital from January 2015 to August 2016.

Results: Twelve patients (19 eyes) were identified, including 11 males. The mean age was 35 years, and seven men were identified as MSM. Two men were diagnosed with human immunodeficiency virus (HIV) infection at presentation. Blurred vision (n = 10) and/or floaters (n = 9) were the most common presenting symptoms. All patients had uveitis as the manifestation of the ocular involvement; however, redness and pain were not universally reported.

Discussion: GPs should be alert to the possibility of ocular syphilis at the time of syphilis diagnosis, particularly among MSM. Urgent ophthalmic referral is required if the patient is found to have new onset visual symptoms.

Background: Procedural skills are an essential component of general practice vocational training. The aim of this study was to investigate the type, frequency and rural or urban associations of procedures performed by general practice registrars, and to establish levels of concordance of procedures performed with a core list of recommended procedural skills in general practice training.

Methods: A cross-sectional analysis of a cohort study of registrars' consultations between 2010 and 2016 was undertaken. Registrars record 60 consecutive consultations during each six-month training term. The outcome was any procedure performed.

Results: In 182,782 consultations, 19,411 procedures were performed. Procedures (except Papanicolaou [Pap] tests) were performed more often in rural than urban areas. Registrars commonly sought help from supervisors for more complex procedures. The majority of procedures recommended as essential in registrar training were infrequently performed.

Discussion: Registrars have low exposure to many relevant clinical procedures. There may be a need for greater use of laboratory-based training and/or to review the expectations of the scope of procedural skills in general practice.