The Diamond Cohort Study- Examining Depressive Symptoms In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$570,886.00
Summary
Depression is the single largest cause of disability for people in Australia. It is mainly managed in general practice-primary care, yet many people experiencing depression go unrecognised by their family doctor or general practitioner (GP). Some people, even when given treatment, remain depressed. Guides on how to manage depression have been mainly based upon people attending psychiatrists and hospitals. In addition, there have been a number of large studies overseas testing new ways of helping ....Depression is the single largest cause of disability for people in Australia. It is mainly managed in general practice-primary care, yet many people experiencing depression go unrecognised by their family doctor or general practitioner (GP). Some people, even when given treatment, remain depressed. Guides on how to manage depression have been mainly based upon people attending psychiatrists and hospitals. In addition, there have been a number of large studies overseas testing new ways of helping people with depression. Unfortunately, they do not seem any better than usual care by a GP. We are currently funded by the NHMRC for diamond 1 to follow 800 people to investigate the factors from the patient's and doctor's point of view that are likely to aid recovery from depression, and to detail the way in which people are cared for in the primary health care system. There is increasing research showing that depression is a chronic and relapsing condition and that a one-year follow-up, whilst longer than most previous studies, will capture only a small glimpse of the health service use and relapse patterns of the patients enrolled in our study. In this application, we request funding to continue to follow participants. diamond 2 aims to explore the patient characteristics and health service use patterns of patients who experience persistent major depression with patients who experience a single episode of depression within a 3-year period. We will use the data gathered to develop models that predict recovery-relapse-persistence of depression. Such models will enable us to develop guidelines and design interventions that better target those at risk of continuing and disabling illness. This work will be of international significance and has the potential to influence the entire primary mental health care system and contribute to substantial system change.Read moreRead less
DESPATCH: DElivering Stroke Prevention For Atrial Fibrillation: Assisting Evidence-based CHoice In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$561,447.00
Summary
Non-valvular atrial fibrillation (NVAF) is a common heart condition associated with a major risk of fatal and disabling stroke. Inexpensive anticoagulant medication has been proven to reduce all-causes of death and stroke in patients with NVAF. Anticoagulant treatment for NVAF is substantially under-used resulting in avoidable patient deaths and disabling stroke. The National Institute of Clinical Studies of Australia summarised the large, unrealised benefit of anticoagulation, stating that 'eac ....Non-valvular atrial fibrillation (NVAF) is a common heart condition associated with a major risk of fatal and disabling stroke. Inexpensive anticoagulant medication has been proven to reduce all-causes of death and stroke in patients with NVAF. Anticoagulant treatment for NVAF is substantially under-used resulting in avoidable patient deaths and disabling stroke. The National Institute of Clinical Studies of Australia summarised the large, unrealised benefit of anticoagulation, stating that 'each year, for every 1000 patients with NVAF given anticoagulants, we can assume that about 25 fewer people will experience a stroke and 12 fewer will die from a stroke than would be the case if they were not given them'. Despite this realisation, there is a lack of evidence to support any strategy to improve the care of patients with NVAF. This study seeks to optimise the management of NVAF in general practice. The DESPATCH study will employ a rigorous randomised design to evaluate an innovative educational intervention intended to overcome barriers to the best management of NVAF. If successful, DESPATCH will inform policy and practice aimed at overcoming barriers to best practice for the large and growing number of people with NVAF to reduce the risk of fatal and disabling stroke.Read moreRead less
Trial Of Structured Support To Enhance The Role Of Non-GP Staff In Chronic Disease Management In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$780,625.00
Summary
Chronic disease presents a significant burden to individuals and the health care system , contributing to both an increasing proportion of the work of primary health care practitioners and to health expenditure. A number of interventions have been shown to result in sustained improvement of health outcomes for people with chronic diseases, including: more effective use of non-physician providers of care and nurse case management; integration of self-management support programs with guideline bas ....Chronic disease presents a significant burden to individuals and the health care system , contributing to both an increasing proportion of the work of primary health care practitioners and to health expenditure. A number of interventions have been shown to result in sustained improvement of health outcomes for people with chronic diseases, including: more effective use of non-physician providers of care and nurse case management; integration of self-management support programs with guideline based treatment plans; more intensive follow up and registries that provide reminders and feedback. While some of these approaches have been pursued within the Coordinated Care Trials and the Enhanced Primary Care (EPC) program in Australia, the role of non medical staff within general practice in chronic disease care has not been systematically investigated. In 2001 the Commonwealth introduced a number of initiatives to support better quality of care for diabetes and asthma in general practice and $104.2 million over four years was provided for general practices in areas of high workforce pressure to employ more Nurses. The roles of the Practice Manager and Receptionist have received much less attention. They include faclitating access to care, supporting the delivery of quality clinical care by the practitioners through the provision of expert management services (primarily information technology, staff, financial and facilities management) to the practice. With recent government initiatives expanding the role of general practice in Australia, effective management structures and processes within general practices are vital. Non-GP general practice staff may be the means by which more effective chronic disease management can be achieved at a time of increasing workforce pressure. This project aims to evaluate the impact of a program in which non-GP staff are trained and facilitated to be involved in the management of patients with chronic disease.Read moreRead less
Improving The Care For People With Acute Low Back Pain By Allied Health Professionals: Cluster RCT.
Funder
National Health and Medical Research Council
Funding Amount
$682,134.00
Summary
The project focuses on the NHMRC Clinical Practice Guidelines (CPG) for the management of acute low back pain, and more specifically the key messages of non-referral to x-ray and advising patients to stay active. A mixed design approach will be used in line with the framework for evaluating complex interventions (MRC 2000). A qualitative approach using semi-structured interviews with physiotherapists, chiropractors and the patients of both will be conducted to identify the barriers and enablers ....The project focuses on the NHMRC Clinical Practice Guidelines (CPG) for the management of acute low back pain, and more specifically the key messages of non-referral to x-ray and advising patients to stay active. A mixed design approach will be used in line with the framework for evaluating complex interventions (MRC 2000). A qualitative approach using semi-structured interviews with physiotherapists, chiropractors and the patients of both will be conducted to identify the barriers and enablers to implementation of the evidence-based clinical practice guideline. The interviews will be underpinned by a theoretical framework grounded in behavioural theory. Information from the interviews will be used to develop a survey to canvas views of a larger population of chiropractors and physiotherapists. The results of the interviews and survey will inform the development of a targeted implementation strategy suitable for use in private physiotherapy and chiropractic clinics. Potential interventions include educational strategies, patient and practitioner information via various media, reminder systems and peer leadership. A cluster randomised controlled trial (C-RCT) will then be conducted to determine the effects of the strategy. Practices will be randomised to receive either the developed implementation strategy, including strategies targeted at clinicians and patients, or to a control group receiving access to the guideline alone. The outcomes of the implementation strategy will be assessed at the level of the practitioner (did the strategy result in a change of practice?), and the patient (did the practice change result in improved patient outcomes?). Subgroup analyses will investigate effects specific to chiropractors and physiotherapists.Read moreRead less
A Randomised Controlled Trial Of Evidence Based Medicine In The Management Of Hypertension
Funder
National Health and Medical Research Council
Funding Amount
$319,475.00
Summary
Hypertension is a major condition managed in general practice. The condition is under diagnosed and under treated. Where hypertension is treated, it is often with drugs that are expensive rather than with equally efficacious inexpensive drugs. Hypertension is associated with higher risk of stroke, coronary artery disease, cardiac failure, renal disease and peripheral vascular disease. Clear evidence-based information has been available for some years that provide reasonably guidelines to practit ....Hypertension is a major condition managed in general practice. The condition is under diagnosed and under treated. Where hypertension is treated, it is often with drugs that are expensive rather than with equally efficacious inexpensive drugs. Hypertension is associated with higher risk of stroke, coronary artery disease, cardiac failure, renal disease and peripheral vascular disease. Clear evidence-based information has been available for some years that provide reasonably guidelines to practitioners of the treatment thresholds for hypertension. However, the incorporation of this evidence into general practice has been slow. This project will build upon extensive pilot work to create a system to collect diagnostic, treatment and outcome data from general practice patients. The use of peer-compared feedback, particularly related to a readily understandable health outcome measure such as blood pressure, can change clinical behaviour when provided to the treating clinician. The aim of this project is to show whether or not training in the use of an evidence-based guideline to assist doctors in the decision of whether or not to initiate antihypertensive treatment, and to provide guidance on the type of treatment, leads to better outcomes than that of feedback alone. A cost-benefit analysis will clarify the impact of guideline implementation on health care costs. The incorporation into the cost-benefit analysis of patients perceptions of treatment by doctors using a guideline will show how such practice, compared with standard care, is valued by patients. While the project will focus on hypertension, the database members will continue to develop the research capability of the database, and expand it to incorporate a range of evidence-based information to improve the quality of care for other conditions. The database could achieve an expanding and sustainable influence on the quality of primary health care.Read moreRead less