Aust Fam Physician
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Serum creatinine concentration is an unreliable and insensitive marker of chronic kidney disease (CKD). To improve CKD detection, Australasian guidelines have recently recommended that laboratories calculate and report an estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula with every request for serum creatinine concentration. ⋯ The accuracy and precision of eGFRs are reasonable in most adults in whom calculated values are ENTITY lt 60 mL/min/1.73 m2. However, eGFRs should be interpreted with caution in some settings (particularly patients with eGFRs ENTITY gt 60 mL/min/1.73 m2 and children). Automatic laboratory reporting of eGFR will enhance early detection of CKD, allow the timely institution of appropriate reno- and cardio-protective therapies, and better inform decisions regarding the prescription of renally excreted medications.
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Self directed learning (SDL) for continuing medical education (CME) is the most effective approach for improving physician performance and patient care outcomes. Self directed learning is an essential basis for CME. ⋯ This article briefly examines the evolution of SDL and its importance in lifelong learning for general practice. The challenge for CME providers is to facilitate SDL while taking general practitioners' views and preferences into consideration.
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The Royal Australian College of General Practitioners (RACGP) has worked with funding from the Australian government to improve support and training for general practitioners working in Aboriginal and Torres Strait Islander communities. ⋯ The RACGP plays an important role in supporting GPs working in Aboriginal and Torres Strait Islander communities. This includes current RACGP Aboriginal and Torres Strait Islander health projects such as providing support for the NACCHO GP Network, provision of accessible relevant cultural safety training for GPs, a national meeting of those working in Aboriginal and Torres Strait Islander health, access to the RACGP library's Aboriginal and Torres Strait Islander health resource collection, and the ongoing distribution of other resources, as well as RACGP organisational support for a range of other initiatives. On an individual level, all GPs are challenged to work at being well informed, and to take a personal leadership role so they can play a part in improving Aboriginal and Torres Strait Islander health.
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Expenditure through major commonwealth funded health programs such as the Pharmaceutical Benefits Scheme (PBS) is much lower for Aboriginal and Torres Strait Islander peoples than other Australians. Section 100 of the National Health Act (1953) allows for special access arrangements where pharmaceutical benefits cannot be conveniently supplied. ⋯ The implementation of S100 medications for remote area Aboriginal health services (AHSs) represents a breakthrough in medicines access, and is one of the most significant improvements in health service delivery for many years. If we are to achieve equity in access to the PBS for all Aboriginal and Torres Strait Islander peoples, an extension of this initiative is necessary for rural and urban AHSs.