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Background: Electronic health record datasets have been used to determine the prevalence of musculoskeletal complaints in general practice but not to examine the associated characteristics and healthcare utilisation at the primary care level., Aim: To describe the prevalence and characteristics of patients presenting to general practitioners with musculoskeletal complaints., Design and Setting: A five-year analysis within three Primary Health Networks (PHNs) in Victoria, Australia., Method: We included patients with at least one face-to-face consultation 2014 to 2018 inclusive and a low back (≥ 18 years), and/or neck, shoulder or knee (≥ 45 years) complaint determined by SNOMED codes derived from diagnostic text within the medical record. We determined prevalence, socio-demographic characteristics and diagnostic codes for patients with an eligible diagnosis; and number of consultations within one year of diagnosis., Results: 324,793/1,294,021 (25%) presented with at least one musculoskeletal diagnosis, of whom 41% (n = 133,279) fulfilled our inclusion criteria. There were slightly more females (n = 73,428, 55%), two-thirds (n = 88,043) were of working age (18-64 years) and 83,816 (63%) had at least one comorbidity. Over half had a low back diagnosis (n = 76,504, 57%) followed by knee (n = 33,438, 25%), shoulder (n = 26,335, 20%) and neck (n = 14,492, 11%). Most codes included 'pain' and/or 'ache' (low back: 58%, neck: 41%, shoulder: 32%, knee 26%). Median (IQR) all-cause consultations per patient within one year of diagnosis was 7 (4-12)., Conclusion: The burden of MSK complaints at the primary care level is high as evidenced by the prevalence of people with musculoskeletal complaints presenting to a general practitioner, the preponderance of comorbidities and the numerous consultations per year. Identification and evaluation of strategies to reduce this burden are needed., (© 2023. The Author(s).)

Introduction: General practice is integral to the Australian healthcare system. Outcome Health's POpulation Level Analysis and Reporting (POLAR) database uses de-identified electronic health records to analyse general practice data in Australia. Previous studies using routinely collected health data for research have not consistently reported the codes and algorithms used to describe the population, exposures, interventions and outcomes in sufficient detail to allow replication. This paper reports a study protocol investigating patterns of care for people presenting with musculoskeletal conditions to general practice in Victoria, Australia. Its focus is on the systematic approach used to classify and select eligible records from the POLAR database to facilitate replication. This will be useful for other researchers using routinely collected health data for research., Methods and Analysis: This is a retrospective cohort study. Patient-related data will be obtained through electronic health records from a subset of general practices across three primary health networks (PHN) in southeastern Victoria. Data for patients with a low back, neck, shoulder and/or knee condition and who received at least one general practitioner (GP) face-to-face consultation between 1 January 2014 and 31 December 2018 will be included. Data quality checks will be conducted to exclude patients with poor data recording and/or non-continuous follow-up. Relational data files with eligible and valid records will be merged to select the study cohort and the GP care received (consultations, imaging requests, prescriptions and referrals) between diagnosis and 31 December 2018. Number and characteristics of patients and GPs, and number, type and timing of imaging requests, prescriptions for pain relief and referrals to other health providers will be investigated., Ethics and Dissemination: Ethics approval was obtained from the Cabrini and Monash University Human Research Ethics Committees (Reference Numbers 02-21-01-19 and 16975, respectively). Study findings will be reported to Outcome Health, participating PHNs, disseminated in academic journals and presented in conferences., Competing Interests: Competing interests: RH, DAO’C, RB and DM report grants from Arthritis Australia (not-for-profit organisation), during the conduct of the study. CP is an employee of Outcome Health, the not-for-profit organisation that developed the POLAR database and chairs the Product improvement group of the Australian Digital Health Agency. It has no relationship with the research, but has provided grant funding to Outcome Health. LB reports consultancy fees paid to Monash University from Charite Medical University Berlin, Jesuit Social Services Victoria and Swinburne University of Technology, outside the submitted work., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To identify the views of GPs and general practice staff regarding barriers and enablers to implementation of obesity guideline recommendations in general practice., Methods: Twenty general practitioners (GPs) and 18 practice staff from inner-eastern Melbourne, Australia, participated in semi-structured telephone interviews. The interview schedule was informed by the Theoretical Domains Framework (TDF). Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis., Results: Participants lacked familiarity with and knowledge of the NHMRC obesity guidelines. Barriers and enablers were predominantly related to five theoretical domains: (1) environmental context and resources, (2) knowledge, (3) emotion, (4) beliefs about consequences, and (5) motivation and goals. Time pressures in consultations, costs for the patient, reluctance to add to patient burden particularly in those with comorbidities such as mental health issues, lack of awareness about services to refer patients to and GPs' fear of embarrassing patients and losing them were significant barriers. Enablers included having a strong doctor-patient relationship and a sense of responsibility to the patient to address weight., Conclusions: Obesity guidelines and policy makers need to better engage with issues of multimorbidity, socioeconomic disadvantage and workforce issues if recommendations are to be widely adopted in general practice. Tasksharing, teamwork and technology are potential solutions to some of the barriers. Patient perspectives and approaches to being able to overcome stigma and legitimise obesity management in primary care consultations could also assist., (Copyright © 2019 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Purpose To determine whether healthcare use and return-to-work (RTW) outcomes differ with GPs' injured-worker caseload. Methods Retrospective analyses of the Compensation Research Database, which captures approximately 85% of all injured worker claims in Victoria, Australia was conducted. Four injured-worker caseload groups were examined that represented the 25th, 50th, 75th, and 100th percentiles of claimants seen per GP over the 8-year study period (2003-2010): (i) 1-13 claimants; (ii) 14-26 claimants; (iii) 27-48 claimants; and (iv) 49+ claimants (total claims, n = 124,342; total GPs, n = 9748).The characteristics of claimants in each caseload group, as well as the influence of caseload on three outcomes relevant to RTW (weekly compensation paid, work incapacity days, medical-and-like costs), were examined. Results Distinct profiles for high versus low caseload groups emerged. High caseload GPs treated significantly more men in blue collar occupations and issued significantly more 'alternate duties' certificates. Conversely, low caseload GPs treated significantly more women in white collar occupations, predominantly for mental health injuries, and issued significantly more 'unfit-for-work' certificates. Few significant differences were found between the two intermediate GP caseload groups. High caseload was associated with significantly greater medical-and-like costs, however, no caseload group differences were detected for weekly compensation paid or duration of time-off-work. Conclusions Training GPs who have a low injured-worker caseload in workers' compensation processes, utilising high caseload GPs in initiatives involving peer-to-peer support, or system changes where employers are encouraged to provide preventive or rehabilitative support in the workplace may improve RTW outcomes for injured workers.

Aim: To describe the patterns of antimicrobial prescribing in general practice for children aged ≤18 years., Methods: This is a review of routinely collected patient data extracted from computerised medical records from 39 general practices in eastern metropolitan Melbourne over a 5-year period, 2010-2014., Main Outcome Measures: Proportion of paediatric consultations resulting in antibiotic prescription, type and frequency of antibiotics prescribed, antibiotic prescribing stratified by age, reason for indication and inter-practice variation., Results: There were 744 883 consultations for 89 983 individual paediatric patients and 85 913 prescriptions for antibiotics during the study period. Of these antibiotic prescriptions, 75 410 were associated with a consultation, and 10 503 (12.2% of all prescriptions) had no associated consultation in the data. On average, one in five individual children was prescribed an antibiotic each year. The most commonly prescribed antibiotics were cephalexin, amoxycillin/clavulanate, cefaclor, phenoxymethylpenicillin and roxithromycin. Less than 3% of all prescriptions were for amoxycillin. Prescribing of cefaclor and roxithromycin decreased, although cefaclor remained the third most common antibiotic choice for general practitioners. Peaks in prescribing were noted over winter months. Reason for prescription was not recorded for 82% of prescriptions. The frequency of antibiotic prescription per consultation varied substantially (2.1-19.7%) between general practitioner clinics. Overall, antibiotic prescribing decreased by 2.3% over the 5-year period., Conclusions: This study provides a focused examination of antibiotic prescribing practices for children in Australian general practice. More information is required to better understand specific prescribing practices in children, including the low frequency of amoxycillin prescription and ongoing prescription of cefaclor., (© 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background and Objectives: The computerised medical records of general practice patients can inform our understanding of antibiotic prescribing and assist in antimicrobial stewardship (AMS). The aim of this study was to describe Australian general practitioner (GP) antibiotic prescribing patterns using data extracted from electronic medical records (EMR)., Method: A descriptive analysis of patient records from 44 general practices, between 2010 and 2014, in the eastern region of metropolitan Melbourne was undertaken., Results: Of the 615,362 antibiotic prescriptions, cefalexin, amoxicillin–clavulanic acid, roxithromycin, doxycycline and clarithromycin were the most frequently prescribed antibiotics. Except for cefalexin, prescribing rates of the antibiotics increased in winter. Of 472,197 patients consulting a GP in one of these practices, 34.8% received an antibiotic at some point over the five years. There was a higher rate of prescribing per consultation in patients aged <20 years., Discussion: This study shows that it is possible to examine EMR for antibiotic prescriptions, and that a descriptive analysis can identify AMS targets.

Objective Older patients are over-represented in emergency departments (ED), with many presenting for conditions that could potentially be managed in general practice. The aims of the present study were to examine the characteristics of ED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations. Methods A retrospective analysis was performed of routinely collected data comprising ED presentations by patients aged ≥70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012. Presentations were classified according to the National Healthcare Agreement definition for PAGP-type presentations. Presentations were characterised according to patient demographic and clinical factors and were compared across PAGP-type and non-PAGP-type groups. Results There were 744519 presentations to the ED by older people, of which 103471 (13.9%) were classified as PAGP-type presentations. The volume of such presentations declined over the study period from 20893 (14.9%) in 2008 to 20346 (12.8%) in 2012. External injuries were the most common diagnoses (13761; 13.3%) associated with PAGP-type presentations. Sixty-one per cent of PAGP-type presentations did not involve either an investigation or a procedure. Patients were referred back to a medical officer (including a general practitioner (GP)) in 58.7% of cases. Conclusion Older people made a significant number of PAGP-type presentations to the ED during the period 2008-12. A low rate of referral back to the primary care setting implies a potential lost opportunity to redirect older patients from ED services back to their GPs for ongoing care. What is known about the topic? Older patients are increasingly attending EDs, with a proportion attending for problems that could potentially be managed in the general practice setting (termed PAGP-type presentations). What does this paper add? This study found that PAGP-type presentations, although declining, remain an important component of ED demand. Patients presented for a wide array of conditions and during periods that may indicate difficulty accessing a GP. What are the implications for practitioners? Strategies to redirect PAGP-type presentations to the GP setting are required at both the primary and acute care levels. These include increasing out-of-hours GP services, better triaging and appointment management in GP clinics and improved communication between ED clinicians and patients' GPs. Although some strategies have been implemented, further examination is required to assess their ongoing effectiveness.

Unlabelled: OBJECTIVE; The aim ofthis study was to present the views of four stakeholder groups, namely general practitioners (GP), employers (EMP), injured workers (IW) and compensation agents (CA), about the content and usability of the draft of the new Victorian sickness certificate., Methods: A cross-sectional mixed-methods qualitative study was conducted in GP clinics and community settings in Melbourne, Australia. Interviews were conducted with GPs, EMPs and IWs and one focus group discussion was completed with CAs (n = 29). Data were collected between October and December 2013. Thematic analysis was performed., Results: All stakeholders viewed the new draft certificate as an improvement on the old one. GPs saw the certificate as a form of communication, whereas EMPs and CAs saw it as a therapeutic device. GPs continued to certify based on incapacity and provided little information about what IWs could do on return to work. All groups said that assessments for mental health needed more clarity and specificity. GPs, EMPs and CAs also said that the new certificates must be electronically available and integrated into existing medical software to streamline uptake., Conclusions: To ensure appropriate use of the new certificate, stakeholders must share a common understanding about its purpose and the certificate must be incorporated into existing medical software. Content on mental health assessment, an area of continued difficulty, needs additional refinement. The new certificate replaced the old certificate in March 2015; after it has been established in clinical practice, an impact evaluation should be completed to determine whether GPs are certifying capacity and earlier return to work.

Background: People with a history of stroke or heart disease are at increased risk of future stroke; therefore, identification of risk factors by GPs is critical., Objectives: To compare the following among general practice patients with and without a history of stroke or heart disease: (i) self-reported prevalence rates of lifestyle risk factors; (ii) accuracy of GP detection of patient-reported risk factors and (iii) average proportion of patient-reported risk factors detected by GPs., Methods: Consecutive patients attending a participating general practice clinic were invited to participate in a cross-sectional touchscreen survey assessing lifestyle risk factors in 2010-11. The GP of each consenting patient completed a corresponding survey assessing the patient's risk factors. Demographic characteristics of patients and GPs were obtained., Results: Data from 51 GPs and 564 patients were analysed. Patients without a history of stroke or heart disease reported significantly higher rates of smoking (12%) and risky alcohol consumption (56%) than patients with a history of stroke or heart disease (6% and 36%, respectively). Low sensitivity of GP detection of risk factors was found for all risk factors for all patients. Patients with a history of stroke or heart disease have a significantly higher mean proportion of risk factors detected by their GP compared to patients without a history of stroke or heart disease (P = 0.00)., Conclusion: Given low sensitivity and specificity of GP detection of risk factors among patients, alternate methods of identification are needed. Research is required to determine strategies to facilitate secondary care of patients with a history of stroke or heart disease by GPs., (© The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: More than a fifth of Australian children arrive at school developmentally vulnerable. To counteract this, the Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. Delivery of services has, however, remained low. The Theoretical Domains Framework, which provides a method to understand behaviours theoretically, can be condensed into three core components: capability, opportunity and motivation, and the COM-B model. Utilising this system, this study aimed to determine the barriers and enablers to delivery of the HKC, to inform the design of an intervention to promote provision of HKC services in Australian general practice., Methods: Data from 6 focus group discussions with 40 practitioners from general practices in socio-culturally diverse areas of Melbourne, Victoria, were analysed using thematic analysis., Results: Many practitioners expressed uncertainty regarding their capabilities and the practicalities of delivering HKCs, but in some cases HKCs had acted as a catalyst for professional development. Key connections between immunisation services and delivery of HKCs prompted practices to have systems of recall and reminder in place. Standardisation of methods for developmental assessment and streamlined referral pathways affected practitioners' confidence and motivation to perform HKCs., Conclusion: Application of a systematic framework effectively demonstrated how a number of behaviours could be targeted to increase delivery of HKCs. Interventions need to target practice systems, the support of office staff and referral options, as well as practitioners' training. Many behavioural changes could be applied through a single intervention programme delivered by the primary healthcare organisations charged with local healthcare needs (Medicare Locals) providing vital links between general practice, community and the health of young children.

Objective: To examine patterns of the sickness certification of workers compensation claimants by general practitioners in Victoria, Australia, by nature of injury or illness., Design, Setting and Patients: Retrospective analysis of Victorian workers compensation data for all injured and ill workers with an accepted workers compensation claim between 2003 and 2010., Main Outcome Measures: Type (unfit for work, alternative duties, or fit for work) and duration of initial medical certificates relating to workers compensation claims that were issued by GPs, in six categories of injury and illness., Results: Of 124,424 initial medical certificates issued by GPs, 74.1% recommended that workers were unfit for work and 22.8% recommended alternative duties. Unfit-for-work certificates were issued to 94.1% of workers with mental health conditions, 81.3% of those with fractures, 79.1% of those with other traumatic injuries, 77.6% of those with back pain and strains, 68.0% of those with musculoskeletal conditions and 53.0% of those with other diseases. Alternative-duties certificates were significantly longer in duration than unfit-for-work certificates in all injury and illness categories (P < 0.001) but certificates for workers with musculoskeletal injuries and diseases, back pain and strains and other traumatic injuries were of lesser duration than those for workers with fractures, mental health conditions and other diseases., Conclusion: The high proportion of medical certificates recommending complete absence from work presents major challenges in terms of return to work, labour force productivity, the viability of the compensation system, and long-term social and economic development. There is substantial variation in the type and duration of medical certificates issued by GPs. People with mental health conditions are unlikely to receive a certificate recommending alternative duties. Further research is required to understand GP certification behaviour.

Objective: To identify barriers to, and enablers of, the uptake of preventive care in general practice from the perspective of community members, and to explore their sense of the effectiveness of that care., Design, Participants and Setting: Qualitative study involving 18 focus groups comprising 85 community members aged over 25 years, from two areas of metropolitan Melbourne that were identified as being of high and low socioeconomic status (SES). The study was performed between 25 May and 9 December 2010. Groups were stratified by age, sex and location (high or low SES)., Main Outcome Measures: Factors related to practitioners, patients and structure and organisation that may act as barriers to and/or enablers of preventive care in general practice., Results: Participants saw preventive care as legitimate in general practice when it was associated with concrete action or a test, but rated their general practitioners as poor at delivering prevention. Trust, rapport and continuity of care were viewed as enablers for participants to engage in prevention with their GP. Barriers to participants seeking preventive care through their GPs included lack of knowledge about what preventive care was relevant to them, consultations focused exclusively on acute-care concerns, time pressures and the cost of consultations., Conclusions: A disconnect exists between patient perceptions of prevention in general practice and government expectations of this sector at a time when general practice is being asked to increase its focus and effectiveness in this field.

Background: Despite strong evidence of the benefits of preconception interventions to improve pregnancy outcomes, the delivery and uptake of preconception care in general and periconceptional folate supplementation in particular remains low. The aim of this study was to determine women's views of the barriers and enablers to the uptake of preconception care and periconceptional folate supplementation., Methods: Focus groups were undertaken in 2007 with 17 women of reproductive age (18-45 years). To identify key issues and themes within the data, focus groups were analysed using an inductive process of thematic analysis., Results: Most women were unaware of the need to attend for preconception care and were surprised at the breadth of issues involved. Women also felt general practitioners (GPs) should be more proactive in promoting preconception care availability but acknowledged that they themselves had to be thinking about pregnancy or becoming pregnant to be receptive to it. Barriers to periconceptional folate supplementation included confusion about reasons for use, dose, duration, timing and efficacy of folate use. Enablers included the desire to do anything they could to ensure optimum pregnancy outcomes, and promotional material and letters of invitation from their GP to advise them of the availability and the need for preconception care., Conclusion: A number of important barriers and enablers exist for women regarding the delivery and uptake of preconception care and periconceptional folate supplementation. It is essential that these patient perspectives are addressed in both the implementation of evidence based clinical practice guidelines and in the systematic design of an intervention to improve preconception care delivery.

Health for Kids in the South East (HFK) was a project funded by the Victorian Government Department of Human Services, Hospital Admission Risk Program. The project aimed to improve health outcomes for children in southeast Melbourne (Victoria) by building partnerships between child health clinicians and implementing best practice.

Acute diarrhoea in children is a common presentation in both the general practice and hospital emergency department settings. Current practice focuses on the prevention and management of dehydration in young children. However, general practitioners may not be aware of recommendations against the use of routine investigation, antidiarrhoeals and antiemetics in children or recommendations regarding dietary advice.

Croup is a common presentation in both the general practice and hospital emergency department setting. The relatively recent introduction of steroid use in the management of croup has resulted in decreased hospital admissions and improved outcomes for children.

Objective: To determine the prevalence of domestic violence, childhood abuse and sexual assault experienced by women attending general practitioners., Design: A cross-sectional, questionnaire-based prevalence survey., Setting: 15 general practices in metropolitan Melbourne between November 1993 and February 1994., Subjects: 3026 women over the age of 18 attending for a consultation., Results: The response rate was 72%. Over a quarter of women in relationships had been victims of physical or emotional partner abuse in the previous year, one in 10 having experienced severe physical violence. Thirteen percent of women had experienced rape or attempted rape, 10% had been severely beaten during childhood and 28% had experienced childhood sexual abuse involving physical contact. The abuse had been disclosed to the woman's doctor by only 27% of those who had experienced partner or childhood physical abuse (mostly because the doctor had never asked) and 9% of those who had experienced sexual abuse (mostly because the woman did not see it as relevant to the consultation)., Conclusion: There is a high prevalence of physical, sexual and emotional violence against women as well as poor communication about this violence to their general practitioners., Recommendation: Medical practitioners should be more proactive in questioning women about violence.

Objective: To determine the current prevalence of psychotropic drug use by women and any association between use and demographic variables., Design: A cross-sectional, questionnaire-based survey., Setting: Metropolitan Melbourne between November 1993 and February 1994., Subjects: Consecutive women aged over 18, attending 15 randomly selected general practices for a consultation., Outcome Measures: Psychotropic drugs taken in the last year and duration of their use, reported by the doctor from the patients' clinical notes and patient interview. Patient demographic characteristics., Results: The questionnaire was returned complete for 2048/3026 women. Of these, 20.4% had taken at least one psychotropic drug for at least a month in the past year. Most of these women had taken the drug for longer than 12 months and a quarter had taken more than one psychotropic drug in the past year. Psychotropic drug use by women was significantly associated with increasing age, having been married, parity, lower educational attainment, manual occupation, unemployment and being supported by a government pension., Conclusions: Psychotropic drug use by women is common and mostly long term. Psychotropic drugs should be prescribed carefully and judiciously, with continual review of the indications for their use and with an awareness of the association with social situation.