Measuring older patients’ attitudes to general practice registrars: Exploratory factor analysis of a survey instrument

Introduction: Training general practice registrars (GPRs) to meet the challenges of an ageing population is hampered by their relatively reduced contact with older patients and a paucity of suitable research to inform training models. This paper describes an exploratory factor analysis of a survey instrument assessing the attitudes of older patients to GPRs, as part of a project to address these concerns. Methods: The instrument was developed on the basis of a qualitative study and a literature review and distributed to 500 patients aged 60 years and over from 10 training practices in regional Australia. Responses to 22 of the survey’s Likert scale items were examined, including inter-item correlations and internal consistency (Cronbach’s alpha). Exploratory factor analysis was performed to identify domains of patients’ attitudes. Results: The response rate was 39.2% (n=196). None of the items were redundant and the scale had appropriate levels of internal consistency (Cronbach’s alpha = 0.76). The exploratory factor analysis identified three factors. Factor one, labelled ‘interpersonal trust’, explained 26.2% of the variance. Factor two accounted for 11.4% of the variance and was labelled ‘system trust’. Factor three, labelled ‘interpersonal continuity’, explained 7.5% of the variance. Conclusion: The instrument demonstrated acceptable psychometric properties and three distinct factors reflecting older patients’ attitudes toward GPRs, with trust appearing to be particularly important. The instrument appears effective in obtaining valid data, which should assist in developing improved training models. These findings warrant confirmation with a larger sample and exploration of adaptations of the instrument to be used in other contexts. Keywords: general practice registrar; post-graduate training; patient attitude

An Australian discharge summary quality assessment tool: A pilot study

Background and objective Patients\u27 transition from hospital care to their general practitioner (GP) can put them at risk of unforeseen adverse events, which can be minimised by the GP receiving timely access to hospital discharge summaries. The objective of this article was to develop and pilot a discharge summary assessment tool, inclusive of components that Australian GPs identified as being most important for the safe transfer of care. Method Development of the instrument was informed by a literature review pertaining to key components of effective discharge summaries. These components were included in a survey instrument, which was piloted by Australian GP participants. Results From 118 responses, the five highest ranked components of a discharge summary included lists of medications on discharge, diagnoses on discharge, reasons for any changes in medications, and details of follow-up arrangements and treatment in hospital. Discussion This paper describes the initial development and results of piloting an Australian discharge summary quality assessment tool

Older patients\u27 attitudes to general practice registrars: a qualitative study

Background Research suggests that older patients may be reluctant to engage general practice registrars (GPRs) in their care. The authors undertook a qualitative study of the attitudes of older patients to GPRs to investigate this issue. Method Thirty-eight patients aged 60 years and over from three training practices participated in semistructured telephone interviews, which explored patients responses to GPRs. The interviews were recorded, transcribed and analysed using a template analysis approach. Results Analysis of the interviews produced five major themes concerning patient attitudes to GPRs: desire for continuity, desire for access, openness, trust and a desire for meaningful communication. Discussion Older patients attitudes to GPRs cannot be viewed in isolation from their relationship with their usual general practitioner, and this needs to be taken into account when engaging GPRs in the care of older patients. Systems need to be developed to maintain relational and informational continuity with older patients\u27 regular GPs

Contraceptive Implanon: Why do GPs get asked to remove it early?

Nineteen women aged 18 to 39 years of age from four Coast City Country GP Training practices were interviewed regarding their experiences with Implanon and the reasons for early removal. All participants were in relationships and approximately half had children

Role of Area-Level Access to Primary Care on the Geographic Variation of Cardiometabolic Risk Factor Distribution: A Multilevel Analysis of the Adult Residents in the Illawarra—Shoalhaven Region of NSW, Australia

Background: Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. Methods: Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for individual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region. Results: Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91–0.96) and obesity (OR 0.91, CI 0.88–0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4–1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%. Conclusion: The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and individual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region

A feasibility study of team-based primary care for chronic disease management training in rural Australia

Increasing rates of chronic disease management (CDM) are projected to contribute to significant effective shortfalls in the primary care workforce in Australia.1 Additionally, rural Australia carries a higher burden of chronic illness2 and has existing medical workforce shortages.3 Therefore, it is imperative that rural primary care maximises the efficiency of the CDM it provides

Using health risk assessments to target and tailor: An innovative social marketing program in aged care facilities

The number of Australians over the age of 65 years is expected to double by 2021. Many older Australians suffer from one or more chronic diseases - including cancer, coronary heart disease, respiratory diseases (AIHW, 2009) resulting in increased morbidity and mortality, lower quality of life and a higher need for health care (Hickey and Stilwell, 1991). There is increasing evidence that the adoption of healthy lifestyles can have significant benefits even into older age (Haveman-Nies et al, 2002). This project utilized a social marketing framework to support aged residents of retirement homes to adopt healthy lifestyle behaviours to improve their health

Serious Mental Illness, Neighborhood Disadvantage, and Type 2 Diabetes Risk: A Systematic Review of the Literature

Aim of the Study: This review aims to systematically synthesize the body of literature examining the association between neighborhood socioeconomic disadvantage and serious mental illness (SMI)-type 2 diabetes (T2D) co-occurrence. Methods: We conducted an electronic search of four databases: PubMed, Scopus, Medline, and Web of Science. Studies were considered eligible if they were published in English, peer reviewed, quantitative, and focused on the association between neighborhood disadvantage and SMI-T2D comorbidity. Study conduct and reporting complied with PRISMA guidelines, and the protocol is made available at PROSPERO (CRD42017083483). Results: The one eligible study identified reported a higher burden of T2D in persons with SMI but provided only a tentative support for the association between neighborhood disadvantage and SMI-T2D co-occurrence. Conclusion: Research into neighborhood effects on SMI-T2D comorbidity is still in its infancy and the available evidence inconclusive. This points to an urgent need for attention to the knowledge gap in this important area of public health. Further research is needed to understand the health resource implications of the association between neighborhood deprivation and SMI-T2D comorbidity and the casual pathways linking them

Patients\u27 attitudes towards chaperone use for intimate physical examinations in general practice

BACKGROUND: The objective of this article is to investigate patients\u27 attitudes to the use of chaperones for intimate physical examinations (IPEs) in a sample of Australian general practices. METHODS: A cross-sectional survey of adult patients from 13 randomly selected general practices in regional New South Wales was conducted between September and November 2012. Generalised linear mixed models were used for analysis. RESULTS: Of 780 surveys distributed, 687 (88%) were returned; the age range was 18-91 years and 356 (52%) were from female patients. Most women had never had a chaperone present for a Papanicolaou (Pap) smear (82.6%). Between 23% and 33% of respondents preferred a chaperone with their usual general practitioner (GP) across IPEs and gender of the respondents. The odds of preference for a chaperone were significantly less with a GP whom the respondents did not know well, compared with their usual GP, for a Pap smear (female) or genital examination (male). DISCUSSION: Individualised discussion regarding chaperone use for IPEs is warranted, especially with patients seeing their usual GP

Management of Intracranial Meningiomas Using Keyhole Techniques

BACKGROUND: Keyhole craniotomies are increasingly being used for lesions of the skull base. Here we review our recent experience with these approaches for resection of intracranial meningiomas. METHODS: Clinical and operative data were gathered on all patients treated with keyhole approaches by the senior author from January 2012 to June 2013. Thirty-one meningiomas were resected in 27 patients, including 9 supratentorial, 5 anterior fossa, 7 middle fossa, 6 posterior fossa, and 4 complex skull base tumors. Twenty-nine tumors were WHO Grade I, and 2 were Grade II. RESULTS: The mean operative time was 8 hours, 22 minutes (range, 2:55-16:14) for skull-base tumors, and 4 hours, 27 minutes (range, 1:45-7:13) for supratentorial tumors. Simpson Resection grades were as follows: Grade I = 8, II = 8, III = 1, IV = 15, V = 0. The median postoperative hospital stay was 4 days (range, 1-20 days). In the 9 patients presenting with some degree of visual loss, 7 saw improvement or complete resolution. In the 6 patients presenting with cranial nerve palsies, 4 experienced improvement or resolution of the deficit postoperatively. Four patients experienced new neurologic deficits, all of which were improved or resolved at the time of the last follow-up. Technical aspects and surgical nuances of these approaches for management of intracranial meningiomas are discussed. CONCLUSIONS: With careful preoperative evaluation, keyhole approaches can be utilized singly or in combination to manage meningiomas in a wide variety of locations with satisfactory results