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Biomedical subjects

Michael R Kidd

Publications and source records attributed to Michael R Kidd.

10 recordsLinked to original sources
PubMed2006

Protocol for the Quick Clinical study: a randomised controlled trial to assess the impact of an online evidence retrieval system on decision-making in general practice.

BACKGROUND: Online information retrieval systems have the potential to improve patient care but there are few comparative studies of the impact of online evidence on clinicians' decision-making behaviour in routine clinical work. METHODS/DESIGN: A randomized controlled parallel design is employed to assess the effectiveness of an online evidence retrieval system, Quick Clinical (QC) in improving clinical decision-making processes in general practice. Eligible clinicians are randomised either to receive access or not to receive access to QC in their consulting rooms for 12 months. Participants complete pre- and post trial surveys.Two-hundred general practitioners are recruited. Participants must be registered to practice in Australia, have a computer with Internet access in their consulting room and use electronic prescribing. Clinicians planning to retire or move to another practice within 12 months or participating in any other clinical trial involving electronic extraction of prescriptions data are excluded from the study. The primary end-points for the study is clinician acceptance and use of QC and the resulting change in decision-making behaviour. The study will examine prescribing patterns related to frequently prescribed medications where there has been a recent significant shift in recommendations regarding their use based upon new evidence. Secondary outcome measures include self-reported changes in diagnosis, patient education, prescriptions written, investigations and referrals. DISCUSSION: A trial under experimental conditions is an effective way of examining the impact of using QC in routine general practice consultations.

Adult↗
PubMed2006

General practitioners' use of computers for prescribing and electronic health records: results from a national survey.

OBJECTIVE: To describe how general practitioners use computers for clinical purposes. DESIGN: Mail survey of a cross-sectional national stratified random sample of 3000 GPs in primary care settings between 10 October and 31 December 2005. MAIN OUTCOME MEASURES: Use of computers, and use of computerised clinical functions such as prescribing, medication checking, generating health summaries, running recall systems, and writing progress notes. RESULTS: Of 1186 GPs responding (39.5% response rate), 90% used a clinical software package. GPs used clinical packages for prescribing (98%), checking for drug-drug interactions (88%), recording a reason for prescribing (65%), to order laboratory tests (85%), run recall systems (78%), and record progress notes (64%). Less frequently used functions included generating lists of patients needing vaccines (43%) and taking the same medication (39%). Less than 20% of GPs who used a clinical package accessed computerised information during the consultation. CONCLUSIONS: Australian general practice has achieved near-universal clinical computerisation. Electronic prescribing alone has probably improved efficiency and quality of care, and reduced medication errors. Increasing the use of other functions, such as accessing online decision support and maintaining registries of patients, is likely to lead to further health gains, especially in managing chronic conditions.

Adult↗
PubMed2006

The Threats to Australian Patient Safety (TAPS) study: incidence of reported errors in general practice.

OBJECTIVE: To determine the incidence of errors anonymously reported by general practitioners in NSW. DESIGN: The Threats to Australian Patient Safety (TAPS) study used anonymous reporting of errors by GPs via a secure web-based questionnaire for 12 months from October 2003. SETTING: General practices in NSW from three groupings: major urban centres (RRMA 1), large regional areas (RRMA 2-3), and rural and remote areas (RRMA 4-7). PARTICIPANTS: 84 GPs from a stratified random sample of the population of 4666 NSW GPs - 41 (49%) from RRMA 1, 22 (26%) from RRMA 2-3, and 21 (25%) from RRMA 4-7. Participants were representative of the GP source population of 4666 doctors in NSW (Medicare items billed, participant age and sex). MAIN OUTCOME MEASURES: Total number of error reports and incidence of reported errors per Medicare patient encounter item and per patient seen per year. RESULTS: 84 GPs submitted 418 error reports, claimed 490 864 Medicare patient encounter items, and saw 166 569 individual patients over 12 months. The incidence of reported error per Medicare patient encounter item per year was 0.078% (95% CI, 0.076%-0.080%). The incidence of reported errors per patient seen per year was 0.240% (95% CI, 0.235%-0.245%). No significant difference was seen in error reporting frequency between RRMA groupings. CONCLUSIONS: This is the first study describing the incidence of GP-reported errors in a representative sample. When an anonymous reporting system is provided, about one error is reported for every 1000 Medicare items related to patient encounters billed, and about two errors are reported for every 1000 individual patients seen by a GP.

Family Practice↗
PubMed2006

Principles for supporting task substitution in Australian general practice.

The workforce crisis in Australian general practice provides an impetus to consider new roles for other health professionals. Any innovations need to be appraised in advance for their potential risks and benefits. We propose six principles for this appraisal. These are the need for the new roles to: support the relationship between patients and their general practitioners; be clearly defined, aligned with competency and with relevant professional registration; be supported by practice systems providing safeguards against medical error; be underpinned by a system ensuring informed patient consent to activities being undertaken by members of the general practice team; be supported by effective medical indemnity insurance and be supported with appropriate financing.

Attitude of Health Personnel↗
PubMed2006

Axes of differentiation in the bower-building cichlids of Lake Malawi.

The 500-1000 cichlid species endemic to Lake Malawi constitute one of the most rapid and extensive radiations of vertebrates known. There is a growing debate over the role natural and sexual selection have played in creating this remarkable assemblage of species. Phylogenetic analysis of the Lake Malawi species flock has been confounded by the lack of appropriate morphological characters and an exceptional rate of speciation, which has allowed ancestral molecular polymorphisms to persist within species. To overcome this problem we used amplified fragment length polymorphism (AFLP) to reconstruct the evolution of species within three genera of Lake Malawi sand-dwelling cichlids that construct elaborate male display platforms, or bowers. Sister taxa with distinct bower morphologies, and that exist in discrete leks separated by only 1-2 m of depth, are divergent in both sexually selected and ecological traits. Our phylogeny suggests that the forces of sexual and ecological selection are intertwined during the speciation of this group and that specific bower characteristics and trophic morphologies have evolved repeatedly. These results suggest that trophic morphology and bower form may be inappropriate characters for delineating taxonomic lineages. Specifically the morphological characters used to describe the genera Lethrinops and Tramitichromis do not define monophyletic clades. Using a combination of behavioural and genetic characters, we were able to identify several cryptic cichlid species on a single beach, which suggests that sand dweller species richness has been severely underestimated.

Animals↗
PubMed2002

An international taxonomy for errors in general practice: a pilot study.

OBJECTIVES: To develop an international taxonomy describing errors reported by general practitioners in Australia and five other countries. DESIGN AND SETTING: GPs in Australia, Canada, the Netherlands, New Zealand, the United Kingdom and the United States reported errors in an observational pilot study. Anonymous reports were electronically transferred to a central database. Data were analysed by Australian and international investigators. PARTICIPANTS: Non-randomly selected GPs: 23 in Australia, and between 8 and 20 in the other participating countries. MAIN OUTCOME MEASURES: Error categories, and consequences. RESULTS: In Australia, 17 doctors reported 134 errors, compared with 301 reports by 63 doctors in the other five countries. The final taxonomy was a five-level system encompassing 171 error types. The first-level classification was "process errors" and "knowledge and skills errors". The proportion of errors in each of these primary groups was similar in Australia (79% process; 21% knowledge and skills) and the other countries (80% process; 20% knowledge and skills). Patient harm was reported in 32% of reports from Australia and 30% from other countries. Participants considered the harm "very serious" in 9% of Australian reports and 3% of other countries' reports. CONCLUSIONS: This pilot study indicates that errors are likely to affect primary care patients in similar ways in countries with similar primary healthcare systems. Further comparative studies are required to improve our understanding of general practice error differences between Australia and other countries.

Australia↗
PubMed2002

Antiretroviral medications and HIV.

BACKGROUND: Since 1996 the use of combination antiretroviral treatment including protease inhibitors has dramatically improved the prognosis for many people with HIV. However, antiretroviral medications are associated with significant side effects. OBJECTIVE: To outline some of the important side effects of antiretroviral medications and strategies for managing complications. DISCUSSION: Awareness of potential problems, careful prescribing behaviour and close monitoring can reduce the impact of many side effects of antiretroviral medication. Identification and management of side effects may also assist in improving adherence to treatment.

Anti-HIV Agents↗
PubMed2002

The better medication management system. Implications for Australian general practice.

BACKGROUND: The Better Medication Management System (BMMS) is a national initiative to use information technology to bring together the fragmented medication record systems currently used in Australian health care. OBJECTIVE: This article provides a brief outline of the BMMS and some of its implications for Australia's general practitioners and their patients. DISCUSSION: The BMMS has the potential to assist in achieving significantly better health outcomes by providing current information to assist prescribing and dispensing decisions and by promoting more informed medication management partnerships between consumers and their doctors and pharmacists.

Australia↗