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Justin J Beilby

Publications and source records attributed to Justin J Beilby.

5 recordsLinked to original sources
PubMed2003

Factors associated with rural practice among Australian-trained general practitioners.

OBJECTIVE: To determine the factors associated with general practitioners' current practice location, with particular emphasis on rural location. DESIGN: Observational, retrospective, case-control study using a self-administered questionnaire. SETTING: Australian general practices in December 2000. PARTICIPANTS: 2414 Australian-trained rural and urban GPs. MAIN OUTCOME MEASURE: Current urban or rural practice location. RESULTS: For Australia as a whole, rural GPs were more likely to be male (odds ratio [OR], 1.42; 95% CI, 1.17-1.73), Australian-born (OR, 1.95; 95% CI, 1.55-2.45), and to report attending a rural primary school for "some" (OR, 2.21; 95% CI, 1.69-2.89) or "all" (OR, 2.79; 95% CI, 1.94-4.00) of their primary schooling. Rural GPs' partners or spouses were also more likely to report "some" (OR, 2.75; 95% CI, 2.07-3.66) or "all" (OR, 2.86; 95% CI, 2.02-4.05) rural primary schooling. A rural background in both GP and partner produced the highest likelihood of rural practice (OR, 6.28; 95% CI, 4.26-9.25). For individual jurisdictions, a trend towards more rural GPs being men was only significant in Tasmania. In all jurisdictions except Tasmania and the Northern Territory, rural GPs were more likely to be Australian-born. CONCLUSIONS: GPs' and their partners' rural background (residence and primary and secondary schooling) influences choice of practice location, with partners' background appearing to exert more influence.

Adult↗
PubMed2003

Providing healthcare for people with chronic illness: the views of Australian GPs.

OBJECTIVES: To explore general practitioners' views on chronic-disease care: the difficulties and rewards, the needs of patients, the impact of government incentive payments, and the changes needed to improve chronic-disease management. DESIGN: Qualitative study, involving semi-structured questions administered to 10 focus groups of GPs, conducted from April to October 2002. PARTICIPANTS AND SETTING: 54 GPs from both urban and rural practices in New South Wales and South Australia. RESULTS: Consistent themes emerged about the complex nature of chronic-disease management, the tension between patients' and GPs' goals for care, the time-consuming aspects of care (exacerbated by federal government requirements), and the conflicting pressures that prevent GPs engaging in structured multidisciplinary care (ie, team-based care involving systems for patient monitoring, recall, and care planning). CONCLUSIONS: Structured multidisciplinary care for people with chronic conditions can be difficult to provide. Barriers include the lack of fit between systems oriented towards acute care and the requirements of chronic-disease care, and between bureaucratic, inflexible structures and the complex, dynamic nature of GP-patient relationships. These problems are exacerbated by administrative pressures associated with federal government initiatives to improve chronic-illness management. Changes are needed in both policies and attitudes to enable GPs to move from episodic care to providing structured long-term care as part of a multidisciplinary team.

Acute Disease↗
PubMed2003

Investigating tiredness in Australian general practice. Do pathology tests help in diagnosis?

INTRODUCTION: Tiredness is a common presentation in general practice for which pathology tests are commonly ordered. Our aim was to study their utilisation for tiredness. METHODS: We examined an integrated database which contains the medical records for 58,139 patients and their 696,518 associated general practitioner encounters. Three hundred and forty-two patients and their 1652 associated encounters were randomly selected out of 12,291 patients and their 26,748 associated encounters that had mentioned tiredness (or a synonym). RESULTS: One hundred and eighty-one patients (53%) had at least one pathology test ordered at any time in their episode of care. Patients over 60 years of age, patients who consulted their GP more than once and patients without comorbidity were more likely to have a pathology test ordered. Only 12 patients (3%) had a significant clinical diagnosis based on an abnormal pathology test. CONCLUSION: Pathology testing for patients presenting with tiredness is high. Most tests do not yield a significant clinical diagnosis.

Adult↗
PubMed2002

Fundholding: learning from the past and looking to the future.

Australian trials of healthcare initiatives that included fundholding models have not produced convincing quantitative evidence of health gains, but there is qualitative evidence of improved patient well-being and significant changes in service mix, which may produce longer-term health gains. Fundholding is most likely to improve patient outcomes when implemented within a broader healthcare initiative that has the potential to be more effective if financed outside existing funding structures. The most appropriate fundholder organisation depends on the nature of the initiative and the type of stakeholder engagement required, but technical and organisational skills will always be needed for balancing financial viability and additional patient services. Stakeholders' willingness to engage in fundholding depends on the anticipated budget impact, how they will use the savings generated, and whether workforce needs will be fulfilled. Before including fundholding in healthcare initiatives, there must be realistic prospective analyses and community debate. Monitoring and evaluation frameworks must also be in place to provide ongoing evidence of quality of care, health and well-being outcomes and financial implications for fund contributors.

Australia↗