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Biomedical subjects

J P Sturmberg

Publications and source records attributed to J P Sturmberg.

At least 19 recordsLinked to original sources
PubMed2005

Standards and performance--attainment and maintenance of professional capabilities.

The nature of The Royal Australian College of General Practitioners (RACGP) examination came under scrutiny in a recent debate among RACGP members, some of who suggested exploring an alternative pathway for assessment linked to continuing medical education. This article outlines key issues underpinning the examination that is part of the requirements for attaining Fellowship of the RACGP (FRACGP). It provides an overview of the theory and practice of assessment for general practice. The RACGP examination has an international reputation for quality, validity and reliability, a reason why the RACGP has been asked to assist many others in establishing and/or reviewing their own examination processes.

Australia↗
PubMed2003

A community based, patient-centred, longitudinal medical curriculum.

The School of Rural Health is an initiative of the Australian Commonwealth Government, the University of New South Wales, Australia, and the Greater Murray Area Health Service. The school was established in February 2000 to facilitate the recruitment of doctors to and their retention in rural areas. The school is responsible for providing an education program for half of the three-year clinical component of the six-year undergraduate course. This article outlines the educational philosophies and methodologies employed in the development of a community-based, patient-centred, longitudinal approach to medical education. Although developed for and delivered in a rural setting, the curriculum could easily be adapted for implementation in an urban setting. The article presents a synopsis of experiences during the initial implementation of the curriculum, and it provides recommendations for future developments.

Journal Article↗
PubMed2003

Computer-assisted instruction: guiding learning through a key features approach in a community-based medical course.

Computer assisted instruction (CAI) offers a valuable adjunct to the difficulties encountered in teaching medical students in a community-based course in rural Australia. The paper outlines the educational planning processes behind the project and provide an outline of the modular solution to the task. Preliminary results show that this approach is feasible and acceptable to guide students' learning.

Computer-Assisted Instruction↗
PubMed2002

A longitudinal, patient-centred, integrated curriculum: facilitating community-based education in a rural clinical school.

The Greater Murray Clinical School (GMCS) was founded with two main aims in mind one, to provide a community-based learning environment offering diversified clinical educational experiences, and two, by doing so, to help address the doctor shortage for Australians living in rural and remote areas. The GMCS is a community-orientated and community-based clinical school, which has replaced the typical discipline-based curriculum with a longitudinal, patient-centred one. Students are attached to patients--called "the longitudinal patient"--whom they follow through all stages of their care. They share with patients their experience of illness and disease, their varying care needs, and how these are addressed by different service providers. The philosophy of the course, its implementation and our initial experiences are described.

Journal Article↗
PubMed2002

General practice-specific care categories: a method to examine the impact of morbidity on general practice workload.

BACKGROUND: Governments are increasing pressure on GPs to provide better services to their patients without giving consideration or due recognition to the impact of those initiatives on their already heavy workload. OBJECTIVE: This pilot study aimed to measure accurately the impact of case mix on general practice workload. METHOD: The general practice-specific care category (GP-SCC) model was developed and applied to a random sample of patients who attended a four-doctor suburban practice four or more times between July 1995 and June 1997. RESULTS: The random sample comprised 245 patients (126 males, 119 females) out of a total practice population of approximately 4000. The mean patient age was 42.7 years (CI 39.6-45.8; range: 0-95). The mean patient consulted 10.70 times (CI 9.62-11.77) and discussed 13.19 health problems (CI 11.74-14.63), which equated to 1.20 problems per consultation (CI 1.17-1.23). The ambulatory case mix concept allowed the development of the GP-SCC model--defined as GP-SCC 1, acute/self-limiting problems and preventive care; GP-SCC 2, primarily chronic health problems; GP-SCC 3, psychological problems in conjunction with up to two other problem categories; and GP-SCC 4, a combination of four or more problem categories. GP-SCC 1 comprised 31.1% of patients (CI 29.1-35.1), accounting for 25.6% of visits (CI 24.0-27.3) and 21.9% of all problems encountered (CI 20.5-23.3); GP-SCC 2 comprised 16.7% of patients (CI 10.6-19.6), accounting for 10.6% of visits (CI 9.5-11.9) and 9.9% of all problems encountered (CI 8.9-11.0); GP-SCC 3 comprised 7.1% of patients (CI 4.4-11.2), accounting for 7.8% of visits (CI 6.8-8.9) and 7.7% of all problems encountered (CI 6.8-8.7); and GP-SCC 4 comprised 42.0% of all patients (CI 35.8-48.2), accounting for 56.0% of all visits (CI 54.2-57.8) and 60.5% of all problems encountered (CI 58.8-62.2). CONCLUSIONS: The GP-SCC model, built on the ambulatory case mix concept, is a useful tool to analyse the morbidity of practice populations, and has a good predictive value in terms of a practice' workload.

Adult↗
PubMed2002

Health assessments of an 'at risk' population in general practice. Resource implications of identifying unmet health care needs--a case study.

OBJECTIVE: To estimate the resource implications associated with health care assessments for patients with chronic disease and those aged 75-years and over. SETTING: A four doctor general practice on the NSW Central Coast. METHOD: Examination of eligible patients according to health assessment guidelines, and development of health care plans where appropriate. Economic modelling of time and monetary resource requirements for these activities and the follow up management of identified health care issues. RESULTS: Eighty-four patients (80.8%) had a total of 181 additional health care issues identified--73 were geriatric specific, 32 preventive, 63 general medical and 13 of a support services nature. The assessments required a total of 61.5 hours (mean: 36 mins)--GP: 42 hours (mean: 24 mins); nurse: 20 hours (mean: 11 mins)--at a total cost to Medicare of $15,075 (mean: $145). Modelling of the resource requirements estimate a time requirement of 117.5 hours for the GP (mean: 1.1 hours), 57 hours for specialists (mean: 33 mins) and 140 hours for allied health providers (mean: 1.3 hours). The costs to the community are $11,511 for the GP (mean: $111), $18,791 for specialists (mean: $181) and $6688 for allied health care professionals (mean: $64). CONCLUSION: Health assessments of an 'at risk' population in general practice may be worthwhile. However, the resource requirements of all members of the health care system may be so high as to make it unsustainable.

Age Factors↗
PubMed2001

Community based medical education in a rural area: a new direction in undergraduate training.

The Greater Murray Clinical School provides a community based medical education programme for the clinical years at the University of New South Wales. Being a new clinica school in rural Australia allowed the development of a patient-centred longitudinal curriculum. Students follow patients through the health care system, with each exposure stimulating the learning about different aspects of a patient problem. The paper outlines the conceptual approach towards the development and implementation of this novel approach to community based medical education.

Clinical Clerkship↗
PubMed2001

Personal doctoring. Its impact on continuity of care as measured by the comprehensiveness of care score.

OBJECTIVE: To determine the impact of personal provider continuity on continuity of care as measured by the comprehensiveness of care score. DESIGN: Retrospective cross sectional analysis of medical records. SETTING: The setting was a four doctor practice on the New South Wales Central Coast of Australia. METHOD: The subjects were 131 male and 123 female patients with a mean age of 42.7 years (SD 25.9) median age of 42 years and an age range of 1-95 years. The main outcome measures were a comprehensiveness score for each patient in the personal provider continuity and discontinuity of care group over a two year period. RESULTS: The overall comprehensiveness scores in the personal provider continuity group was 7.38 (95% CI: 7.04-7.71) compared to 6.03 (95% CI: 5.7-6.35) for those in the discontinuity group (p < 0.000). A linear regression model revealed that 15.8% of the total variance of the comprehensiveness score is explained by the two independent variables 'modified continuity index' (13.6%) and 'age' (2.2%). Nonrelated independent variables are gender, number of visits and number of years attending the practice. CONCLUSION: Personal doctoring significantly improves continuity of care as measured by the comprehensiveness of care score, and this observation is essentially age independent. These findings clearly suggest that patients should be encouraged to find and stay with one doctor, and that practices should develop systems to enable patients access to their usual provider. Both strategies, combined with the awareness of potential gaps in our service provision, will increase the likelihood of achieving increased continuity of care.

Adolescent↗
PubMed2000

Geriatric medicine in practice. An overview.

Older patients with chronic health problems are a common presentation in general practice. The Central Coast Division of General Practice identified 'care of the elderly' as one of the priorities for local membership. This is the first in a series of articles based on the 'Geriatric Attachment Programme', which was jointly developed between the Division of General Practice and the Department of Geriatric Medicine, Central Coast Health. The recent introduction of the Health Assessment and Health Care Plans for the elderly into the Medical Benefit Schedule encourages preventive and anticipatory care. Doing this successfully requires a structured approach. This series will offer a practical guidance approach to enable readers to achieve this goal. In this article we provide an overview of the issues important to the care of the elderly. Subsequent articles deal with specific issues in detail.

Aged↗
PubMed1999

Implementing best practice guidelines: the influence of personal characteristics.

Clinical practice guidelines (CPGs) have not been widely adopted by general practitioners despite their obvious benefits of improving health care. Personal characteristics have been identified as one factor influencing doctors' attitudes towards guidelines. This study examined the impact of personal characteristics of Australian general practitioners on their attitudes towards guidelines. Favouring a fee-for-service remuneration system is highly associated with a negative view towards guidelines. This finding needs to be taken into account when developing strategies for the implementation of guidelines in the Australian context.

Adult↗
PubMed1999

Could it be whooping cough?

BACKGROUND: Pertussis is an uncommon but serious illness, mainly affecting children under the age of 5 years. OBJECTIVE: Affected children usually contract the disease from older children or adults in whom the disease presents in an atypical way, their coughing being attributed to other aliments. This article discusses the epidemiology, clinical course and management of pertussis. Prophylaxis is also discussed. DISCUSSION: Pertussis presents as a hacking, mostly nocturnal cough, before becoming constant and occurring in paroxysms. Even though children appear sick, they classically are afebrile. Erythromycin is the treatment of choice for affected children and their immediate family. Achieving a 90% vaccination coverage would eradicate pertussis, but booster vaccinations later in life have been proposed since the protection of vaccination wanes rapidly over a period of 6-10 years.

Adult↗
PubMed1999

General practice based diabetes clinics. An integration model.

BACKGROUND: Diabetes is a common chronic health problem in general practice. The quality of care for patients with diabetes has been shown to depend on many factors involving the patient and the general practitioner (GP) as well as the care environment. OBJECTIVE: To measure the benefits of general practice based diabetes clinics that integrate all patient care needs in the one place at the one time. METHODS: General practice based diabetes clinics were conducted in the rooms of 23 practices involving 54 GPs. The clinic team consisted of a diabetes educator, a dietitian and the usual GP. The clinic was conducted in accordance with the NSW Clinical Management of Diabetes Guidelines. RESULTS: Follow up after 12 months showed a significant drop in the number of patients with very poorly controlled diabetes (HbA1c > 3% of normal range). Management of co-morbidities (hypertension, hyperlipidaemia, microalbuminuria) improved and complication screening for active/high risk feet and diabetic retinopathy were performed. CONCLUSIONS: This coordinated and integrated approach to the management of diabetes improved glycaemic control of the poorly controlled patient with diabetes and improved GPs' management of complication risk factors.

Adolescent↗