Fundholding: learning from the past and looking to the future

The document attached has been archived with permission from the editor of the Medical Journal of Australia (26 April 2007). An external link to the publisher’s copy is included.Australian trials of healthcare initiatives that included fundholding models have not produced convincing quantitative evidence of health gains, but there is qualitative evidence of improved patient well-being and significant changes in service mix, which may produce longer-term health gains. Fundholding is most likely to improve patient outcomes when implemented within a broader healthcare initiative that has the potential to be more effective if financed outside existing funding structures. The most appropriate fundholder organisation depends on the nature of the initiative and the type of stakeholder engagement required, but technical and organisational skills will always be needed for balancing financial viability and additional patient services. Stakeholders’ willingness to engage in fundholding depends on the anticipated budget impact, how they will use the savings generated, and whether workforce needs will be fulfilled. Before including fundholding in healthcare initiatives, there must be realistic prospective analyses and community debate. Monitoring and evaluation frameworks must also be in place to provide ongoing evidence of quality of care, health and well-being outcomes and financial implications for fund contributors.Justin J Beilby and Brita Pekarsk

Preventive activities during consultations in general practice : influences on performance

Copyright © 2005 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.BACKGROUND: The relationship between the performance of opportunistic preventive activities in general practice consultations and characteristics of patients, general practitioners, consultations and preventive opportunities is poorly understood. METHODS: We recorded the performance of 11 preventive care activities by 10 GPs in one practice and examined the associations of performance of the preventive activities and the characteristics of the patients, GPs, consultations and preventive opportunities. RESULTS: Every patient, GP, consultation and preventive opportunity characteristic studied was independently significantly associated with the performance of at least two of the preventive activities. DISCUSSION: These findings suggest ways of designing more effective reminders, particularly for patients least likely to receive prevention counselling.Oliver Frank, John Litt and Justin Beilb

Opportunistic electronic reminders : improving performance of preventive care in general practice

Copyright © 2004 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.BACKGROUND: Preventive care is an important role for general practitioners, yet opportunities for prevention are often missed. METHOD: We provided an automatic electronic record preventive care reminder system for 12 preventive care activities for one 10 doctor practice. All patients who attended were randomised by the terminal digit of their record number. RESULTS: The control uptake of opportunistic prevention was low; ranging from 1.5% (tetanus immunisation) to 27% (influenza immunisation). The reminders increased this by significant but small amounts for four out of 12 activities (immunisation for tetanus and pneumococcus and recording of allergies and weight), insignificant increases for four (mumps, measles and rubella immunisation, recording of smoking, and taking of cervical smears and of blood pressure), and insignificantly decreased influenza immunisation, and screening for diabetes and hyperlipidaemia. DISCUSSION: Opportunistic electronic reminders have the potential to increase preventive care in general practice.Oliver Frank, John Litt and Justin Beilb

Talking to patients about death and dying

Copyright © 2004 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.INTRODUCTION: Talking about death and dying, either with patients terminally ill or well, presents challenges for the general practitioner. There are few Australian educational resources and little Australian research into this area. METHODS: We undertook two focus groups, an interview process, and a final consultation with palliative care experts and GPs. RESULTS: General practitioners felt they needed support and education in talking about death and dying. This is separate from discussions about 'Advanced Health Care Directives'. General practitioners were open to learning new ways to help patients and families approach dying, but require support and education around initiating discussions, asking the right questions and accessing services. Participating GPs emphasised the importance of utilising palliative care supports and resources to provide ongoing spiritual and physical care. Many were particularly concerned with access to support for dying patients for both indigenous patients and those from other cultures. Advance Health Care Directives were regarded by participating GPs to be tools to facilitate a discussion around death and dying, rather than their primary purpose. DISCUSSION: We developed a booklet to provide practical, useful guidelines for GPs in their daily practice.Teresa A. Burgess, Mary Brooksbank and Justin Beilb

The impact of a stuttering disorder on Western Australian children and adolescents

In this study, we examined the impact of a stuttering disorder on children (n=50) and adolescents (n=45) living in Western Australia. We compared the reactions and experiences of children and adolescents who stutter to children and adolescents who do not stutter. We compared the participants who stuttered and the fluent participants using adapted versions of the Overall Assessment of the Speaker’s Experience of Stuttering (OASES). We also examined the relationship between biopsychosocial impact and stuttered speech frequency. We saw higher levels of adverse impact in young people who stuttered compared to their fluent peers. In addition, we found moderate correlations between OASES scores and stuttered speech frequency in children. These findings provided a baseline for establishing the degree of negative impact that a stuttering disorder may bring about in children and adolescents. The experiences of young people who stuttered were significantly different from the experiences of young people who were typically fluent. These findings reinforce the notion that stuttering is a disorder that can lead to negative impact for young people

People aged to 18 years per metropolitan and rural GP

Copyright © 2005 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.The authors report that the 0–18 years age group is 25% of the population. The 0–18 year population ratio per rural GP in South Australia is nearly three times greater than for metropolitan GPsDavid Petchell, Justin J. Beilby and Don M. Roberto

How do Australian GPs manage shoulder dysfunction?

Copyright © 2004 Royal Australian College of General PractitionersNorman A Broadhurst; Angela Gialamas; Heather J McElroy; Justin J Beilb

Electronic decision support systems at point of care: trusting the deus ex machina

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Justin J Beilby, Andre J Duszynski, Anne Wilson and Deborah A Turnbul

Collaborative medication management services: improving patient care

The document attached has been archived with permission from the editor of the Medical Journal of Australia (10 January 2008). An external link to the publisher’s copy is included.Objective: To implement and evaluate a collaborative medication management service model. Design: Participatory action research. Setting and participants: The study was conducted from March 1999 to March 2000; 1000 patients, 63 pharmacists and 129 general practitioners from six Divisions of General Practice in South Australia participated. Interventions: A collaborative service delivery model, involving a preliminary case conference, a home visit and a second case conference, was agreed through discussions with medical and pharmacy organisations and then implemented. Outcome measures: Medication-related problems; actions recommended; actions implemented; and outcomes after actions taken. Results: Overall, 2764 problems were identified. The most common medication-related problem (17.5% of all problems) was the need for additional tests. Thirty-seven per cent of problems related to medicine selection, 20% to patient knowledge, and 17% to the medication regimen. Of 2764 actions recommended to resolve medication-related problems, 42% were implemented. Of the 978 problems for which action was taken and follow-up data were available, 81% were reported to be "resolved", "well managed" or "improving". Conclusion: This implementation model was successful in engaging GPs and pharmacists and in assisting in the resolution of medication-related problems.Andrew L Gilbert, Elizabeth E Roughead, Justin Beilby, Kathy Mott and John D Barrat

Uptake of spirometry training by GPs

Please see first page of PDF for this item. Copyright © 2006 Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.Justin Beilby, Clare Harper, Christine Holton, Judy Proudfoot, Mark Harri