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

Hepatitis C virus (HCV): prevalence in a gynecological urgent care clinic population.

OBJECTIVE: To determine the prevalence of hepatitis C virus (HCV) among women seeking urgent gynecological care. METHODS: Women were asked to complete a short self-assessment screening of HCV risk. Those answering yes to any of the screening questions were offered HCV testing and were asked to complete a more detailed questionnaire. RESULTS: Among the 125 women who completed the screening questionnaire, 80% (100) answered yes to one or more of the screening questions. Of the 99 women who underwent testing, six (6.1%) were HCV seropositive; a history of injection drug use was the only finding associated with HCV seropositivity (R.R 9.7: 95% CI 1.90-49.40). CONCLUSIONS: Women seeking urgent outpatient gynecological care, particularly those who are injection drug users, are at a substantial risk of HCV infection. A careful risk assessment should be completed in order to identify women who should be offered HCV testing

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

Prospects for Sustainable Housing in Northern Ghana with the use of Local Walling Materials

In 2006 the World Bank described Ghana as a third World country having only 1 out of 3 persons sheltered. Suggestions were made that locally available materials instead of imported materials be used in building so as to cut down on costs and subsequently increase supply of housing units. In response, this study, focusing on Northern Ghana, conducted a cross-sectional survey of seventy respondents with a structured questionnaire to identify the major locally available walling material in use as well as find benefits and challenges associated with it. Unburnt earth bricks were identified as the major locally available walling material in use in Northern Ghana. Benefits found to be promoting its use were the thermal comforts it provided, the manner housing became cheaper, the cultural heritage that it promoted and the fact that only simple tools and methods were employed in its use as a building component. Challenges associated with the unburnt earth brick wall were, lack of recognition by Statutory Authorities, lack of strength and durability, challenges in satisfying new needs in building forms and functions, invasion by termites and rodents as well as its weakness in withstanding vagaries of the weather. Recommendations were made to overcome challenges associated with the use of the material with the aim of enhancing prospects of adopting it for sustainable housing. The study concluded that the Locally available walling material in the form of unburnt earth brick had a huge potential for sustainable housing in Northern Ghana if only government would, through competitive tenders among building technologists utilise existing research findings to get the material stabilised to the required strengths and characteristics so as to pave the way for its recognition by statutory authorities and subsequent packaging for commercial use in the building industry. This paper contributes to the body of knowledge in the areas of Environment, Architecture, Construction Management and Building Materials in a middle income country setting. Keywords: Local, Walling materials, Housing, Northern Ghana, Sustainability, Middle income countr

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

Designing citizen science tools for learning: lessons learnt from the iterative development of nQuire

This paper reports on a 4-year research and development case study about the design of citizen science tools for inquiry learning. It details the process of iterative pedagogy-led design and evaluation of the nQuire toolkit, a set of web-based and mobile tools scaffolding the creation of online citizen science investigations. The design involved an expert review of inquiry learning and citizen science, combined with user experience studies involving more than 200 users. These have informed a concept that we have termed ‘citizen inquiry’, which engages members of the public alongside scientists in setting up, running, managing or contributing to citizen science projects with a main aim of learning about the scientific method through doing science by interaction with others. A design-based research (DBR) methodology was adopted for the iterative design and evaluation of citizen science tools. DBR was focused on the refinement of a central concept, ‘citizen inquiry’, by exploring how it can be instantiated in educational technologies and interventions. The empirical evaluation and iteration of technologies involved three design experiments with end users, user interviews, and insights from pedagogy and user experience experts. Evidence from the iterative development of nQuire led to the production of a set of interaction design principles that aim to guide the development of online, learning-centred, citizen science projects. Eight design guidelines are proposed: users as producers of knowledge, topics before tools, mobile affordances, scaffolds to the process of scientific inquiry, learning by doing as key message, being part of a community as key message, every visit brings a reward, and value users and their time