Australian journal of primary health
-
This article reviews the literature concerning barriers in making a diagnosis of dementia in general practice and examines these from a rural perspective. It is proposed that the increasing prevalence of dementia in coming years in Australia will be felt most keenly in rural communities where there are already shortages of GPs and dementia-specific services to manage growing demand. ⋯ This review examines these barriers and their impact on making a dementia diagnosis from a rural general practice perspective. Identification of these practice issues and their influence on service delivery is essential to inform relevant policy decisions and to improve dementia management in rural general practice.
-
Comparative Study
How do rural GPs' workloads and work activities differ with community size compared with metropolitan practice?
Rural communities continue to experience shortages of doctors, placing increased work demands on the existing rural medical workforce. This paper investigates patterns of geographical variation in the workload and work activities of GPs by community size. Our data comes from wave 1 of the Medicine in Australia: Balancing Employment and Life longitudinal study, a national study of Australian doctors. ⋯ Our results showed that a GP's total hours worked per week consistently increases as community size decreases, ranging from 38.6 up to 45.6h in small communities, with most differences attributable to work activities of rural GPs in public hospitals. Higher on-call workload is also significantly associated with smaller rural communities, with the likelihood of GPs attending more than one callout per week ranging from 9% for metropolitan GPs up to 48-58% in small rural communities. Our study is the first to separate hours worked into different work activities whilst adjusting for community size and demographics, providing significantly greater insight to the increased hours worked, more diverse activities and significant after-hours demands experienced by current rural GPs.
-
Opioid substitution therapy (OST) is a well-recognised, evidence-based treatment for opioid dependence. Since the early 1990s, Australia has used a community-based general practitioner (GP) model ofprescribing, particularly within the state of Victoria, where over 85% of OST prescribing is undertaken by GPs in community settings. Yet the majority of GPs invited to complete the required OST training decline the offer, while of those who complete training, the majority prescribe to few or no patients. ⋯ General practitioners who became regular prescribers were highly committed with lengthy general practice experience. Concerns exist about the recruitment process for OST prescriber training, where nearly all GPs decline the offer of training, and the barriers that prevent GPs prescribing after training. Action is needed to address barriers to GP OST training and prescribing, and further research is necessary to ascertain measures required to facilitate long-term prescribing.
-
Health access behaviours of doctors need to be understood if the profession is to adequately respond to concerns raised about doctors' health. There has been limited investigation of these issues and most qualitative studies have focussed on doctors who have been seriously unwell. This research project was designed to explore doctors' attitudes to health access and the barriers they experience using six independently facilitated focus groups (37 general practitioners) in Brisbane, Australia. ⋯ A framework of patient, provider and profession barrier domains is developed to enable a comparison between the health access barriers of the doctor and those experienced by the general community. The complexity is highlighted as the socio-cultural factors woven through these barrier domains are recognised. The potential for this framework to provide a structure for future interventions to enhance doctors' health access is discussed.
-
Mass gatherings such as Schoolies Festivals are often situated in existing communities. Schoolies Festivals are generally unbounded, transient mass gathering events that are situated within various coastal communities around Australia. Mass gatherings are traditionally examined as separate case studies or through using a mass gathering framework to assess patient safety. ⋯ As a primary health care framework, the Ottawa Charter provides researchers and policy makers with the capacity to think 'outside the square' to develop strategies to prevent harm for young people attending such events. In addition the Ottawa Charter is a useful framework as it views the health of whole populations and maintains its relevance today. Through examining the needs of the community through a primary health care framework, the interface between the Schoolies event and the wider community can be examined to address some of the underlying structural factors that contribute to the safety of young people at Schoolies Festivals.