Acute Bronchitis In General Practice: What Factors Predict A Poor Outcome And Can Antibiotics Help?
Funder
National Health and Medical Research Council
Funding Amount
$393,750.00
Summary
In Australia acute bronchitis is one of the commonest reasons for patients to attend their general practitioner. It can have considerable impact on patients lives with patients coughing on average for two weeks, with a third spending some time in bed and a quarter not returning to their usual activities for many weeks. If they attend a general practitioner (GP) it is likely they will receive antibiotics. But researchers believe that antibiotics are over prescribed for this condition and the emer ....In Australia acute bronchitis is one of the commonest reasons for patients to attend their general practitioner. It can have considerable impact on patients lives with patients coughing on average for two weeks, with a third spending some time in bed and a quarter not returning to their usual activities for many weeks. If they attend a general practitioner (GP) it is likely they will receive antibiotics. But researchers believe that antibiotics are over prescribed for this condition and the emergence of bacterial resistance is a real concern to health authorities. GPs are therefore being urged to reduce the prescription of antibioics for this common condition. But surveys by the National Prescribing Service (NPS) indicate that this is one area where GPs find it difficult to meet national recommendations. In part this may be because GPs do not wish to undertreat or miss a serious respiratory illness. Also results from randomised controlled trials examining the effectiveness of antibiotics for acute bronchitis suggest some benefit from treatment, at least in some patients. However it is not clear who these patients are and how much benefit they would get from receiving antibiotics. This creates a great deal of uncertainity for GPs who then opt for a 'just in case prescription' for everyone presenting with acute bronchitis. Our study will re-examine the symptoms, and clinical findings of patients presenting to their GP with acute cough and explore the impact of this common illness on patients lives. We will determine who does and does not benefit from antibiotics, and give guidance to GPs about the symptoms, clinical findings and investigations that predict a poorer outcome. Evidence from this study will be incorporated into treatment guidelines for acute bronchitis leading to more rational and effective management of this common problem.Read moreRead less
This study proposes to examine the quality of procedural medical care provided by rural doctors who are not specialists. The disciplines of Anaesthetics, Surgery and Obstetrics will be included. Most of these services in rural Australia are not provided by specialist medical practitioners, but rather by rural general practitioners who have obtained additional training, albeit shorter than that undertaken by specialist trainees, and who are supported by skilled nurses and other health professiona ....This study proposes to examine the quality of procedural medical care provided by rural doctors who are not specialists. The disciplines of Anaesthetics, Surgery and Obstetrics will be included. Most of these services in rural Australia are not provided by specialist medical practitioners, but rather by rural general practitioners who have obtained additional training, albeit shorter than that undertaken by specialist trainees, and who are supported by skilled nurses and other health professionals in relatively small rural hospitals. Patients and rural doctors often have little choice but to manage urgent cases locally and in some cases experienced and skilled local teams are able to offer a wider range of services, including a limited number of elective procedures. Despite underlying assumptions that the quality of the services cannot match that of specialist care in larger hospitals, there is no agreement on what constitutes quality of rural procedural care and little evidence that the quality is different. This issue is important as substantial government funds are spent on recruiting, training and retaining a qualified rural medical workforce, and yet fewer rural doctors are providing these services and fewer rural hospitals have the facilities to support those rural doctors still providing the services. Further, measuring the quality of care is a complex issue on which different stakeholders may have different views. This study proposes a multi-perspective approach to assessing the quality of care through a number of case studies provided by rural doctors.Read moreRead less
Translating The Evidence To Practice: Getting The Vaccine Hesitant To Vaccinate
Funder
National Health and Medical Research Council
Funding Amount
$177,197.00
Summary
One of the key examples of this poor research translation is the rise of vaccine hesitancy, where the unequivocal evidence base for public health benefit of childhood immunisations has not been translated into vaccination uptake in many areas.This project will partner with primary health care organisations and develop strategies based on pilot research to improve vaccination information to vaccine hesitant parents, to assist with the uptake of this important public health intervention.
Stepping Up To Insulin: A Cluster Randomised Trial Of Team-based Transition To Insulin In Primary Care For Patients With Poorly Controlled Type 2 Diabetes
Funder
National Health and Medical Research Council
Funding Amount
$796,751.00
Summary
Helping people control their diabetes through the best possible medical care is important. Most people with diabetes eventually need insulin yet this is a step in treatment that is often resisted by patients and GPs. This study will help GPs and Practice Nurses work with patients who have reached this stage make the change to insulin treatment in a safe, effective, convenient and timely way. This will have enormous benefits through reduced diabetes complications and improved quality of life.
Randomized Control Trial Of A Cancer Shared Care Model
Funder
National Health and Medical Research Council
Funding Amount
$242,400.00
Summary
Cancer care in Australia remains fragmented. Shared care has been seen as a potentially more effective way to manage patients with chronic and subacute diseases, by overcoming many of the difficulties which beset the traditional hospital-based model. These difficulties include poor communication between hospital-based and community-based carers, the high costs of hospital-based care and the loss of involvement of the primary care health professional in ongoing care. This project is a trial of a ....Cancer care in Australia remains fragmented. Shared care has been seen as a potentially more effective way to manage patients with chronic and subacute diseases, by overcoming many of the difficulties which beset the traditional hospital-based model. These difficulties include poor communication between hospital-based and community-based carers, the high costs of hospital-based care and the loss of involvement of the primary care health professional in ongoing care. This project is a trial of a Shared Care Model (SCM) with cancer patients in a hospital in Western Australia. The project is designed to improve the emotional well-being and feelings of empowerment of the patients as well as reduce the number of unplanned admissions these patients need to make during their cancer treatment. The SCM intervention includes: -A patient-held record (PHR) comprising chemotherapy road map, treatment intention, medication list and communication pages for health workers; - Earlier and timely direct communication between specialist and general practitioner; -A Shared Care coordinator to assist with patient care and information; and - General practitioner educational and resource packages with tailored side effects table detailing anticipated side effects and actions to be taken. - For rural patients, the model can be expanded to include general practitioner administration of selected chemotherapeutic agents on alternate cycles. - Protocols for general practitioners administration of selected chemotherapeutic agents.Read moreRead less
Evaluation Of Enhanced Models Of Primary Care In The Management Of Stroke And Other Chronic Diseases
Funder
National Health and Medical Research Council
Funding Amount
$556,184.00
Summary
Chronic diseases are the leading cause of death and disability in Australia. Since 1999, patients in Australia have been able to access a variety of comprehensive disease management programs subsidised through Medicare. We will use comprehensive linked data from survivors of stroke registered in the Australian Stroke Clinical Registry to provide the first robust evaluation of the effectiveness of these enhanced models of primary care in patients with chronic diseases using stroke as an example.