502 results on '"Spike Neil"'
Search Results
152. Family medicine trainees’ clinical experience of chronic disease during training: a cross-sectional analysis from the registrars’ clinical encounters in training study
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Magin, Parker, primary, Morgan, Simon, additional, Henderson, Kim, additional, Tapley, Amanda, additional, McElduff, Patrick, additional, Pearlman, James, additional, Goode, Susan, additional, Spike, Neil, additional, Laurence, Caroline, additional, Scott, John, additional, Thomson, Allison, additional, and van Driel, Mieke, additional
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- 2014
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153. Antibiotic prescribing for respiratory infections: a cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in primary care
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Dallas, Anthea, primary, Magin, Parker, additional, Morgan, Simon, additional, Tapley, Amanda, additional, Henderson, Kim, additional, Ball, Jean, additional, Scott, John, additional, Spike, Neil, additional, McArthur, Lawrie, additional, and van Driel, Mieke, additional
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- 2014
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154. How we use patient encounter data for reflective learning in family medicine training
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Morgan, Simon, primary, Henderson, Kim, additional, Tapley, Amanda, additional, Scott, John, additional, van Driel, Mieke, additional, Thomson, Allison, additional, Spike, Neil, additional, McArthur, Lawrie, additional, Presser, Jenny, additional, and Magin, Parker, additional
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- 2014
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155. Difficult-to-Treat-Depression—Perceptions of GPs and GP Trainees
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Jones, Kay M., primary, Piterman, Leon, additional, and Spike, Neil, additional
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- 2014
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156. Problems managed by Australian general practice trainees: results from the ReCEnT (RegistrarClinicalEncounters inTraining) study
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Morgan, Simon, primary, Henderson, Kim, additional, Tapley, Amanda, additional, Scott, John, additional, Thomson, Allison, additional, Spike, Neil, additional, McArthur, Lawrie, additional, van Driel, Mieke, additional, and Magin, Parker, additional
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- 2014
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157. Evaluation of a Theory-Informed Implementation Intervention for the Management of Acute Low Back Pain in General Medical Practice: The IMPLEMENT Cluster Randomised Trial
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French, Simon D., primary, McKenzie, Joanne E., additional, O'Connor, Denise A., additional, Grimshaw, Jeremy M., additional, Mortimer, Duncan, additional, Francis, Jill J., additional, Michie, Susan, additional, Spike, Neil, additional, Schattner, Peter, additional, Kent, Peter, additional, Buchbinder, Rachelle, additional, Page, Matthew J., additional, and Green, Sally E., additional
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- 2013
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158. Challenges to children's health care in an ageing Australia
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Freed, Gary L, primary, Sewell, Jillian R, additional, and Spike, Neil A, additional
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- 2011
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159. IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): Cluster randomised controlled trial study protocol
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McKenzie, Joanne E, primary, French, Simon D, additional, O'Connor, Denise A, additional, Grimshaw, Jeremy M, additional, Mortimer, Duncan, additional, Michie, Susan, additional, Francis, Jill, additional, Spike, Neil, additional, Schattner, Peter, additional, Kent, Peter M, additional, Buchbinder, Rachelle, additional, and Green, Sally E, additional
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- 2008
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160. Continuity of care in general practice vocational training: prevalence, associations and implications for training.
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Pearlman, James, Morgan, Simon, van Driel, Mieke, Henderson, Kim, Tapley, Amanda, McElduff, Patrick, Scott, John, Spike, Neil, Thomson, Allison, and Magin, Parker
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Continuity of care is a defining characteristic of general practice. Practice structures may limit continuity of care experience for general practice registrars (trainees). This study sought to establish prevalence and associations of registrars' continuity of care. We performed an analysis of an ongoing cohort study of Australian registrars' clinical consultations. Primary outcome factors were 'Upstream' continuity (having seen the patient prior to the index consultation) and 'Downstream' continuity (follow-up organised post-index consultation). Independent variables were registrar, practice, patient, consultation and educational factors. 400 registrars recorded 48,114 consultations. 43% of patients had seen the registrar pre-index consultation, and 49% had follow-up organised. 'Upstream' continuity associations included registrar seniority, Australian medical qualification, practice billing policy, smaller practice size, registrar's previous training in the practice, chronic disease and older, female patients (but not registrar full-time/part-time status). Associations of 'Downstream' continuity included non-Australian qualification, billing, chronic disease and the patient having seen the registrar previously. Consultations prompting follow-up were more complex: longer duration, involving more problems and generating more learning goals. There was, however, evidence for limited educational utility of this 'continuity'. In our study, continuity of care in Australian registrars' training experience is modest. Associations are complex, but may inform initiatives to increase in-training continuity. [ABSTRACT FROM AUTHOR]
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- 2016
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161. How we use patient encounter data for reflective learning in family medicine training.
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Morgan, Simon, Henderson, Kim, Tapley, Amanda, Scott, John, van Driel, Mieke, Thomson, Allison, Spike, Neil, McArthur, Lawrie, Presser, Jenny, and Magin, Parker
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REFLECTIVE learning ,PROFESSIONAL education ,ADULTS ,PHYSICIAN-patient relations ,FAMILY medicine ,LEARNING strategies ,MEDICAL referrals ,STUDY & teaching of medicine ,REFLECTION (Philosophy) ,HUMAN services programs - Abstract
Introduction: Consulting with patients is the core learning activity of Australian family medicine (general practice/GP) training, providing a rich source of reflective learning for trainees. We have developed a reflective learning program for postgraduate vocational trainees based on clinical encounters. Methods: The Registrar Clinical Encounters in Training (ReCEnT) program is an educational program documenting GP trainees’ consultations in five Australian GP training providers. Trainees record patient demographics, consultation details, problems managed, management practices and educational factors from sixty consecutive consultations per six-month training term. Trainees receive a detailed feedback report comparing individual data to aggregated trainee data and national GP data. Results: The patient encounter system provides multiple opportunities for reflective learning across a number of domains of exposure and practice. Reflection can occur during completion of the encounter form; as self-reflection on the feedback report; as facilitated reflection with the GP trainer and medical educator; and as part of integration of data into teaching. We have identified areas for further development, including enhancing the reflective skills of trainees and trainers. Conclusion: The ReCEnT patient encounter program provides a rich platform for reflective learning for vocational trainees and supports development of skills in lifelong learning. [ABSTRACT FROM PUBLISHER]
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- 2015
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162. The Registrars' Clinical Encounters in Training (ReCEnT) project: educational and research aspects of documenting general practice trainees' clinical experience.
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Magin, Parker, Morgan, Simon, Henderson, Kim, Tapley, Amanda, Scott, John, Spike, Neil, McArthur, Lawrie, Presser, Jenny, Lockwood, Natalie, van Driel, Mieke, and van Driel, Mieke L
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- 2015
163. International Medical Graduates: The Australian Perspective
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Spike, Neil A., primary
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- 2006
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164. Clinical encounters of Australian general practice registrars with Aboriginal and Torres Strait Islander patients
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Thomson, Allison, Morgan, Simon, O'Mara, Peter, Tapley, Amanda, Henderson, Kim, van Driel, Mieke, Oldmeadow, Christopher, Ball, Jean, Scott, John, Spike, Neil, McArthur, Lawrie, and Magin, Parker
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Objective:General practice is central to Aboriginal and Torres Strait Islander health care, and this area is a core element of Australian general practice (GP) training. We aimed to describe the prevalence, nature and associations of GP registrar encounters with Aboriginal and Torres Strait Islander patients. Methods:A cross‐sectional analysis from a cohort study of GP registrars’ clinical consultations 2010–2013. Registrars record demographic, clinical and educational details of consecutive patient encounters. Multivariable associations were tested with logistic regression. Results:A total of 592 registrars contributed data from 69,188 consultations. Encounters with Aboriginal and Torres Strait Islander patients comprised 1.0% of consultations. Significant positive associations included younger patient age; new patient to the registrar; lower socioeconomic status of practice location; non‐urban practice setting; more problems managed; and follow‐up arranged. A greater proportion of Aboriginal and Torres Strait Islander patients’ problems were psychological/social and a lesser proportion were cardiovascular. Consultation duration did not differ between the two groups Conclusions:GP registrars encounter Aboriginal and Torres Strait Islander patients less than do established GPs. Our results suggest possible variability in registrar experience of Aboriginal and Torres Strait Islander health. Implications:Our findings will inform training of a culturally and clinically competent workforce in this area.
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- 2016
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165. The recording of Aboriginal and Torres Strait Islander status in general practice clinical records: a cross‐sectional study
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Thomson, Allison, Morgan, Simon, O'Mara, Peter, Tapley, Amanda, Henderson, Kim, van Driel, Mieke, Oldmeadow, Christopher, Ball, Jean, Scott, John, Spike, Neil, McArthur, Lawrie, and Magin, Parker
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Objectives:To document the frequency of recording of Aboriginal and Torres Strait Islander status in general practice (GP) clinical records and to establish associations of this recording. Methods:Cross‐sectional analysis of recording of patients’ Aboriginal and Torres Strait Islander status in GP clinical records from GP training practices in four Australian states. Results:Of the 9,704 clinical records examined, the patients’ Aboriginal and Torres Strait Islander status had been documented in 5,165 (53.2%). Higher rates of recording were associated with older patient age, practices outside a major city, patients who were not new to the practice and the patient being Aboriginal and Torres Strait Islander. In encounters with Aboriginal and Torres Strait Islander patients, the patient's status had been documented in 82% of records. Those attending larger practices were less likely to have had their status recorded. Conclusions:This is the first report of Aboriginal and Torres Strait Islander status recording in GP clinical records. Almost 20% of Aboriginal and Torres Strait Islander patients did not have their status recorded in the clinical record, with indications that recording may be unsystematic. Implications:Our findings reinforce the need for a systematic approach to identification of Aboriginal and Torres Strait Islander status in general practice and will inform policy and practice in this important area.
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- 2016
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166. Saunders review of family practice. 2nd ed.
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Spike, Neil, primary
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- 1998
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167. Changes in the demography of Australia and therefore general practice patient populations.
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Freed, Gary L., Sewell, Jill, Spike, Neil, Moran, Lauren, and Brooks, Peter
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- 2012
168. The paediatric clinical experiences of general practice registrars.
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Freed, Gary L., Spike, Neil, Magin, Parker, Morgan, Simon, Fitzgerald, Michael, and Brooks, Peter
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- 2012
169. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework.
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French, Simon D., Green, Sally E., O'Connor, Denise A., McKenzie, Joanne E., Francis, Jill J., Michie, Susan, Buchbinder, Rachelle, Schattner, Peter, Spike, Neil, and Grimshaw, Jeremy M.
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MEDICAL practice ,EVIDENCE-based medicine ,PRIMARY care ,INTERVENTION (Social services) ,PAIN management - Abstract
Background: There is little systematic operational guidance about how best to develop complex interventions to reduce the gap between practice and evidence. This article is one in a Series of articles documenting the development and use of the Theoretical Domains Framework (TDF) to advance the science of implementation research. Methods: The intervention was developed considering three main components: theory, evidence, and practical issues. We used a four-step approach, consisting of guiding questions, to direct the choice of the most appropriate components of an implementation intervention: Who needs to do what, differently? Using a theoretical framework, which barriers and enablers need to be addressed? Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? And how can behaviour change be measured and understood? Results: A complex implementation intervention was designed that aimed to improve acute low back pain management in primary care. We used the TDF to identify the barriers and enablers to the uptake of evidence into practice and to guide the choice of intervention components. These components were then combined into a cohesive intervention. The intervention was delivered via two facilitated interactive small group workshops. We also produced a DVD to distribute to all participants in the intervention group. We chose outcome measures in order to assess the mediating mechanisms of behaviour change. Conclusions: We have illustrated a four-step systematic method for developing an intervention designed to change clinical practice based on a theoretical framework. The method of development provides a systematic framework that could be used by others developing complex implementation interventions. While this framework should be iteratively adjusted and refined to suit other contexts and settings, we believe that the four-step process should be maintained as the primary framework to guide researchers through a comprehensive intervention development process. [ABSTRACT FROM AUTHOR]
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- 2012
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170. Testing and screening for chlamydia in general practice: a cross‐sectional analysis
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Thomson, Allison, Morgan, Simon, Henderson, Kim, Tapley, Amanda, Spike, Neil, Scott, John, van Driel, Mieke, and Magin, Parker
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Objectives:Chlamydia screening is widely advocated. General practice registrars are an important stage of clinical behaviour development. This study aimed to determine rates of, and factors associated with, registrars' chlamydia testing including asymptomatic screening.
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- 2014
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171. Australian general practice registrars’ billing patterns: a cross-sectional analysis from the Registrars Clinical Encounters in Training (ReCEnT) study.
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Fisher, Katie, Tapley, Amanda, Ralston, Anna, Davey, Andrew, Holliday, Elizabeth, Dizon, Jason, Wearne, Susan, Fielding, Alison, van Driel, Mieke, Spike, Neil, Clarke, Lisa, and Magin, Parker
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Background: In Australia, a government insurance scheme (Medicare) pays set rebates for a range of distinct general practitioner (GP) services. GPs may ‘bulk-bill’ and accept the Medicare rebate fee directly, or ‘privately-bill’ by charging the patient a higher fee that is partially reimbursed by Medicare. The billing behaviour of Australian GP registrars (trainees) and their decision to bulk- or privately-bill patients is an evidence gap. This study aimed to establish the prevalence and associations of registrars’ bulk-billing versus private-billing. Methods: A cross-sectional analysis of data from the ReCEnT study, 2010–2021. The primary analysis used univariable and multivariable logistic regression, with the outcome factor being whether a consultation was bulk-billed versus privately-billed. The primary analysis excluded practices that universally bulk-bill or universally privately-bill all patients. A secondary analysis included all practices regardless of billing policy to provide an overall perspective of billing across the breadth of GP vocational training. Results: For the primary analysis, 3,086 GP registrars recorded details of 316,141 consultations. Bulk-billing accounted for 61.8%, [95% CI:61.6%, 62.0%] of consultations. Significant positive associations of bulk-billing included: younger and older patient age (compared to patients aged 15–34 years, aOR 5.45; CI: [5.06, 5.87] for patients aged 0–14 years, aOR 2.36; 95% CI: [2.24, 2.49] for patients aged 65–74 years, and aOR 4.48; CI: [4.13, 4.85] for 75 years-and-older). Significant negative associations of bulk-billing included patients new to the practice (aOR 0.39; CI: [0.37, 0.41]) and patients new to the registrar (aOR 0.56; CI: [0.55, 0.58]), compared to existing patients of the registrar and practice; and practices with lesser socio-economic disadvantage (aOR 0.91; CI: [0.89, 0.93] per decile decrease in socioeconomic disadvantage). Bulk-billed consultations were positively associated with arranging patient follow-up (with the registrar aOR 1.06; CI: [1.03, 1.09]; or with another GP in the practice aOR 1.40; CI: [1.33, 1.46]). Conclusions: Registrar billing decisions may, in part, reflect government bulk-billing incentives but our findings suggest other factors may contribute, including the provision of affordable care recognising patient need (children and elderly, and those living in areas of greater socioeconomic disadvantage) and continuity of care. Further research is needed to better understand how, and why, registrars make billing decisions. [ABSTRACT FROM AUTHOR]
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- 2024
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172. Prevalence and associations of provision of nursing home visits and home visits by early‐career specialist general practitioners.
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Turnock, Allison, Fielding, Alison, Moad, Dominica, Blowes, Ashley, Tapley, Amanda, Davey, Andrew, Holliday, Elizabeth, Ball, Jean, Bentley, Michael, FitzGerald, Kristen, Kirby, Catherine, Spike, Neil, van Driel, Mieke L., and Magin, Parker
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HEALTH services accessibility , *HOME care services , *COMMUNITY health services , *CROSS-sectional method , *RESEARCH funding , *FAMILY medicine , *MEDICAL care , *QUESTIONNAIRES , *DESCRIPTIVE statistics , *MULTIVARIATE analysis , *HOSPITAL medical staff , *NURSING care facilities , *RURAL health services , *ODDS ratio , *CONFIDENCE intervals , *DATA analysis software , *URBAN health - Abstract
Objective: To establish prevalence and associations of provision of nursing home visits (NHV) and home visits (HV) by early‐career specialist GPs. Of particular interest were associations of rurality with performing NHVs and HVs. Methods: A cross‐sectional study. Design: A questionnaire‐based study. Setting: Australian general practice. Participants: Early‐career specialist GPs, practising in Australia, who attained Fellowship between January 2016 and July 2018, inclusive, having completed GP training in NSW, the ACT, Eastern Victoria or Tasmania. Main Outcome Measures: Current provision of NHV and HV. Results: NHV were provided by 34% of participants (59% in rural areas) and HV by 41% of participants (60% in rural areas). Remote, rural or regional practice location, as compared to major‐city practice, was strongly associated with performing NHV as an early‐career specialist GP; multivariable OR 5.87 (95% CI: 2.73, 12.6), p < 0.001, and with the provision of HV; multivariable OR 3.64 (95% CI: 1.63, 8.11), p = 0.002. Rurality of GP training (prior to attaining Fellowship) was significantly univariably associated with providing NHV and with providing HV as an early‐career specialist GP. On multivariable analyses, these were no longer statistically significant. Conclusion: Early‐career specialist GPs located in regional/remote areas are more likely than their urban colleagues to provide NHV and HV. [ABSTRACT FROM AUTHOR]
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- 2024
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173. Temporal patterns of antibiotic prescribing for sore throat, otitis media, and sinusitis: a longitudinal study of general practitioner registrars.
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Turner, Alexandria, Driel, Mieke L van, Mitchell, Benjamin L, Davis, Joshua S, Fielding, Alison, Davey, Andrew, Holliday, Elizabeth, Ball, Jean, Ralston, Anna, Tapley, Amanda, Mulquiney, Katie, Baillie, Emma J, Spike, Neil, Clarke, Lisa, and Magin, Parker
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OTITIS media , *GENERAL practitioners , *DRUG prescribing , *ACUTE otitis media , *SINUSITIS - Abstract
Background Antibiotics provide minimal benefit for sore throat, otitis media, and sinusitis. Antibiotic stewardship, with reduced prescribing, is required to address antibiotic resistance. As most antibiotic prescribing occurs in general practice and prescribing habits develop early, general practitioner (GP) trainees (registrars) are important for effective antibiotic stewardship. Objectives To establish temporal trends in Australian registrars' antibiotic prescribing for acute sore throat, acute otitis media, and acute sinusitis. Design A longitudinal analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study from 2010 to 2019. Participants ReCEnT is an ongoing cohort study of registrars' in-consultation experiences and clinical behaviours. Pre-2016, 5 of 17 Australian training regions participated. From 2016, 3 of 9 regions (42% of Australian registrars) participate. Main measures The outcome was prescription of an antibiotic for a new acute problem/diagnosis of sore throat, otitis media, or sinusitis. The study factor was year (2010–2019). Key results Antibiotics were prescribed in 66% of sore throat diagnoses, 81% of otitis media, and in 72% of sinusitis. Prescribing frequencies decreased between 2010 and 2019 by 16% for sore throat (from 76% to 60%) by 11% for otitis media (from 88% to 77%) and by 18% for sinusitis (from 84% to 66%). In multivariable analyses, "Year" was associated with reduced prescribing for sore throat (OR 0.89; 95%CI 0.86–0.92; p < 0.001), otitis media (OR 0.90; 95%CI 0.86–0.94; p < 0.001), and sinusitis (OR 0.90; 95%CI 0.86, 0.94; p < 0.001). Conclusions Registrars' prescribing rates for sore throat, otitis media, and sinusitis significantly decreased during the period 2010–2019. However, educational (and other) interventions to further reduce prescribing are warranted. [ABSTRACT FROM AUTHOR]
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- 2024
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174. Video versus telephone for telehealth delivery: a cross-sectional study of Australian general practice trainees.
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Fisher, Katie, Tapley, Amanda, Ralston, Anna, Davey, Andrew, Fielding, Alison, Driel, Mieke van, Holliday, Elizabeth, Ball, Jean, Dizon, Jason, Spike, Neil, Clarke, Lisa, and Magin, Parker
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SOCIOECONOMIC disparities in health , *TELEPHONES , *GENERALIZED estimating equations , *COVID-19 pandemic , *TELEMEDICINE - Abstract
Background Remunerated telehealth consultations were introduced in Australia in 2020 in response to the COVID-19 pandemic. Videoconferencing has advantages over telephone-consulting, including improved diagnostic and decision-making accuracy. However, videoconferencing uptake in Australia has been low. This study aimed to establish prevalence and associations of video versus telephone consultations in Australian general practice (GP) registrars' practice. Methods A cross-sectional analysis of data from 2020 to 2021 (three 6-monthly data-collection rounds) from the Registrars Clinical Encounters in Training (ReCEnT) study. GP registrars record details of 60 consecutive consultations every 6-month term, for a total of 3 terms. Univariable and multivariable logistic regression were performed within the Generalized Estimating Equations framework with the outcome video versus telephone. Results 102,286 consultations were recorded by 1,168 registrars, with 21.4% of consultations performed via telehealth. Of these, telephone accounted for 96.6% (95% CI: 96.3–96.8%) and videoconferencing for 3.4% (95% CI: 3.2–3.7%). Statistically significant associations of using videoconferencing, compared to telephone, included longer consultation duration (OR 1.02, 95% CI: 1.01–1.03 per minute; and mean 14.9 versus 12.8 min), patients aged 0–14 years old (OR 1.29, 95% CI: 1.03–1.62, compared to age 15–34), patients new to the registrar (OR 1.19, 95% CI: 1.04–1.35), part-time registrars (OR 1.84, 95% CI: 1.08–3.15), and areas of less socioeconomic disadvantage (OR 1.27, 95% CI: 1.00–1.62 per decile). Conclusions Registrars' telehealth consultations were mostly performed via telephone. Telephone use being associated with socioeconomic disadvantage has health equity implications. Future research should explore barriers to videoconferencing use and strategies to increase its uptake. [ABSTRACT FROM AUTHOR]
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- 2024
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175. The prevalence and associations of Australian early‐career general practitioners' provision of after‐hours care.
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Turnock, Allison, Fielding, Alison, Moad, Dominica, Tapley, Amanda, Davey, Andrew, Holliday, Elizabeth, Ball, Jean, Bentley, Michael, FitzGerald, Kristen, Kirby, Catherine, Spike, Neil, van Driel, Mieke L., and Magin, Parker
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LABOR mobility , *ACCESS to primary care , *STATISTICS , *CONFIDENCE intervals , *CROSS-sectional method , *VOCATIONAL education , *MULTIVARIATE analysis , *RURAL conditions , *SCHOLARSHIPS , *COMPARATIVE studies , *CRITICAL care medicine , *DISEASE prevalence , *QUESTIONNAIRES , *DESCRIPTIVE statistics , *RESEARCH funding , *RURAL health , *LOGISTIC regression analysis , *METROPOLITAN areas , *ODDS ratio , *MEDICAL practice - Abstract
Introduction: Access to after‐hours care (AHC) is an important aspect of general practice service provision. Objective: To establish the prevalence and associations of early‐career GPs' provision of AHC. Design: An analysis of data from the New alumni Experiences of Training and independent Unsupervised Practice (NEXT‐UP) cross‐sectional questionnaire‐based study. Participants were early‐career GPs (6‐month to 2‐year post‐Fellowship) following the completion of GP vocational training in NSW, the ACT, Victoria or Tasmania. The outcome factor was 'current provision of after‐hours care'. Associations of the outcome were established using multivariable logistic regression. Findings: Three hundred and fifty‐four early‐career GPs participated (response rate 28%). Of these, 322 had responses available for analysis of currently performing AHC. Of these observations, 128 (40%) reported current provision of AHC (55% of rural participants and 32% of urban participants). On multivariable analysis, participants who provided any AHC during training were more likely to be providing AHC (odds ratio (OR) 5.51, [95% confidence interval (CI) 2.80–10.80], p < 0.001). Current rural location and in‐training rural experience were strongly associated with currently providing AHC in univariable but not multivariable analysis. Discussion: Early‐career GPs who provided AHC during training, compared with those who did not, were more than five times more likely to provide after‐hours care in their first 2 years after gaining Fellowship, suggesting participation in AHC during training may have a role in preparing registrars to provide AHC as independent practitioners. Conclusion: These findings may inform future GP vocational training policy and practice concerning registrars' provision of AHC during training. [ABSTRACT FROM AUTHOR]
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- 2023
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176. General practice trainees' telehealth use during the COVID-19 pandemic: a cross-sectional study.
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Fisher, Katie, Tapley, Amanda, Ralston, Anna, Davey, Andrew, Fielding, Alison, Driel, Mieke van, Holliday, Elizabeth, Ball, Jean, Dizon, Jason, Spike, Neil, Clarke, Lisa, and Magin, Parker
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COVID-19 pandemic , *TELEMEDICINE , *CROSS-sectional method , *ODDS ratio , *GENERAL practitioners - Abstract
Background Prompted by the COVID-19 pandemic, remuneration was introduced for Australian general practice telehealth consultations. General practitioner (GP) trainees' telehealth use is of clinical, educational, and policy importance. The aim of this study was to assess the prevalence and associations of telehealth versus face-to-face consultations amongst Australian GP registrars (vocational GP trainees). Methods Cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, from 2020 to 2021 (three 6-month terms), including registrars in 3 of Australia's 9 Regional Training Organisations. In ReCEnT, GP registrars record details of 60 consecutive consultations, 6 monthly. The primary analysis used univariate and multivariable logistic regression, with outcome of whether the consultation was conducted via telehealth (phone and videoconference) or face-to-face. Results 1,168 registrars recorded details of 102,286 consultations, of which 21.4% (95% confidence interval [CI]: 21.1%–21.6%) were conducted via telehealth. Statistically significant associations of a telehealth consultation included shorter consultation duration (odds ratio [OR] 0.93, 95% CI: 0.93–0.94; and mean 12.9 versus 18.7 min); fewer problems addressed per consultation (OR 0.92, 95% CI: 0.87–0.97); being less likely to seek assistance from a supervisor (OR 0.86, 95% CI: 0.76–0.96) while being more likely to generate learning goals (OR 1.18, 95% CI: 1.02–1.37); and being more likely to arrange a follow-up consultation (OR 1.18, 95% CI: 1.02–1.35). Conclusions That telehealth consultations were shorter, with higher rates of follow-up, has GP workforce/workload implications. That telehealth consultations were less likely to involve in-consultation supervisor support, but more likely to generate learning goals, has educational implications. [ABSTRACT FROM AUTHOR]
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- 2023
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177. Absolute cardiovascular risk assessment by Australian early-career general practitioners: a cross-sectional study.
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Morgan, Toby, Ralston, Anna, Davey, Andrew, Holliday, Elizabeth G., Nelson, Mark, Fielding, Alison, van Driel, Mieke, Tapley, Amanda, Moad, Dominica, Ball, Jean, Presser, Jennifer, Spike, Neil, and Magin, Parker
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GENERAL practitioners , *TORRES Strait Islanders , *CARDIOVASCULAR diseases risk factors , *CROSS-sectional method , *RISK assessment - Abstract
Objective To determine the prevalence and associations of general practice registrars' performing absolute cardio-vascular risk (ACVR) assessment (ACVRa). Design A cross-sectional study employing data (2017-2018) from the Registrar Clinical Encounters in Training project, an ongoing inception cohort study of Australian GP registrars. The outcome measure was whether an ACVRa was performed. Analyses employed univariable and multivariable regression. Analysis was conducted for all patient problems/diagnoses, then for an 'at-risk' population (specific problems/diagnoses for which ACVRa is indicated). Setting Three GP regional training organisations (RTOs) across three Australian states. Participants GP registrars training within participating RTOs. Results 1003 registrars (response rate 96.8%) recorded details of 69 105 problems either with Aboriginal and/or Torres Strait patients aged 35 years and older or with non-Indigenous patients aged 45 years and older. Of these problems/diagnoses, 1721 (2.5% (95% CI 2.4% to 2.6%)) involved an ACVRa. An ACVRa was 'plausibly indicated' in 10 384 problems/diagnoses. Of these, 1228 (11.8% (95% CI 11.2% to 12.4%)) involved ACVRa. For 'all problems/diagnoses', on multivariable analysis female gender was associated with reduced odds of ACVRa (OR 0.61 (95% CI 0.54 to 0.68)). There was some evidence for Aboriginal and/or Torres Strait Islander people being more likely to receive ACVRa (OR 1.40 (95% CI 0.94 to 2.08), p=0.10). There were associations with variables related to continuity of care, with reduced odds of ACVRa: if the patient was new to the registrar (OR 0.65 (95% CI 0.57 to 0.75)), new to the practice (OR 0.24 (95% CI 0.15 to 0.38)) or the problem was new (OR 0.68 (95% CI 0.59 to 0.78)); and increased odds if personal follow-up was organised (OR 1.43 (95% CI 1.24 to 1.66)). For 'ACVRa indicated' problems/diagnoses, findings were similar to those for 'all problems/diagnoses'. Association with Aboriginal and/or Torres Strait Islander status, however, was significant at p<0.05 (OR 1.60 (95% CI 1.04 to 2.46)) and association with female gender was attenuated (OR 0.88 (95% CI 0.77 to 1.01)). Conclusion Continuity of care is associated with registrars assessing ACVR, reinforcing the importance of care continuity in general practice. Registrars' assessment of an individual patient's ACVR is targeted to patients with individual risk factors, but this may entail ACVRa underutilisation in female patients and younger age groups. [ABSTRACT FROM AUTHOR]
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- 2023
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178. Prevalence and associated skills of Australian general practice registrars seeing children with functional bowel and bladder problems.
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Goldfeld, Sharon, Tapley, Amanda, O'Connor, Elodie, Spike, Neil, Morgan, Simon, Freed, Gary L, Davey, Andrew, Holliday, Elizabeth, Ball, Jean, and Magin, Parker
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ENURESIS , *BLADDER , *FECAL incontinence , *CHILD patients , *GENERAL practitioners , *URINARY incontinence - Abstract
Aim: Functional bowel (constipation and faecal incontinence) and bladder (urinary incontinence and enuresis) problems in children are often treated by paediatricians yet should mostly be managed by general practitioners (GPs). To understand whether the necessary skills and knowledge are being built in general practice, this study aimed to establish the prevalence and associated skills of Australian general practice registrars managing children with functional bowel and bladder problems. Together as paediatricians and GPs, we use these data to determine how best to ensure high quality, equitable care for children. Methods: We drew on 16 rounds of data collection from the Registrar Clinical Encounters in Training (ReCEnT) multi‐site cohort study (2010–2017) of general practice registrars' in‐consultation experience. It included a measure of paediatric consultations in which a functional bowel or bladder problem was managed, as well as demographic information. Results: Out of 62 721 problems/diagnoses for paediatric patients (0–17 years), 844 (1.4%) were coded as functional bowel (n = 709; 1.13% (95% confidence interval, CI: 1.05–1.22)) and/or bladder (n = 135; 0.22% (95% CI: 0.18–0.25)) presentations. Registrars were more likely to prescribe medication for bowel problems (odds ratio (OR) = 2.22 (95% CI: 1.86–2.64)) than for all other problems, but less likely to prescribe medication (OR = 0.31 (95% CI: 0.18–0.52)) for night‐time wetting and more likely to make a specialist referral (OR = 1.99 (95% CI: 1.22–3.25)) compared to all other problems. Conclusions: Only a small proportion of children with functional bowel and bladder problems were seen by registrars despite high prevalence in the community and amenability to management in the general practice setting (i.e. generally low morbidity and low complexity) versus need for specialists. Registrars appeared to be managing functional bowel and bladder problems according to evidence‐based guidelines, but with relatively high levels of referral. Given the inequitable access to specialist care, paediatricians should support local general practice management of these problems. This might include (i) engaging with training programs to ensure appropriate education and (ii) liaising with individual registrars/practices to provide management advice for individual or example cases. [ABSTRACT FROM AUTHOR]
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- 2023
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179. Early-career general practitioners' perceptions of the utility of vocational training for subsequent independent practice.
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Tran, Michael, Wearne, Susan, Fielding, Alison, Moad, Dominica, Tapley, Amanda, Holliday, Elizabeth, Ball, Jean, Davey, Andrew, van Driel, Mieke, FitzGerald, Kristen, Spike, Neil, Bentley, Michael, Kirby, Catherine, and Magin, Parker
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GENERAL practitioners , *OCCUPATIONAL roles , *TEACHING methods , *VOCATIONAL education , *CROSS-sectional method , *MULTIPLE regression analysis , *MEDICAL personnel , *PHYSICIANS' attitudes , *MANN Whitney U Test , *PEDIATRICS , *EVIDENCE-based medicine , *ENTRY level employees , *INTERNSHIP programs , *PRIMARY health care , *COMPARATIVE studies , *PSYCHOSOCIAL factors , *RESEARCH funding , *SCALE analysis (Psychology) , *CLINICAL competence , *MEDICAL practice , *PHYSICIANS , *CLINICAL education , *ELDER care , *MEDICAL education - Abstract
To evaluate Australian early-career general practitioners' perceptions of the utility of their prior vocational training in preparing them for independent specialist practice. We hypothesised that in-practice teaching would be perceived as more useful than formal education delivered by Regional Training Organisations (RTOs). A cross-sectional questionnaire-based study of early-career general practitioners (RTO 'alumni'). The outcomes were Likert scale ratings of alumni's perceived impact of RTO education versus in-practice training on their preparedness for independent practice. Ratings were compared using Wilcoxon signed-rank tests. Multivariable linear regression was used to establish alumni characteristics associated with perceptions of utility of in-practice versus RTO-delivered education. Three hundred and fifty-four alumni responded (response rate 28%). In-practice training was rated statistically significantly higher than RTO education for minor procedural skills, teaching skills, professional responsibilities, tolerating clinical uncertainty, and preparing for managing child and adolescent health, aged care, chronic disease, multi-morbidity and mental health. RTO education rated higher than in-practice training for practising evidence-based medicine and Aboriginal and Torres Strait Islander health. For a number of further areas, there was no statistically significant difference in alumni ratings of utility. In-practice or RTO-led teaching was perceived as more useful for some components of independent practice, whilst for others there was no significant difference. The findings support recognition of the individual educational components of a blended education/training structure. [ABSTRACT FROM AUTHOR]
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- 2023
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180. Temporal trends in, and associations of, early-career general practitioner prescriptions of second-line Type 2 Diabetes medications, 2010–2018.
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Patsan, Irena, Tapley, Amanda, Davoren, Peter, Fielding, Alison, Holliday, Elizabeth, Ball, Jean, Davey, Andrew, van Driel, Mieke, Turner, Rachel, Mulquiney, Katie, Spike, Neil, FitzGerald, Kristen, and Magin, Parker
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SODIUM-glucose cotransporters , *TYPE 2 diabetes , *GENERAL practitioners , *SODIUM-glucose cotransporter 2 inhibitors , *GLUCAGON-like peptide 1 , *GLYCEMIC control - Abstract
Introduction: Second-line pharmacotherapy for Type 2 Diabetes Mellitus ('diabetes') is necessary for optimal glycaemic control and preventing longer-term complications. We aimed to describe temporal trends in, and associations of, Australian general practitioner (GP) registrars' prescription, and initiation, of 'new' second-line oral agents (dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 agonists) compared to sulphonylureas. Materials and methods: A longitudinal analysis (2010–2018) of data from the Registrar Clinical Encounters in Training project. Analysis included any diabetes problem/diagnosis that involved prescription of sulphonylureas or 'new' oral agents. Simple and multiple logistic regression models were fitted within the generalised estimating equations framework. Results: 2333 registrars recorded 6064 diabetes problems/diagnoses (1.4%). 835 problems/diagnoses involved sulphonylurea or 'new' medication prescription. Of these, 61.0% [95% CI:57.4–64.4] involved 'new' medication prescription. 230 problems/diagnoses involved sulphonylurea or 'new' medication initiation, with 77% [95%CI:70.8–82.1] involving a 'new' medication. There was a significant 52% per year increase in prescribing (OR = 1.52[95% CI:1.38–1.68],p<0.001), and a 77% per (two-to-three-year) time-interval increase in initiation (OR = 1.77,[95% CI:1.30–2.43],p = <0.001) of 'new' medications compared to sulphonylureas. 'New' medications were prescribed less for non-English-speaking patients. There was some regional variation in prescribing. Conclusion: Registrar uptake of 'new' oral agents compared to sulphonylureas has increased rapidly. [ABSTRACT FROM AUTHOR]
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- 2023
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181. 1500 answers for GPs
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Spike, Neil
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- 1998
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182. Changes in Australian Early-Career General Practitioners' Benzodiazepine Prescribing: a Longitudinal Analysis.
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Magin, Parker, Tapley, Amanda, Dunlop, Adrian J, Davey, Andrew, van Driel, Mieke, Holliday, Elizabeth, Morgan, Simon, Henderson, Kim, Ball, Jean, Catzikiris, Nigel, Mulquiney, Katie, Spike, Neil, Kerr, Rohan, and Holliday, Simon
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BENZODIAZEPINE abuse , *BICYCLIC diazepines , *TRANQUILIZING drugs , *FAMILY medicine , *PHYSICIANS , *PREVENTION , *GOVERNMENT policy - Abstract
Background: Australian and international guidelines recommend benzodiazepines and related drugs (hereafter "benzodiazepines") as second-line, short-term medications only. Most benzodiazepines are prescribed by general practitioners (GPs; family physicians). Australian GP registrars ("trainees" or "residents" participating in a post-hospital training, apprenticeship-like, practice-based vocational training program), like senior GPs, prescribe benzodiazepines at high rates. Education within a training program, and experience in general practice, would be expected to reduce benzodiazepine prescribing.Objective: To establish if registrars' prescribing of benzodiazepines decreases with time within a GP training program DESIGN: Longitudinal analysis from the Registrar Clinical Encounters in Training multi-site cohort study PARTICIPANTS: Registrars of five of Australia's 17 Regional Training Providers. Analyses were restricted to patients ≥ 16 years.Main Measures: The main outcome factor was prescription of a benzodiazepine. Conditional logistic regression was used, with registrar included as a fixed effect, to assess within-registrar changes in benzodiazepine-prescribing rates. The "time" predictor variable was "training term" (6-month duration Terms 1-4). To contextualize these "within-registrar" changes, a mixed effects logistic regression model was used, including a random effect for registrar, to assess within-program changes in benzodiazepine-prescribing rates over time. The "time" predictor variable was "year" (2010-2015).Key Results: Over 12 terms of data collection, 2010-2015, 1161 registrars (response rate 96%) provided data on 136,809 face-to-face office-based consultations. Two thousand six hundred thirty-two benzodiazepines were prescribed (for 1.2% of all problems managed). In the multivariable model, there was a significant reduction in within-program benzodiazepine prescribing over time (year) (p = < 0.001, OR = 0.94, CI = 0.90, 0.97). However, there was no significant change in 'within-registrar' prescribing over time (registrar Term) (p = 0.92, OR = 1.00 [95% CI = 0.94-1.06]).Conclusions: Despite a welcome temporal trend for reductions in overall benzodiazepine prescribing from 2010 to 2015, there is still room for improvement and our findings suggest a lack of effect of specific GP vocational training program education and, thus, an opportunity for targeted education. [ABSTRACT FROM AUTHOR]- Published
- 2018
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183. Referrals to dietitians/nutritionists: A cross‐sectional analysis of Australian GP registrars’ clinical practice.
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Mulquiney, Katie J., Tapley, Amanda, van Driel, Mieke L., Morgan, Simon, Davey, Andrew R., Henderson, Kim M., Spike, Neil A., Kerr, Rohan H., Watson, Jane F., Catzikiris, Nigel F., and Magin, Parker J.
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GENERAL practitioners , *CHI-squared test , *CHRONIC diseases , *CONFIDENCE intervals , *DIETITIANS , *LONGITUDINAL method , *MEDICAL cooperation , *MEDICAL referrals , *TYPE 2 diabetes , *OBESITY , *PROBABILITY theory , *RESEARCH , *LOGISTIC regression analysis , *MULTIPLE regression analysis , *EFFECT sizes (Statistics) , *CROSS-sectional method , *DATA analysis software , *DESCRIPTIVE statistics , *ODDS ratio , *MANN Whitney U Test - Abstract
Aim: The present study aimed to describe referral patterns of general practitioner (GP) registrars to dietitians/nutritionists. There is a paucity of research regarding GP referral patterns to dietitians/nutritionists. Limited data show increasing referrals from established GPs to dietitians/nutritionists. There are no data on GP registrar (trainee) referrals. Methods: This was a cross‐sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing, multicentre, prospective cohort study of registrars, which documents 60 consecutive consultations of each registrar in each of the three six‐month GP training terms. The outcome factor in this analysis was a problem/diagnosis resulting in dietitian/nutritionist referral (2010–2015). Independent variables were related to registrar, patient, practice and consultation. Results: A total of 1124 registrars contributed data from 145 708 consultations. Of 227 190 problems/diagnoses, 587 (0.26% (confidence interval: 0.23–0.29)) resulted in dietitian/nutritionist referral. The most common problems/diagnoses referred related to overweight/obesity (27.1%) and type 2 diabetes (21.1%). Of referrals to a dietitian/nutritionist, 60.8% were for a chronic disease, and 38.8% were related to a Chronic Disease Management plan. Dietitian/nutritionist referral was significantly associated with a number of independent variables reflecting continuity of care, patient complexity, chronic disease, health equity and registrar engagement. Conclusions: Established patients with chronic disease and complex care needs are more likely than other patients to be referred by registrars to dietitians/nutritionists. Nutrition behaviours are a major risk factor in chronic disease, and we have found evidence for dietitian/nutritionist referrals representing one facet of engagement by registrars with patients’ complex care needs. [ABSTRACT FROM AUTHOR]
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- 2018
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184. What proportion of paediatric specialist referrals originates from general practitioners?
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Kunin, Marina, Turbitt, Erin, Gafforini, Sarah A., Sanci, Lena A., Spike, Neil A., and Freed, Gary L.
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PEDIATRICS , *HEALTH service areas , *PUBLIC hospitals , *PUBLIC health , *GENERAL practitioners - Abstract
Aim: To determine (i) the proportion of different referral sources for new referrals to paediatric specialist outpatient clinics and (ii) any association of referral source with utilisation of additional health services.Methods: Survey of parents presenting with their child at five paediatric specialist outpatient clinics at two Melbourne public hospitals.Results: Just over half (52%) of the respondents were referred by a general practitioner (GP). The remainder were referred by a paediatrician (27%) at hospital discharge (16%) or from the ED (6%). Most respondents (71%) reported that their child also has a referral to see another specialist for the same health concern but had not yet had the consultation; 44% had consulted another doctor for the same health concern between receiving the referral and the appointment. Paediatrician referrals were more likely to see another specialist for the same health concern compared to other referral sources (P = 0.032).Conclusion: Only half of the referrals of new patients to paediatric specialist outpatient clinics come from GPs. Future research should investigate whether multiple referral sources have a negative impact on the co-ordination and cost of paediatric health care. [ABSTRACT FROM AUTHOR]- Published
- 2018
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185. Responses to clinical uncertainty in Australian general practice trainees: a cross-sectional analysis.
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Cooke, Georga, Tapley, Amanda, Holliday, Elizabeth, Morgan, Simon, Henderson, Kim, Ball, Jean, Driel, Mieke, Spike, Neil, Kerr, Rohan, and Magin, Parker
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MEDICAL education , *CLINICAL competence , *PROFESSIONAL education , *UNCERTAINTY , *CROSS-sectional method , *ANXIETY , *FAMILY medicine , *HOSPITAL medical staff , *EVALUATION of medical care , *MEDICAL cooperation , *PATIENT-professional relations , *METROPOLITAN areas , *RESEARCH , *DISCLOSURE , *SOCIOECONOMIC factors , *TEACHING methods - Abstract
Context Tolerance for ambiguity is essential for optimal learning and professional competence. General practice trainees must be, or must learn to be, adept at managing clinical uncertainty. However, few studies have examined associations of intolerance of uncertainty in this group. Objectives The aim of this study was to establish levels of tolerance of uncertainty in Australian general practice trainees and associations of uncertainty with demographic, educational and training practice factors. Methods A cross-sectional analysis was performed on the Registrar Clinical Encounters in Training (Re CEnT) project, an ongoing multi-site cohort study. Scores on three of the four independent subscales of the Physicians' Reaction to Uncertainty ( PRU) instrument were analysed as outcome variables in linear regression models with trainee and practice factors as independent variables. Results A total of 594 trainees contributed data on a total of 1209 occasions. Trainees in earlier training terms had higher scores for 'Anxiety due to uncertainty', 'Concern about bad outcomes' and 'Reluctance to disclose diagnosis/treatment uncertainty to patients'. Beyond this, findings suggest two distinct sets of associations regarding reaction to uncertainty. Firstly, affective aspects of uncertainty (the 'Anxiety' and 'Concern' subscales) were associated with female gender, less experience in hospital prior to commencing general practice training, and graduation overseas. Secondly, a maladaptive response to uncertainty (the 'Reluctance to disclose' subscale) was associated with urban practice, health qualifications prior to studying medicine, practice in an area of higher socio-economic status, and being Australian-trained. Conclusions This study has established levels of three measures of trainees' responses to uncertainty and associations with these responses. The current findings suggest differing 'phenotypes' of trainees with high 'affective' responses to uncertainty and those reluctant to disclose uncertainty to patients. More research is needed to examine the relationship between clinical uncertainty and clinical outcomes, temporal changes in tolerance for uncertainty, and strategies that might assist physicians in developing adaptive responses to clinical uncertainty. [ABSTRACT FROM AUTHOR]
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- 2017
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186. General practice trainees’ clinical experience of dermatology indicates a need for improved education: A cross-sectional analysis from the Registrar Clinical Encounters in Training Study.
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Whiting, Georgina, Magin, Parker, Morgan, Simon, Tapley, Amanda, Henderson, Kim, Oldmeadow, Chris, Ball, Jean, Driel, Mieke, Spike, Neil, McArthur, Lawrie, Scott, John, and Stocks, Nigel
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SKIN diseases , *DERMATOLOGY , *FAMILY medicine , *DERMATOLOGISTS , *FAMILY medicine education , *TRAINING - Abstract
Background/Objectives: Skin conditions are commonly encountered in general practice but dermatology is underrepresented in undergraduate medical courses. Australian and international studies have shown that the dermatological diagnostic ability of general practitioners (GPs) is suboptimal, contributing to increased dermatology outpatient referrals. Dermatological experience in GP vocational training is thus of particular importance. We aimed to document the prevalence of skin disease presentations and the range of skin diseases encountered by GP trainees. We also sought to establish associations of GP trainee’s skin disease experience, including their personal characteristics, consultation factors, and the actions arising from the consultation. Methods: This study took place in the Registrars Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing, prospective, multi-site cohort study of Australian GP trainees’ consultations. A descriptive cross-sectional analysis was performed on trainees’ consultation data. Results: In total, 645 individual trainees contributed data from 84 615 consultations. Altogether, 11% of all problems managed were skin problems. Infections, dermatitis, injury and wounds were the most common presentations. Associations of consultations for skin problems (compared with all other problems) included seeking in-consultation advice, planning patient follow up and generating learning goals. Conclusions: These findings suggest GP trainees find skin problems challenging and may indicate a need for more and better targeted undergraduate and GP trainee education. [ABSTRACT FROM AUTHOR]
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- 2017
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187. General practitioner trainees' in-consultation generation of clinical questions for later answering: prevalence and associations.
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Magin, Parker, Tapley, Amanda, Davey, Andrew, Morgan, Simon, Holliday, Elizabeth, Ball, Jean, Wearne, Susan, Henderson, Kim, Catzikiris, Nigel, Mulquiney, Katie, Spike, Neil, Kerr, Rohan, and van Driel, Mieke
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GENERAL practitioners , *PHYSICIAN training , *MEDICAL consultation , *LEARNING goals , *MUSCULOSKELETAL system diseases , *RESPIRATORY diseases , *CHRONIC diseases , *FAMILY medicine , *INTERNSHIP programs , *LEARNING , *LONGITUDINAL method , *MEDICAL referrals , *TIME , *INFORMATION-seeking behavior , *DISEASE prevalence , *CROSS-sectional method - Abstract
Background: As well as generating patient-specific questions, patient consultations are a rich source of questions relating to clinicians' need to acquire or maintain wider clinical knowledge. This is especially so for GP trainees.Objectives: To establish the prevalence and associations of GP trainees' generation of 'learning goals' (LGs: questions generated during clinical consultations for intended post-consultation answering). Also, to characterize the type of learning goals generated.Methods: A cross-sectional analysis (2010-15) of an ongoing cohort study of Australian GP trainees' consultations. Once each 6-month training term, trainees record detailed data of 60 consecutive consultations. The primary outcome was generation of an LG. Analysis was at the level of individual problem/diagnosis managed. The secondary outcome was the problems/diagnoses to which the LGs related.Results: One thousand one hundred and twenty-four trainees contributed data for 154746 consultations including 222307 problems/diagnoses. LGs were generated for 16.6% [95% confidence intervals (CI) = 16.4-16.7] of problems/diagnoses, in 22.1% (95% CI = 21.9-22.3%) of consultations. Associations of LGs included patient factors: younger age and having seen the trainee previously; trainee factors: earlier training stage, being overseas-trained and the trainee's training organization; consultation factors: longer duration, addressing a chronic disease, referring the patient, organizing follow-up, organizing investigations and accessing in-consultation information. LGs were commonly generated for skin (12.9% of all learning goals), musculoskeletal (12.7%) and respiratory (8.7%) problems. LGs were generated for 31.8% of male genital, 27.0% of neurological and 23.3% of eye problems.Conclusion: Australian GP trainees frequently generate questions in-consultation to be pursued post-consultation. Prevalence, 'complexity' and familiarity of clinical topic area influenced LG generation. [ABSTRACT FROM AUTHOR]- Published
- 2017
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188. Pathology test-ordering behaviour of Australian general practice trainees: a cross-sectional analysis.
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MORGAN, SIMON, HENDERSON, KIM M., TAPLEY, AMANDA, SCOTT, JOHN, VAN DRIEL, MIEKE L., SPIKE, NEIL A., MCARTHUR, LAWRIE A., DAVEY, ANDREW R., OLDMEADOW, CHRIS, BALL, JEAN, and MAGIN, PARKER J.
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GENERAL practitioners , *PHYSICIAN training , *DIAGNOSIS , *MULTIVARIATE analysis , *PATHOLOGY , *FAMILY medicine , *CROSS-sectional method , *ROUTINE diagnostic tests , *EDUCATION - Abstract
Objective: In the context of increasing over-testing and the implications for patient safety, to establish the prevalence and nature of pathology test-ordering of GP trainees, and to describe the associations of this test-ordering.Design: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study.Setting: Five of Australia's 17 general practice regional training providers, encompassing urban-to-very remote practices.Participants: GP trainees.Main Outcome Measures: The number of pathology tests ordered per problem/diagnosis managed.Results: A total of 856 individual trainees (response rate 95.2%) contributed data from 1832 trainee-terms, 108 759 encounters and 169 304 problems. Pathology test-ordering prevalence was 79.3 tests (95% CI: 78.8-79.8) per 100 encounters, 50.9 (95% CI: 50.6-51.3) per 100 problems, and at least 1 test was requested in 22.4% of consultations. Most commonly ordered was full blood count (6.1 per 100 problems). The commonest problem prompting test-ordering was 'check-up' (18.6%). Test-ordering was significantly associated, on multivariable analysis, with the trainee having worked at the practice previously; the patient being adult, male and new to both trainee and practice; the practice being urban; the problem/diagnosis being new; imaging being ordered; referral being made and follow-up being arranged. Trainees were significantly less likely to order tests for problems/diagnoses for which they had sought in-consultation information or advice.Conclusions: Compared with the established GPs, trainees order more pathology tests per consultation and per problem managed, and in a higher proportion of consultations. Our findings will inform educational policy to enhance quality and safety in general practice training. [ABSTRACT FROM AUTHOR]- Published
- 2015
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189. IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): Cluster randomised controlled trial study protocol
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Francis Jill, Michie Susan, Mortimer Duncan, Grimshaw Jeremy M, O'Connor Denise A, French Simon D, McKenzie Joanne E, Spike Neil, Schattner Peter, Kent Peter M, Buchbinder Rachelle, and Green Sally E
190. IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): cluster randomised controlled trial study protocol
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Jill J Francis, Susan Michie, Peter Schattner, Sally Green, Duncan Mortimer, Jeremy M. Grimshaw, Rachelle Buchbinder, Neil Spike, Joanne E. McKenzie, Peter Kent, Denise O'Connor, Simon D. French, McKenzie, Joanne, French, Simon, O'Connor, Denise, Grimshaw, Jeremy, Mortimer, Duncan Stuart, Michie, Susan, Francis, Jill, Spike, Neil, Schattner, Peter, Kent, Peter, Buchbinder, R, and Green, S
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medicine.medical_specialty ,Psychological intervention ,Public Health and Health Services not elsewhere classified ,Health Informatics ,law.invention ,03 medical and health sciences ,Study Protocol ,0302 clinical medicine ,Health Economics ,Randomized controlled trial ,law ,evidence-based ,Business Studies n.e.c ,medicine ,030212 general & internal medicine ,Cluster randomised controlled trial ,behavioural theory ,Medicine(all) ,clinical trials ,lcsh:R5-920 ,business.industry ,Health Policy ,Health services research ,Public Health, Environmental and Occupational Health ,Consolidated Standards of Reporting Trials ,Evidence-based management ,General Medicine ,Guideline ,lower back pain ,3. Good health ,Clinical trial ,Family medicine ,business ,lcsh:Medicine (General) ,clinical practice guidelines ,RA ,030217 neurology & neurosurgery ,110399 [FOR] - Abstract
Background Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).
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- 2007
191. Factors associated with early-career GPs' retention as independent specialists in former training practices.
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Tran M, Fielding A, Moad D, Tapley A, Holliday E, Ball J, Davey A, van Driel M, FitzGerald K, Spike N, Bentley M, Kirby C, Turnock A, and Magin P
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- Humans, Female, Male, Cross-Sectional Studies, Adult, Australia, Surveys and Questionnaires, Middle Aged, Career Choice, Professional Practice Location statistics & numerical data, Personnel Turnover statistics & numerical data, General Practitioners education, Rural Health Services organization & administration
- Abstract
Introduction: Retention of general practice registrars in their training practices is important for addressing the GP workforce deficit and maldistribution of GPs. Given that rural and remote general practices are disproportionately affected by low retention, identifying the factors that promote retention may be as important as developing recruitment strategies in these areas. Quantifying the impact of relevant factors on registrar retention will enable a better understanding of how to incentivise retention and attenuate the loss of the rural workforce to other areas. We sought to establish the prevalence and associations of retention of general practice registrars in their training practices., Methods: This analysis was a component of the New alumni Experience of Training and independent Unsupervised Practice (NEXT-UP) study: a cross-sectional questionnaire-based study of early-career GPs in conjunction with evaluation of data contemporaneously recorded as part of vocational training. Participants were former registrars of three regional training organisations delivering general practice training in New South Wales, Tasmania, the Australian Capital Territory and Eastern Victoria, who had attained Fellowship of the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine between January 2016 and July 2018. The outcome measured was whether the registrar had previously worked at their current practice during vocational training. Multivariable logistic regression was used to estimate the association between relevant explanatory variables and the outcome., Results: A total of 354 alumni responded (response rate 28%), of whom 322 provided data regarding previous training practice retention, with 190 (59%) having previously worked at their current practice as registrars. Among respondents who reported currently working in a regional-rural practice location (n=100), 69% reported having previously worked at their current practice during training. GPs were more likely to be retained by a practice they had trained at if it was of lower socioeconomic status (adjusted odds ratio (aOR) 0.82 (95% confidence interval (CI) 0.73-0.91), p<0.001 for each decile of socioeconomic status) and if the practice provided two or more of home visits, nursing home visits or after-hours services (aOR 4.29 (95%CI 2.10-8.75), p<0.001). They were less likely to be retained by the practice if training was completed in a regional-rural area (aOR 0.35 (95%CI 0.17-0.72), p=0.004)., Conclusion: Regional-rural training location is associated with reduced odds of subsequent retention of general practice registrars. This is occurring despite significant government investment in expansion of general practice training in regional and rural areas. The practice factor most strongly associated with GP retention was the provision of out-of-practice and after-hours care. There may be altruistic, rather than monetary, reasons that explain this finding. Such training opportunities, if provided to all trainees, especially in regional and rural areas, would be a learning opportunity, a way of promoting holistic community-based care and an incentive for subsequent retention within the practice and community as an established GP.
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- 2024
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192. Caring for kids: Australian general practice registrar confidence in delivering paediatric primary care.
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Mahoney C, Williams IR, Lamb K, Spike N, McArthur L, Magin P, Bentley M, Bradford C, Hiscock H, Irwin R, and Sanci L
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- Humans, Cross-Sectional Studies, Australia, Male, Female, Surveys and Questionnaires, Clinical Competence statistics & numerical data, Clinical Competence standards, Adult, General Practice methods, General Practice statistics & numerical data, Child, Middle Aged, Primary Health Care statistics & numerical data, Pediatrics methods, Pediatrics statistics & numerical data
- Abstract
Background and Objectives: The burden of disease for Australian children from non-acute conditions is growing; however, little is known about how well prevocational training experiences prepare trainee doctors. This study examines the confidence of general practice registrars in managing paediatric consultations in primary care and whether confidence varies by prevocational training type., Method: This was a cross-sectional national survey of Australian general practice registrars that measured confidence in managing paediatric primary care presentations., Results: Respondents reported feeling confident (65%) or very confident (8%) in managing paediatrics in primary care, with higher confidence for those more advanced in their training or with greater exposure to paediatrics during prevocational training. Regression models showed registrars were more likely to report higher confidence when managing acute versus non-acute presentations., Discussion: Although most registrars reported confidence in managing paediatric presentations, confidence levels were notably lower for non-acute conditions and when prevocational training experiences included limited exposure to paediatric patients.
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- 2024
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193. Prediction of general practice licensure/certification examination performance by a measure of 'questionable' activities in clinical practice: a retrospective cohort study.
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Magin P, Ralston A, Fielding A, Holliday E, Tran M, Tapley A, van Driel M, Ball J, Moad D, Mitchell B, Fisher K, FitzGerald K, Spike N, Turner R, and Davey A
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- Humans, Australia, Retrospective Studies, Female, Licensure, Medical, Male, Adult, Education, Medical, Graduate, Clinical Competence standards, Certification, Educational Measurement methods, General Practice standards, General Practice education
- Abstract
Purpose: 'Low-value' clinical care and medical services are 'questionable' activities, being more likely to cause harm than good or with disproportionately low benefit relative to cost. This study examined the predictive ability of the QUestionable In Training Clinical Activities Index (QUIT-CAI) for general practice (GP) registrars' (trainees') performance in Australian GP Fellowship examinations (licensure/certification examinations for independent GP)., Methods: The study was nested in ReCEnT, an ongoing cohort study in which Australian GP registrars document their in-consultation clinical practice. Outcome factors in analyses were individual registrars' scores on the three Fellowship examinations ('AKT', 'KFP', and 'OSCE' examinations) and pass/fail rates during 2012-21. Analyses used univariable and multivariable regression (linear or logistic, as appropriate). The study factor in each analysis was 'QUIT-CAI score percentage'-the percentage of times a registrar performed a QUIT-CAI clinical activity when 'at risk' (i.e. when managing a problem where performing a QUIT-CAI activity was a plausible option)., Results: A total of 1265, 1145, and 553 registrars sat Applied Knowledge Test, Key Features Problem, and Objective Structured Clinical Exam examinations, respectively. On multivariable analysis, higher QUIT-CAI score percentages (more questionable activities) were significantly associated with poorer Applied Knowledge Test scores (P = .001), poorer Key Features Problem scores (P = .003), and poorer Objective Structured Clinical Exam scores (P = .005). QUIT-CAI score percentages predicted Royal Australian College of General Practitioner exam failure [odds ratio 1.06 (95% CI 1.00, 1.12) per 1% increase in QUIT-CAI, P = .043]., Conclusion: Performing questionable clinical activities predicted poorer performance in the summative Fellowship examinations, thereby validating these examinations as measures of actual clinical performance (by our measure of clinical performance, which is relevant for a licensure/certification examination)., (© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine.)
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- 2024
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194. Utilisation of in-consultation supervisor assistance in general practice training and personal cost to trainees: a cross-sectional study.
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Sturman N, Tapley A, Holliday E, Fielding A, Davey A, van Driel M, Ball J, FitzGerald K, Spike N, and Magin P
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- Humans, Cross-Sectional Studies, Cohort Studies, Australia, Referral and Consultation, General Practice
- Abstract
Aim The aim of the study was to establish whether two previously described barriers to effective in-consultation assistance-seeking by general practice (GP) vocational specialist trainees (ie concern about patient impressions of their competence, and discomfort presenting to supervisors in front of patients) influenced the frequency of trainee in-consultation assistance-seeking from their supervisor. Methods This was a cross-sectional study nested in the Registrar Clinical Encounters in Clinical Training ongoing cohort study of Australian GP trainees. Trainee participants completed contemporaneous records of 60 consecutive patient consultations, including whether supervisory assistance was sought. Trainees also completed a cross-sectional survey including items eliciting their beliefs about patient impressions and their own discomfort in seeking in-consultation supervisory assistance. These were factors of interest in multivariable logistic regression analyses; the outcome factor in both regression models was the seeking of in-consultation supervisory assistance. Results In 2018, 778 trainees (778/876, response rate 89%) completed the cross-sectional survey. No association was found between the odds of in-consultation help-seeking and perceived decrease in patient impressions of trainee competence (OR = 1.09; 95% CI: 0.91, 1.31; P = 0.36) or higher comfort presenting outside patients' hearing (OR = 0.9; 95% CI: 0.77, 1.05; P = 0.19). Discussion Contrary to expected utility models of help-seeking, trainees may not consider personal discomfort or impression management to be important enough, compared to patient safety and other considerations, to influence decisions regarding in-consultation help-seeking. Clinical supervisors should, nevertheless, consider the potential personal costs to trainees and maintain trainee self-esteem and confidence by providing in-consultation assistance in front of patients as comfortably and effectively as possible.
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- 2024
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195. Pivoting in the pandemic: A regional tale of the rapid pivot to virtual continuing professional development for general practitioner supervisors during COVID-19.
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Willems J, Baker M, Samargis S, O'Shea C, Johnson C, and Spike N
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- Humans, Pandemics, Communicable Disease Control, Education, Medical, Continuing, COVID-19, General Practitioners education
- Abstract
Background: The COVID-19 pandemic disrupted face-to-face delivery of general practitioner supervisor training in an unprecedented way. Simultaneously, the need for continuing professional development (CPD) amplified. The rapid pivot to virtual and blended learning solutions required great organisational agility, and a toolbox of solutions., Objective: Against the backdrop of the COVID-19 restrictions on face-to-face learning, this article shares the strategies employed to achieve the pivot to virtual CPD., Discussion: There was much trial and error, as well as successes and learning opportunities, as training organisations grappled with how to deliver virtual CPD during lockdowns.
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- 2023
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196. 'Low-value' clinical care in general practice: a cross-sectional analysis of low-value care in early-career GPs' practice.
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Ralston A, Fielding A, Holliday E, Ball J, Tapley A, van Driel M, Davey A, Turner R, Moad D, FitzGerald K, Spike N, Mitchell B, Tran M, Fisher K, and Magin P
- Subjects
- Humans, Australia, Cohort Studies, Cross-Sectional Studies, General Practice, General Practitioners, Low-Value Care
- Abstract
Nonevidence-based and 'low-value' clinical care and medical services are 'questionable' clinical activities that are more likely to cause harm than good or whose benefit is disproportionately low compared with their cost. This study sought to establish general practitioner (GP), patient, practice, and in-consultation associations of an index of key nonevidence-based or low-value 'questionable' clinical practices. The study was nested in the Registrar Clinical Encounters in Training study-an ongoing (from 2010) cohort study in which Australian GP registrars (specialist GP trainees) record details of their in-consultation clinical and educational practice 6-monthly. The outcome factor in analyses, performed on Registrar Clinical Encounters in Training data from 2010 to 2020, was the score on the QUestionable In-Training Clinical Activities Index (QUIT-CAI), which incorporates recommendations of the Australian Choosing Wisely campaign. A cross-sectional analysis used negative binomial regression (with the model including an offset for the number of times the registrar was at risk of performing a questionable activity) to establish associations of QUIT-CAI scores. A total of 3206 individual registrars (response rate 89.9%) recorded 406 812 problems/diagnoses where they were at risk of performing a questionable activity. Of these problems/diagnoses, 15 560 (3.8%) involved questionable activities being performed. In multivariable analyses, higher QUIT-CAI scores (more questionable activities) were significantly associated with earlier registrar training terms: incidence rate ratios (IRRs) of 0.91 [95% confidence interval (CI) 0.87, 0.95] and 0.85 (95% CI 0.80, 0.90) for Term 2 and Term 3, respectively, compared to Term 1. Other significant associations of higher scores included the patient being new to the registrar (IRR 1.27; 95% CI 1.12, 1.45), the patient being of non-English-speaking background (IRR 1.24; 95% CI 1.04, 1.47), the practice being in a higher socioeconomic area decile (IRR 1.01; 95% CI 1.00, 1.02), small practice size (IRR 1.05; 95% CI 1.00, 1.10), shorter consultation duration (IRR 0.99 per minute; 95% CI 0.99, 1.00), and fewer problems addressed in the consultation (IRR 0.84; 95% CI 0.79, 0.89) for each additional problem]. Senior registrars' clinical practice entailed less 'questionable' clinical actions than junior registrars' practice. The association of lower QUIT-CAI scores with a measure of greater continuity of care (the patient not being new to the registrar) suggests that continuity should be supported and facilitated during GP training (and in established GPs' practice)., (© The Author(s) 2023. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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197. Climate change and Australian general practice vocational education: a cross-sectional study.
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Wild K, Tapley A, Fielding A, Holliday E, Ball J, Horton G, Blashki G, Davey A, van Driel M, Turner A, FitzGerald K, Spike N, and Magin P
- Subjects
- Female, Humans, Australia, Climate Change, Cross-Sectional Studies, Vocational Education, General Practice education, General Practitioners
- Abstract
Background: Climate change is a rapidly progressing threat to global health and well-being. For general practitioners (GPs) currently in training, the effects of climate change on public health will shape their future professional practice We aimed to establish the prevalence and associations of Australian GP registrars' (trainees') perceptions of climate change as it relates to public health, education, and workplaces., Methods: A cross-sectional questionnaire-based study of GP registrars of three Australian training organizations. The questionnaire assessed attitudes regarding adverse health effects of climate change (over the next 10-20 years), and agreement with statements on (i) integrating health impacts of climate change into GP vocational training, and (ii) GPs' role in making general practices environmentally sustainable., Results: Of 879 registrars who participated (response rate 91%), 50.4% (95% CI 46.8%, 54.0%) perceived a large or very large future health effect of climate change on their patients, and 61.8% (95% CI 58.6%, 65.0%) agreed that climate health impacts should be integrated within their education programme. 77.8% (95% CI 74.9%, 80.4%) agreed that GPs should have a leadership role in their practices' environmental sustainability. Multivariable associations of these attitudes included female gender, training region, and (for the latter two outcomes) perceptions of future impact of climate change on patient health., Conclusions: GP registrars are motivated to receive climate health education and engage in environmentally sustainable practice. This may primarily reflect concern for future practice and patient care., (© The Author(s) 2022. Published by Oxford University Press.)
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- 2023
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198. The Registrar Clinical Encounters in Training (ReCEnT) cohort study: updated protocol.
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Davey A, Tapley A, van Driel M, Holliday E, Fielding A, Ball J, Mulquiney K, Fisher K, Spike N, Clarke L, Moad D, Ralston A, Patsan I, Mundy B, Turner A, Tait J, Tuccitto L, Roberts S, and Magin P
- Subjects
- Humans, Cohort Studies, Cross-Sectional Studies, Australia, General Practice education, General Practitioners education
- Abstract
Background: During vocational general practice training, the content of each trainee's (in Australia, registrars') in-consultation clinical experience is expected to entail a breadth of conditions that exemplify general practice, enabling registrars to gain competency in managing common clinical conditions and common clinical scenarios. Prior to the Registrar Clinical Encounters in Training (ReCEnT) project there was little research into the content of registrars' consultations despite its importance to quality of training. ReCEnT aims to document the consultation-based clinical and educational experiences of individual Australian registrars., Methods: ReCEnT is an inception cohort study. It is comprised of closely interrelated research and educational components. Registrars are recruited by participating general practice regional training organisations. They provide demographic information about themselves, their skills, and their previous training. In each of three 6-month long general practice training terms they provide data about the practice where they work and collect data from 60 consecutive patient encounters using an online portal. Analysis of data uses standard techniques including linear and logistic regression modelling. The ReCEnT project has approval from the University of Newcastle Human Research Ethics Committee, Reference H-2009-0323., Discussion: Strengths of the study are the granular detail of clinical practice relating to patient demographics, presenting problems/diagnoses, medication decisions, investigations requested, referrals made, procedures undertaken, follow-up arranged, learning goals generated, and in-consultation help sought; the linking of the above variables to the presenting problems/diagnoses to which they pertain; and a very high response rate. The study is limited by not having information regarding severity of illness, medical history of the patient, full medication regimens, or patient compliance to clinical decisions made at the consultation. Data is analysed using standard techniques to answer research questions that can be categorised as: mapping analyses of clinical exposure; exploratory analyses of associations of clinical exposure; mapping and exploratory analyses of educational actions; mapping and exploratory analyses of other outcomes; longitudinal 'within-registrar' analyses; longitudinal 'within-program' analyses; testing efficacy of educational interventions; and analyses of ReCEnT data together with data from other sources. The study enables identification of training needs and translation of subsequent evidence-based educational innovations into specialist training of general practitioners., (© 2022. The Author(s).)
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- 2022
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199. Cross-sectional analysis of the clinical work hours of early-career general practitioners.
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Bentley M, FitzGerald K, Fielding A, Moad D, Tapley A, van Driel ML, Holliday EG, Ball JI, Davey AR, Spike NA, Kirby C, Turnock A, and Magin P
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- Female, Humans, Cross-Sectional Studies, Australia, Workplace, General Practitioners, General Practice
- Abstract
Background and Objectives: The clinical working hours of early-career general practitioners (GPs) are an important factor in Australian GP workforce planning. This study aimed to establish the prevalence and associations of early-career GPs working full time (nine or more sessions per week) in clinical practice., Method: This was a cross-sectional questionnaire-based study of alumni (from six months to two years post-Fellowship) from three regional training organisations. Multivariable logistic regression was used to establish factors associated with alumni working full time., Results: Of 356 currently practising early-career alumni participants, 30% worked full time. Factors associated with working full time included spouse/partner employment and family structure and any examination failure. Factors associated with working less than full time included female gender, being an Australian medical graduate, provision of other medical work and having taken additional leave during training., Discussion: A high proportion of early-career GPs working part time in clinical general practice has implications for workplace planning, as GPs seek workload diversity and flexibility across their career stages.
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- 2022
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200. Immunising older Australians: Pre-COVID-19 associations of opportunistic immunisation in general practice registrar consultations.
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Tranter I, Magin P, Tapley A, Holliday E, Davey AR, Fielding A, Spike N, FitzGerald K, Ball J, and van Driel ML
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- Aged, Australia, Cross-Sectional Studies, Humans, Immunization, Referral and Consultation, Vaccination, COVID-19, General Practice education
- Abstract
Background and Objectives: Vaccine uptake in older Australians is suboptimal. This exploratory study aims to establish the associations of opportunistic older person immunisation in general practice registrars' practice., Method: This study was a cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. Univariate and multivariable regressions explored associations between vaccine recommendations and patient, registrar, practice and consultation factors., Results: A total of 2839 registrars provided data on 74,436 consultations. Associations of lower odds of immunisation included Aboriginal and Torres Strait Islander peoples (odds ratio [OR] 0.69; 95% confidence interval [CI]: 0.50, 0.96), rural/remote practice location (OR 0.75; 95% CI: 0.58, 0.98, compared with major cities) and in areas of greater relative socioeconomic disadvantage (OR per decile 1.03; 95% CI: 1.01, 1.05). Patients new to the practice (OR 2.46; 95% CI: 2.06, 2.94), or to the registrar (2.02; 95% CI: 1.87, 2.18) had higher odds of receiving an immunisation., Discussion: Our findings suggest that general practice registrars may be proactively facilitating immunisation in new patients, but that inequities in vaccination persist.
- Published
- 2022
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