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Biomedical subjects

Mark F Harris

Publications and source records attributed to Mark F Harris.

17 recordsLinked to original sources
PubMed2006

Men's health: what's a GP to do?

Men are at highest risk of cardiovascular disease, chronic lung disease, some cancers, suicide and transport-related injury. An anticipatory approach to men's health in general practice should assess risk for these conditions and offer effective interventions, either to prevent them or manage them early. This requires attention to the barriers, not only to men accessing general practice, but also to appropriate assessment and management, especially among disadvantaged groups.

Accidents↗
PubMed2006

Facing the challenges: general practice in 2020.

A strong primary medical care system is essential to the equity, efficiency and effectiveness of the health system as a whole. General practice in Australia faces significant challenges to its capacity to fulfil its role and function: in its financing, recognition, capacity to provide comprehensive care, and integration with the rest of the health system. Addressing these challenges requires a better system of remuneration for quality in general practice care, strengthening of the role of the generalist within the health system, involvement of Divisions of General Practice in service development, and establishment of collaborative networks and integrated primary health care services.

Australia↗
PubMed2006

Using population health surveys to provide information on access to and use of quality primary health care.

OBJECTIVE: Currently, primary health care (PHC) is under-represented in health statistics due to the lack of a comprehensive PHC data collection. This research explores the utility of population health surveys to address questions relating to access to and use of PHC, using diabetes as an example. METHODS: Drawing on published material relating to diabetes management, we developed a conceptual framework of access to and use of quality PHC. Using this framework we examined three recent population-based health surveys - the 2001 National Health Survey, 2002-03 NSW Health Survey, and AusDiab - to identify relevant information collection. RESULTS: We identified seven domains comprising aspects of quality PHC for people with diabetes. For each domain we proposed associated indicators. In critiquing the three population health surveys in relation to these indicators, we identified strengths and weaknesses of the data collections. CONCLUSION: This approach could inform the development of questions and extension of population health surveys to provide a better understanding of access to and use of quality PHC in Australia. The additional information would complement other data collections with a community-based perspective and contribute to the development of PHC policy.

Health Services Accessibility↗
PubMed2006

The National Health Survey 2001: usefulness to inform a discussion on access to and use of quality primary health care using type 2 diabetes mellitus as an example.

INTRODUCTION: This paper explores the usefulness of the 2001 Australian Bureau of Statistics National Health Survey (2001 NHS) for examining access to and use of quality primary health care (PHC) in Australia, using diabetes as an example. METHODS: Potential indicators of access to and use of quality diabetes care were investigated (diagnosis, preventive pharmacotherapy, complication screening, multidisciplinary care and hospitalisation), and their association with various factors including socioeconomic and diabetes-related health status was assessed. RESULTS: Older Australian-born females were more likely to receive preventive pharmacotherapy, whereas complication screening was associated with duration of disease. Multidisciplinary care was associated with recent hospitalisation and not health need assessed by presence of comorbidity. CONCLUSIONS: This novel use of the 2001 NHS provided information on patterns of access to and use of diabetes-related PHC that were consistent with previous research. It suggests a new role for survey data in monitoring access to and use of PHC over time and complementing other population health data collections in this area.

Aged↗
PubMed2005

Implementation of a SNAP intervention in two divisions of general practice: a feasibility study.

"SNAP" is a model for the general practice management of four common behavioural risk factors: smoking, nutrition, alcohol and physical activity. The SNAP program was developed for the Australian Government in 2002. In 2003 and 2004, a feasibility study was conducted in one urban and one rural division of general practice (DGP) in NSW, in partnership with their local area health services. Information technology support and referral directories were developed, based on an initial needs assessment, SNAP guidelines, a clinical summary chart, patient education materials, and general practitioner and staff training. GPs reported that the SNAP approach fitted general practice consultations well. After its implementation, they were more confident in using motivational interviewing and SNAP interventions and referred more frequently. The impact and sustainability of the SNAP program were limited by a lack of effective practice teamwork, poor linkages with referral services, and the lack of a business model to support SNAP in the practices. DGPs could play an important role in providing practice visits and resources to improve communication, education and collaboration to support SNAP programs.

Alcoholism↗
PubMed2005

General practitioner views on barriers and facilitators to implementation of the Asthma 3+ Visit Plan.

AIM: The Asthma 3+ Visit Plan is an initiative to promote organised asthma care in general practice. This study aimed to identify factors associated with uptake of the plan by general practitioners, and their views on barriers and facilitators to implementation of the plan. DESIGN: Postal survey sent to a random sample of GPs. PARTICIPANTS AND SETTING: 315 GPs in five Divisions of General Practice in metropolitan Sydney, surveyed sequentially between 1 October 2002 and 31 May 2003. OUTCOME MEASURES: Awareness and use of the Asthma 3+ Visit Plan; GP and practice factors associated with use of the plan; and GP views on barriers and facilitators to implementing the plan. RESULTS: The response rate was 55.7%, and 72.1% of participants were male; participants' mean age was 50.5 years. Most GPs (91.2%) were aware of the plan and and 44.9% had used it. GP and practice factors associated with use of the plan were use of the six-step Australian Asthma Management Plan, confidence in aspects of asthma care, practice accreditation, sign-up for asthma incentives, and computerisation. Major barriers to implementing the plan were workload/paperwork and administrative complexities. Patient factors that influenced completion of the plan were their concept of the severity of their asthma, compliance with follow-up, and patient attitudes towards asthma care. CONCLUSION: The perceived workload and administrative complexity of the asthma incentives are barriers to uptake. Factors relating to the illness rather than social factors are seen as the most important influences on completion of the plan by patients.

Aged↗
PubMed2004

How people with chronic illnesses view their care in general practice: a qualitative study.

OBJECTIVES: To explore the perceptions of patients with chronic conditions about the nature and quality of their care in general practice. DESIGN: Qualitative study using focus group methods conducted 1 June to 30 November 2002. PARTICIPANTS AND SETTING: 76 consumers in 12 focus groups in New South Wales and South Australia. MAIN OUTCOME MEASURES: Recurring issues and themes on care received in general practice. RESULTS: Three groups of priorities emerged. One centred on the quality of doctors, including technical competence, interpersonal skills, time for the patient in the consultation and continuity of care. A second concerned the role of patients and consumer organisations, with patients wanting (i) recognition of their knowledge about their condition and self-management, and (ii) for GPs to develop closer links with consumer organisations and inform patients about them. The third focused on the practice team and the importance of practice nurses and receptionists. CONCLUSION: GPs should consider the amount of time they spend with chronically ill patients, and their interpersonal skills and understanding of patients' needs. They need to be better informed about the benefits of patient self-management and consumer organisations, and to incorporate them into their care. They also need to review how their practice nurses and receptionists can maximise the care of patients.

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

Relationship between mental health disorders and unemployment status in Australian adults.

OBJECTIVES: To compare the prevalence of anxiety and affective disorders among employed and unemployed patients and to compare the type of treatment received between the two groups for these disorders. METHOD: A secondary analysis of the 1997 National Survey of Mental Health and Wellbeing of Adults cross-sectional study was undertaken. RESULTS: Unemployed adults were more likely to have symptoms of anxiety (OR = 3.09, 95% CI = 2.80-3.41) or an affective disorder (OR = 2.11, 95% CI = 1.95-2.27) or anxiety and/or affective disorders (OR = 2.53, 95% CI = 2.37-2.69). Unemployed participants with symptoms were less likely to have seen a general practitioner for treatment but when they did they received similar care to employed participants. CONCLUSIONS: These results confirm studies reported elsewhere that the prevalence of symptoms of anxiety and/or affective disorders is higher for unemployed people. The data provide further evidence that people with an anxiety and/or affective disorder who are unemployed are not seeking medical treatment. However, unlike previous research undertaken by our group, these results indicate that symptomatic adults who seek help receive comparable treatment in general practice irrespective of their employment status.

Adult↗
PubMed2002

Quality of care provided by general practitioners using or not using Division-based diabetes registers.

OBJECTIVE: To compare the quality of care provided by general practitioners participating in diabetes shared-care registers with that provided by GPs not using registers. DESIGN: Cross-sectional comparison using Health Insurance Commission (HIC) data for patients attending the GPs. PARTICIPANTS AND SETTING: 155 GPs using diabetes registers, 459 GPs not using registers, and their patients with diabetes (as identified by HIC criteria). The study analysed data for the period January 1996 to December 1998 and was based on Divisions of General Practice within the South Western Sydney Area Health Service. MAIN OUTCOME MEASURES: Frequency of visits to GPs and tests ordered within each of six six-month periods. RESULTS: GPs using the registers had more patients with diabetes, and saw those patients more frequently, than GPs not using registers. "Register" GPs also ordered tests (for HbA(1c) and microalbuminuria) more frequently than "non-register" GPs. CONCLUSION: GPs who participated in diabetes registers were more likely to provide patient care that more closely adhered to evidence-based guidelines than those who did not. Further research is needed to determine whether this was the result of characteristics of the GPs themselves, or their practices, or a was a consequence of their participation.

Australia↗
PubMed2002

The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times.

OBJECTIVE: To compare the rate of provision of longer consultations per head of population across practice locations categorised by socioeconomic status. DESIGN: Retrospective analysis of Medicare data for all consultations for all general practitioners in Australia for the 1998-99 and 1999-2000 financial years, grouped by postcode of practice location. Postcodes were categorised by the Socio-Economic Indexes for Areas, Index of Relative Socio-Economic Disadvantage score. MAIN OUTCOME MEASURES: Number of consultations and number of brief, standard, long and prolonged consultations per capita in each postcode grouping. RESULTS: The absolute number of long plus prolonged consultations showed no trend across postcode groups, but the rate ratio per person was significantly higher in more advantaged postcode areas. This represents an example of care provision in inverse relationship to need. DISCUSSION: Despite higher rates of chronic disease and lower rates of preventive care uptake, patients in low socioeconomic status areas receive longer GP consultations at a lower rate than patients in more advantaged areas. Possible strategies to overcome this inverse care provision include increased numbers of GPs in disadvantaged communities, removal of financial disincentives to longer consultations, and strengthening health promotion and community health services in disadvantaged areas.

Family Practice↗
PubMed2002

Evaluating general practitioners' views on the enhanced primary care items for care planning and case conferencing. A one year follow up.

BACKGROUND: General practitioners have required support to enable adoption of Enhanced Primary Care Medicare items for care planning and case conferencing. METHODS: A qualitative study of previously interviewed GPs' responses to a semi-structured face-to-face interview conducted between September and November 2001 in their surgeries. RESULTS: Twenty-five GPs predominantly identified several practice and Divisional strategies to facilitate uptake of the items. Practice, Divisional and health service personnel should be involved in identifying suitable patients and initiating care planning and case conferencing. CONCLUSION: Support for care planning and case conferencing requires several organisational and service developments in general practices, Divisions and health services.

Attitude of Health Personnel↗