Adverse drug events: counting is not enough, action is needed.
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Adverse Drug Reaction Reporting Systems↗
Biomedical subjects
Stephanie Knox
Publications and source records attributed to Stephanie Knox.
Skin excisions in Australian general practice.
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of encounters where a skin excision was recorded as a procedure. This provides a backdrop against which the articles in this issue of Australian Family Physician can be further considered.
Adolescent↗
Postnatal depression in Australian general practice.
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of encounters at which postnatal depression was managed. This provides a backdrop against which the articles in this issue of Australian Family Physician can be further considered.
Adolescent↗
Patient perception of their weight, attempts to lose weight and their diabetes status.
INTRODUCTION: Patients' self perception of weight status is a factor to be considered before an attempt is made by the clinician to initiate weight loss behaviour. METHOD: We compared the weight self assessment of 1973 general practice patients to their body mass index (BMI). Patients also ranked the success of any weight loss methods they had tried. General practitioners recorded the patients' type 2 diabetes status and this was analysed by BMI group. RESULTS: Overweight/obese patients accounted for 56.6% of the sample. Forty percent of overweight and 12.5% of obese patients did not see themselves as overweight. Close to 40% of patients had attempted to lose weight in the previous year. Diet/ exercise was the most common and successful weight loss method. There was a significantly higher prevalence of type 2 diabetes among obese patients. DISCUSSION: Despite some positive results on weight loss attempts, a considerable proportion of overweight and some obese patients do not perceive themselves as being overweight.
Adolescent↗
The management of alcohol, tobacco and illicit drug use problems by general practitioners in Australia.
The aim of this study was to document the frequency of the management of illicit drug, alcohol and tobacco problems in general practice in Australia. Data from the Bettering the Evaluation and Care of Health (BEACH) study of general practice, April 1998 to March 2003, were analysed. BEACH is an ongoing national study of general practice in Australia. Each year a random sample of approximately 1000 general practitioners (GPs) participate, each providing details of 100 patient encounters. Samples are drawn from the Medicare data held by the Health Insurance Commission. Patient demographic breakdowns, medication, other treatment, referrals and other medical procedures ordered were examined for all problems labelled by GPs as illicit, alcohol and tobacco problems. Annually in Australia, it was estimated that 615,000 GP encounters--or 0.6% of all encounters--involved the management of illicit drug use problems presumably most commonly for problematic heroin use. Despite a much higher population prevalence of use and use disorders, the management of alcohol or tobacco use problems was less common, with 0.4% and 0.3% of encounters, respectively, comprising treatment of these problems. Clear demographic differences existed across the groups. The management of problems also differed, with illicit drug use problems more likely to involve provision of medication, and alcohol and tobacco treatment more likely to involve counselling and/or health advice. Despite higher rates of alcohol and tobacco use problems among patients seeing GPs in Australia, the rate of treatment for such problems was relatively lower than it was for illicit drug use problems. More efforts need to be directed towards assisting GPs to identify and target problematic alcohol and tobacco use among their patients.
Adolescent↗
Encounters with indigenous patients in Australian general practice.
The BEACH program, a continuous national study of general practice activity in Australia, gives an overview of consultations with indigenous patients. Between 1998 and 2003, general practitioners recorded 5476 consultations with people who identified themselves as being of Aboriginal and/or Torres Strait Islander origin. These accounted for approximately 1% of total BEACH encounters for the 5 year period. In this article we compare 'indigenous encounters' with total BEACH encounters. This provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.
Australia↗
The Surgical Nosology In Primary-care Settings (SNIPS): a simple bridging classification for the interface between primary and specialist care.
BACKGROUND: The interface between primary care and specialist medical services is an important domain for health services research and policy. Of particular concern is optimising specialist services and the organisation of the specialist workforce to meet the needs and demands for specialist care, particularly those generated by referral from primary care. However, differences in the disease classification and reporting of the work of primary and specialist surgical sectors hamper such research. This paper describes the development of a bridging classification for use in the study of potential surgical problems in primary care settings, and for classifying referrals to surgical specialties. METHODS: A three stage process was undertaken, which involved: (1) defining the categories of surgical disorders from a specialist perspective that were relevant to the specialist-primary care interface; (2) classifying the 'terms' in the International Classification of Primary Care Version 2-Plus (ICPC-2 Plus) to the surgical categories; and (3) using referral data from 303,000 patient encounters in the BEACH study of general practice activity in Australia to define a core set of surgical conditions. Inclusion of terms was based on the probability of specialist referral of patients with such problems, and specialists' perception that they constitute part of normal surgical practice. RESULTS: A four-level hierarchy was developed, containing 8, 27 and 79 categories in the first, second and third levels, respectively. These categories classified 2050 ICPC-2 Plus terms that constituted the fourth level, and which covered the spectrum of problems that were managed in primary care and referred to surgical specialists. CONCLUSION: Our method of classifying terms from a primary care classification system to categories delineated by specialists should be applicable to research addressing the interface between primary and specialist care. By describing the process and putting the bridging classification system in the public domain, we invite comment and application in other settings where similar problems might be faced.
Australia↗
Relationship between general practitioner certification and characteristics of care.
BACKGROUND: The introduction of mandatory or quasimandatory certification processes for general/family doctors has become common in many countries, including Australia. Whether certification effects the care provided is rarely investigated. OBJECTIVES: The objective of this study was to determine whether certification of general/family physicians is associated with clinical performance. RESEARCH DESIGN: We conducted a secondary comparative analysis of data from an Australian national cross-sectional survey (April 2000-March 2002). SUBJECTS: Subjects consisted of a random sample of 1982 general practitioners (GPs) METHODS: Each participant provided demographic details and information about 100 consecutive patient encounters (total 197,500). We compared characteristics of certified and uncertified general practitioners (GPs), their patients, encounters, problems, management actions, and tested 34 performance indicators. We investigated whether differences identified in descriptive analyses were explained by other factors. RESULTS: Of 1975 GPs who indicated certification status, 659 (33.4%) were vocationally certified. Certificants were more likely to be female, younger, Australian graduates, working fewer sessions, in larger practices, in accredited practices, and using computers for clinical purposes. Their patients were younger, more often female, and less likely to hold a healthcare concession card. Their consultations were longer; they prescribed fewer medications and more clinical treatments and procedures, ordered more pathology tests, and referred more to other health professionals. After adjustment for GP/practice, patient and morbidity differences, certificants had longer consultations, did more therapeutic procedures, prescribed less overall, prescribed fewer nonsteroidal antiinflammatory drugs in the elderly, and fewer antibiotics for upper respiratory infections. CONCLUSION: Certification of general practitioners has a significant association with consultation behavior and patient management.
Adult↗
The demand for surgery: an analysis of referrals from Australian general practitioners.
BACKGROUND: Optimal planning for surgical training and the surgical workforce requires knowledge of the need and demand for surgical care in the community. This has previously relied on indirect indicators, such as hospital throughput. We aimed to describe referrals from general practitioners (GPs) to surgeons in Australia using a classification of surgical disorders developed especially for primary care settings. METHODS: Terms in the International Classification of Primary Care Version 2-Plus were reclassified into categories delineated by specialist surgeons, resulting in the Surgical Nosology In Primary-care Settings (SNIPS). Referrals to surgeons were analysed using data on 303,000 patient encounters by a random sample of 3030 GPs involved in the Bettering the Evaluation and Care of Health (BEACH) study. RESULTS: Thirty-two per cent (143,013) of all problems were classified as potential surgical problems, of which 9.5% (13,570) were referred to surgeons at an overall rate of 44.8 referrals per 1000 GP encounters. Patients with surgical problems were significantly older than the overall general practice patient population. Women and patients with health care cards were significantly less likely than men and patients without health care cards to be referred when a surgical problem was managed by the GP. Forty-two per cent of all surgical referrals were accounted for by the following categories: skin lesions, skin infection/injury, upper gastrointestinal, breast lumps/cancer, spine, knee arthritis/pain, knee injury/instability, infective and non-infective ear disorders. Many commonly referred problems are usually managed as outpatients. CONCLUSIONS: The data from this study may have application for surgical workforce planning and ensuring trainees receive adequate exposure to commonly referred conditions. The classification system (SNIPS) may be useful for future research concerning the interface between primary care and specialist surgical practice.
Adolescent↗
Presentations of 'itch' in Australian general practice.
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Adolescent↗
Current status of hormone therapy in general practice in Australia.
The BEACH program is a continuous national study of general practice activity in Australia. The subject of this analysis was all problems for which a hormone therapy years (HT) medication was prescribed or supplied at HT encounters with women aged 40 and over between March 2002 and April 2004. This provides a backdrop against which the theme articles in this issue of Australian Family Physician can be further considered.
Adult↗
Where there is no surgeon: the effect of specialist proximity on general practitioners' referral rates.
OBJECTIVE: To determine the effect of proximity of surgical specialists on general practitioners' (GPs') rates of referral of surgical problems to specialist care (ie, are surgical referral rates of GPs in rural or remote areas similar to those of GPs in urban centres?). DESIGN: A cross-sectional survey of GP-patient encounters. SETTING: The Bettering the Evaluation and Care of Health (BEACH) program, which involves all active registered GPs in Australia. PARTICIPANTS: A random sample of 3030 GPs, each providing details of 100 consecutive patient encounters. MAIN OUTCOME MEASURES: Proportion of surgical problems (including ophthalmological and obstetric and gynaecological) referred to surgical specialists (surgeons' rooms, hospital outpatient departments or hospital emergency departments). RESULTS: Absence of a local specialist did not significantly influence the proportion of surgical problems referred by GPs overall, but the proportion referred was significantly lower for obstetric (odds ratio [OR], 0.56; 95% CI, 0.44-0.70) and ophthalmological (OR, 0.60; 95% CI, 0.49-0.73) problems. Other factors independently associated with referral of a lower proportion of problems included male GPs, female and younger patients, holders of a Health Care Card, injury-related and non-cancer-related problems, follow-up presentations, and more than one problem managed at an encounter. CONCLUSIONS: Our findings confirm that rural and remote GPs undertake much of their patients' antenatal care, and are less likely to use specialists when managing ophthalmological problems. Absence of local specialists in other surgical specialties is not a barrier to referral of patients with surgical disorders.
Australia↗