Primary care respiratory journal : journal of the General Practice Airways Group
-
Australia has a complex health system with policy and funding responsibilities divided across federal and state/territory boundaries and service provision split between public and private providers. General practice is largely funded through the federal government. Other primary health care services are provided by state/territory public entities and private allied health practitioners. Indigenous health services are specifically funded by the federal government through a series of Aboriginal Community Controlled Organisations. NATIONAL POLICY AND MODELS: The dominant primary health care model is federally-funded private "small business" general practices. Medicare reimbursement items have incrementally changed over the last decade to include increasing support for chronic disease care with both generic and disease specific items as incentives. Asthma has received a large amount of national policy attention. Other respiratory diseases have not had similar policy emphasis. ⋯ Australia's complex primary health care system is incrementally changing from one of exclusive acute- and episodic-care orientation in both the public and private sectors to a system that delivers effective anticipatory chronic disease care as well. From a national policy perspective, asthma has received most attention. COPD and possibly other respiratory diseases may now receive focus.
-
Patients with chronic obstructive pulmonary disease (COPD) receive poor end-of-life (EoL) care, in part because their disease course is not predictable. If the family physician would not be surprised at the patient's death within a year, then EoL issues should be raised for discussion. ⋯ Appropriately-used systemic (not nebulised) opioids are safe and effective for managing dyspnoea. The family physician is in an excellent position to provide comprehensive EoL care for COPD patients.
-
Undiagnosed and retained foreign bodies may result in serious complications such as pneumonia, atelectasis, or bronchiectasis. In this report, the authors present a rare case of temporary bronchiectasis of the left lung due to a long-standing retained foreign body in a child. Interestingly, the whole left lung was affected due to the check valve type of obstruction of the main bronchus. Unexpected, unilateral findings on a chest x-ray or a CT scan could be related to an inhaled foreign body, and any delay in making the diagnosis may result in serious complications.
-
Randomized Controlled Trial
COPD screening efforts in primary care: what is the yield?
Underdiagnosis of COPD appears to be common, although the degree of underdiagnosis is rarely measured. To document the extent of underdiagnosis in a high risk group of ambulatory patients, we performed spirometry in smokers aged 40 years and over drawn from general practices in two countries. ⋯ Screening of smokers over 40 in general practice may yield 10 - 20% undiagnosed COPD cases, with a substantial proportion of these having moderate to severe disease. Earlier diagnosis through targeted case-finding will allow early, aggressive smoking cessation efforts and may lead to a reduction in the burden of COPD symptoms and a reduced impact of the disease on health-related quality of life in these patients.
-
Concerns have been expressed by patient and professional bodies, and the UK Parliamentary Health Select Committee, about the poor standard of allergy teaching in UK medical schools. It is argued that this deficiency is an important contributing factor to the generally poor quality of care experienced by patients with allergic disorders. Allergy services are currently being reviewed by the Scottish Executive and Department of Health for England. ⋯ Although formal teaching on allergic disorders has been identified in a number of modules throughout the five years, it is not comprehensively described in the course documentation and significant gaps exist. We accept that the delivered curriculum may not be captured by the level of detail present in the learning objectives and recommend that further mapping and triangulation is undertaken through student focus groups and information gathering from teaching staff. We also recommend that in the absence of informal and clinical attachment opportunities in allergic disorders, the stated learning objectives be developed into a coherent vertical element throughout the medical curriculum. This, together with an advocate and suitable assessment, would increase the impact of allergy training on students and emphasise the knowledge and skills required to deliver high quality allergy care.