Australian Journal of Primary Health
Volume 27 Number 4 2021
Living with diabetes and comorbidities in rural or remote areas may present particular barriers to the self-management of these conditions. This scoping review identified only 12 peer-reviewed papers that described or addressed the self-management of diabetes in this population. Only two successful interventions were reported, both specifically targeting the self-management of both diabetes and comorbidities. Telehealth may offer some potential as it overcomes limited access to health services.
PY20110 Abstract | PY20110 Full Text | PY20110PDF (342 KB) Open Access Article
PY20176Upscaling HIV and hepatitis C testing in primary healthcare settings: stigma-sensitive practice
This paper describes how clinicians working in primary healthcare can provide HIV and hepatitis C testing in the era committed to eliminating these viruses as public health priorities. It draws on findings from a Victorian consultation exploring best practice in pre- and post-test discussion. We step out, what we call, ‘stigma-sensitive practice’ as an approach to provide testing while attending to the stigmatisation of these viruses.
Medicare strains to supply quality primary care for those who cannot afford private billing GPs. What if patients decide their gap fee value based on their reflection of the service? We explore patient and doctor perceptions of the concept in the first such research into the idea. This model hopes to increase revenue for primary care bulk-billed clinics, while incentivising patient-centred care, without limiting access to those who cannot afford it.
PY20239Oral health care in urban general practice: what are the support and training needs?
Rural GPs often see patients with oral health problems. This research demonstrates that oral health presentations are also common in an outer urban area of Sydney with poor access to dental care. Like their rural colleagues, urban GPs lack confidence and likely also the knowledge, to manage common oral health presentations, though they are keen to learn. Based on this research, learning content and approaches are recommended for both GPs in training and those already in practice.
Learning evidence-based medicine (EBM) skills was introduced in the late 1990s and is now integral to university medical education. However, many practicing GPs trained before this and feel they lack training in this area. Evidence-based journal clubs (EBJCs) address this knowledge gap. GPs participating in this study noted their improved use of EBM in clinical practice by becoming more independent learners, facilitating consistent management approaches in group practices and aligning their skills in EBM with current students after attending EBJCs.
Influenza vaccination is an important public health strategy to reduce the prevalence of seasonal influenza, yet vaccination rates are suboptimal for Australian children. Our survey of GPs and GPNs showed a high level of understanding and positive attitudes to influenza immunisation for young children, the importance of making the influenza vaccine available free-of-charge, and strategies to address parental and health professional barriers. Our findings support the continued public funding for influenza vaccines and establishing dedicated influenza vaccination clinics for young children.
PY20209Incorporation of human papillomavirus self-sampling into the revised National Cervical Screening Program: a qualitative study of GP experiences and attitudes in rural New South Wales
Self-sampling was incorporated into the revised National Cervical Screening Program as a method to engage women who are overdue for screening, but it is dependent on GPs offering this option. Rural GPs reported challenges with incorporating self-sampling into their practice due to limited information provision and other systemic barriers. A more informative and high-level strategic approach may give GPs the confidence to facilitate self-sampling as a cervical screening tool for their patients.
Assessment of pain is challenging, and previous research has shown that doctors frequently underestimate severity. In comparing GP and physiotherapist assessments of pain, we can see profession-level differences in the accuracy of pain assessment. Through this we can begin to identify the differences in practice that may influence the accuracy of that assessment, as well as considering the clinical relevance of accurate assessment of pain severity.
PY20288Termination of pregnancy in Tasmania: access and service provision from the perspective of GPs
Despite being recognised as an important aspect of reproductive health, access to termination of pregnancy remains challenging in many countries. This study examined the extent of known barriers to accessing termination of pregnancy from the perspective of GPs. The results of the study provide insights that can guide interventions to improve the support and provision of termination of pregnancy in primary care.
PY20288 Abstract | PY20288 Full Text | PY20288PDF (161 KB) | PY20288Supplementary Material (4.5 MB) Open Access Article
PY20216Population-based analysis of sociodemographic predictors, health-related quality of life and health service use associated with obstructive sleep apnoea and insomnia in Australia
Given growing recognition of the burden of sleep disorders but poor rates of detection, this representative community-based study examined factors associated with diagnosed sleep apnoea and insomnia, and assessed the effects of these conditions. Distinct sociodemographic and lifestyle factors were associated with sleep apnoea and insomnia, and the adverse relationship between sleep disorders and physical and mental health-related quality of life was substantial and should not be underestimated. These findings highlight the potential for new approaches to manage these sleep disorders.
PY20228Doctors identify regulatory barriers for their patients with type 2 diabetes to access the nutritional expertise of dietitians
Most people with type 2 diabetes never see a dietitian despite the demonstrated benefits. This study explored doctors’ views and experiences with dietetic services and found that doctors refer their patients to dietitians, unless there is a cost issue, lack of access or lack of motivation by patients to see a dietitian. It is important to facilitate and subsidise access to dietetic services by increasing the number of visits on the chronic disease management scheme and provide referral rights to physicians.
Diabetes-related foot disease (DFD) is one of the most feared and costly complications of diabetes. With proactive preventative best practice footcare delivery in primary care, serious complications of DFD may be avoided. Having an understanding of the barriers faced by primary care clinicians in the provision of diabetes-related foot care, as well as the enablers that promote foot care, offers a catalyst for the development and translation of effective intervention strategies across health systems, policy, funding, curriculum and clinical practice.
With ~12 people undergoing a diabetes-related amputation and four people dying daily due to diabetes-related foot disease in Australia, there is an obvious need to assess and prioritise preventative foot care to people with diabetes. Barriers to diabetes-related footcare delivery in primary care are multifaceted, and need to be addressed through the continuation or initiation of a variety of strategies that are underpinned by the elements of co-design, consultation, collaboration, consolidation and co-commissioning.