Australian journal of primary health
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General practice is an ideal setting to be providing nutrition advice; however, it is important that the role of general practitioners (GPs) and practice nurses in providing nutrition advice is acknowledged and defined. This article aims to discuss the role of GPs and practice nurses in the delivery of nutrition advice. Ten general practitioners and 12 practice nurses from a NSW urban Division of General Practice participated in questionnaires and a Lifescripts implementation study, as well as their consenting patients receiving Lifescripts (n=13). ⋯ The provision of basic nutrition advice is acknowledged to be part of the role of GPs and practice nurses, as they are the first point of contact for patients, allowing them to raise nutrition awareness. However, it is important that this advice is evidence based and able to be delivered in a time-efficient manner. Increased nutrition education and the availability of appropriate resources and nutrition-related best practice guidelines will assist in this process.
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The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. ⋯ GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor-patient communication. The impact ofthe modified PACE Australia program on the processes and outcomes ofGP care ofchildren with asthma is now being measured in a randomised controlled trial.
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Health care improvement is always on the planning agenda but can prove frustrating when 'the system' seems to have a life of its own and responds in unpredictable ways to reform initiatives. Looking back over 20 years of general practice and primary health care in Australia, there has been plenty of planning and plenty of change, but not always a direct cause and effect relationship between the two. ⋯ However, when interpreted through human sociology and psychology, a complexity perspective offers a better match with everyday human experience of change. As such, it offers some suggestions for leaders, policy makers and managers in health care: that uncertainty and paradox are inherent in organisational change; that health care reform must pay attention to the constraints and politics of the everyday; and that change in health systems results from the complex processes of relating among those involved and that neither 'the system' nor a few individuals can be accountable for overall performance and outcomes.
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Multicenter Study Comparative Study
Primary oral health service provision in Aboriginal Medical Services-based dental clinics in Western Australia.
Australians living in rural and remote areas have poorer access to dental care. This situation is attributed to workforce shortages, limited facilities and large distances to care centres. Against this backdrop, rural and remote Indigenous (Aboriginal) communities in Western Australia seem to be more disadvantaged because evidence suggests they have poorer oral health than non-Indigenous people. ⋯ The rate of emergency at the non-AMS clinic was 33.5%, compared with 79.2% at the AMS clinics. The present study confirmed that more Indigenous patients were treated in AMS dental clinics and the mix of dental care provided was dominated by emergency care and oral surgery. This indicated a higher burden of oral disease and late utilisation of dental care services (more focus on tooth extraction) among rural and remote Indigenous people in Western Australia.
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As part of the Department of Human Services Hospital Admissions Risk Program (HARP), a group of acute and community based health care providers located in the western suburbs of Melbourne formed a consortium to reduce the demand on hospital emergency services and improve health outcomes for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). The model of care was designed by a team of multidisciplinary specialists and medical consultants. In addition to receiving normal care, patients recruited to the project were assessed by 'Care Facilitators', who identified unmet health care needs and provided information, advice and education for the patient concerning their condition and self-management. ⋯ Recruited CHF patients also displayed reductions in emergency presentations (39%), admissions (36%) and hospital inpatient bed-days (33%), whereas those who declined recruitment displayed lesser reductions for ED presentations (26%) and admissions (20%), and increased their use of hospital inpatient bed-days (15%). The recruited COPD patients reported a significant reduction in their symptoms (P<0.005) and the CHF patients reported an improvement in their overall health and quality of life scores (P<0.001). The outcome measures used in this evaluation suggest that an integrated care facilitation model that is patient focussed, provides an education component to promote greater self-management compliance and delivers a continuum of care through the acute and community health sectors, may reduce the utilisation of acute health care facilities and benefit the patient.