Evaluating The Effectiveness Of Comprehensive Primary Health Care In Local Communities
Funder
National Health and Medical Research Council
Funding Amount
$1,635,268.00
Summary
This research will develop and implement a program logic evaluation in order to assess the effectiveness of various models of primary heatlh care service delivery. Although comprehensive primary health care holds considerable promise to meet the growing demands on the health system, it has not been thoroughly evaluated. Comprehensive primary health care is a large and complex area, therefore part of the project focuses on services and client experiences in two chromic diseases: diabetes and depr ....This research will develop and implement a program logic evaluation in order to assess the effectiveness of various models of primary heatlh care service delivery. Although comprehensive primary health care holds considerable promise to meet the growing demands on the health system, it has not been thoroughly evaluated. Comprehensive primary health care is a large and complex area, therefore part of the project focuses on services and client experiences in two chromic diseases: diabetes and depressionRead 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
A Phase II Trial Of Follow-up Of Men With Prostate Cancer In Primary Care.
Funder
National Health and Medical Research Council
Funding Amount
$584,465.00
Summary
This study aims to develop and test a novel model of shared care for the follow-up of men with prostate cancer. Men treated for prostate cancer experience distressing and ongoing side-effects of treatment and significant psychological issues. Current models of care fail to address adequately these issues. The new model is designed to improve the care received and therefore the quality of life of men after treatment for prostate cancer.
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.
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.
Primary Care Prevention Of Falls And Fractures In The Elderly By Annual Vitamin D Supplementation
Funder
National Health and Medical Research Council
Funding Amount
$305,750.00
Summary
While Australia has one of the highest rates of skin cancer, many of us are not receiving enough sun exposure to adequately maintain necessary blood levels of vitamin D. For years it was assumed that vitamin D deficiency was rarely seen in Australia where sunlight abounds for most of the year. Although few foods are high in vitamin D, it was thought that only certain cultural groups where women are always veiled in public, very dark-skinned people and the housebound elderly, were at risk of vita ....While Australia has one of the highest rates of skin cancer, many of us are not receiving enough sun exposure to adequately maintain necessary blood levels of vitamin D. For years it was assumed that vitamin D deficiency was rarely seen in Australia where sunlight abounds for most of the year. Although few foods are high in vitamin D, it was thought that only certain cultural groups where women are always veiled in public, very dark-skinned people and the housebound elderly, were at risk of vitamin D deficiency. Lower vitamin D levels following wintertime have now been reported in many populations including those living near the Mediterranean and in Geelong, Victoria. Vitamin D insufficiency is associated with an increased risk of falling through increased body sway and muscle weakness. Low levels of the vitamin also encourage the removal of calcium from bones and will predispose to bone fracture for two reasons - increased likelihood of falling and increased bone fragility and osteoporosis. Osteoporotic fractures are amongst the most important causes of ill-health among elderly people, causing an estimated 65,000 fractures in 2000-01. If nothing is done, fracture rates are estimated to increase from one every 8.1 minutes in 2001, to one every 3.7 minutes in 2021. Falls among the elderly are also a major health with about a third of people over 70years falling at least once every year. Almost 90% of all hip fractures result from the impact of a fall. This project will trial an annual dose of vitamin D to the elderly at high risk of vitamin D deficiency, falls and fractures. Fifteen hundred women will be supplemented with either vitamin D or a placebo dummy pill at the beginning of winter for five years. The supplementation will take place through their local doctor and researchers will expect to see fewer falls and bone fractures occurring in those receiving vitamin D than in the group receiving the placebo.Read moreRead less
Primary Health Care Errors Study: Qualification And Quantification Of Errors Occurring In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$191,000.00
Summary
The General Practice Errors Study (GPES) is a project that aims to examine errors that GPs notice in their daily practice, that affect patient well-being or care. Very little work has been done on this subject in General Practice in any other country, and Australia is the only country with previous research that has attempted to describe GP errors with the Quality in Australia Health Care Study (QAHCS). However, we have so far not had any research that has been done on a representative sample of ....The General Practice Errors Study (GPES) is a project that aims to examine errors that GPs notice in their daily practice, that affect patient well-being or care. Very little work has been done on this subject in General Practice in any other country, and Australia is the only country with previous research that has attempted to describe GP errors with the Quality in Australia Health Care Study (QAHCS). However, we have so far not had any research that has been done on a representative sample of GPs, or been able to quantify the frequency with which different types of errors occur. This study plans to ask a representative sample of GPs in both urban and rural areas to report their errors, so that we can try to quantify the incidence and prevalence of these different error types. No previous work has been done in Primary care which has attempted to determine the rate of recognized errors that occur in the community. In addition, since the last major work on this topic was done between 1993 and 1998, there have been many changes to General Practice, especially in the area of computerisation, and the types of problems that GPs face now may have changed significantly. Anonymous reporting is very important in order to encourage health professionals to admit to their mistakes, and in the past, projects have used paper based reporting forms, making it difficult to offer anonymity and requiring protection for participants under a Commonwealth Act of Parliament. However the GPES project will be the first major study of General Practice errors that uses an on-line anonymous reporting form, and high level encryption, located on a secure web-site, to encourage honest reporting. The reporting form was trialled in the 2001 pilot study. By analysing the types of errors occurring, and their contributing factors, we can target at-risk population groups and develop strategies to improve patient care and prevent future harm.Read moreRead less
Systematic Practice-based Asthma Care In The Australian Setting
Funder
National Health and Medical Research Council
Funding Amount
$563,625.00
Summary
Asthma is an illness which increasingly is affecting the health and quality of life of millions of Australians. Much effort has been focused in recent years on ways of improving the management of those people who suffer from moderate and severe asthma. A recent government initiative has been to promote the use of the 3+ Visit Plan, which encourages a more proactive, systematic approach to assessing and treating asthma in general practice. There is currently no evidence about exactly how practice ....Asthma is an illness which increasingly is affecting the health and quality of life of millions of Australians. Much effort has been focused in recent years on ways of improving the management of those people who suffer from moderate and severe asthma. A recent government initiative has been to promote the use of the 3+ Visit Plan, which encourages a more proactive, systematic approach to assessing and treating asthma in general practice. There is currently no evidence about exactly how practices can best be organized to provide this systematic care, in a way which improves the process of care and the health outcomes for patients. This study aims to evaluate the effectiveness of changing aspects of practice organization and structure, such as setting up registers of asthma patients, providing recalls or reminders to patients to come in for regular review, having the GPs provide education and self-management skills to patients, focusing on the contributions which practice staff can make to the process, and initiating quality assurance measures such as audit and feedback to the GPs about their quality of care. We anticipate that these changes will provide positive benefits for the patients, but will also investigate what it costs the practices, patients and government to bring these changes about, within the perspective of efficiency and cost-effectiveness. The evidence generated by this study will provide an excellent base for providing advice to policy makers, as well as contributing to the development of best-practice models of care for asthma patients in general practice.Read moreRead less