Depression in patients in general practice – and response

"I have concerns about the article by Arroll et al (NZ Med J 2002; 115: 176-9). The title of this article is misleading. It suggests the study had the goal of looking at the prevalence of depression in an Auckland general practice. It turned out the article had different goals. The authors' prime goal was to study the abilities of general practitioners (GPs) to diagnose depression as compared to the gold standard of the Beck's Diagnostic Inventory scale. The second goal was to measure the prevalence of depression in Maori and non-Maori patient groups. The final goal was to compare the prescribing of antidepressants in these two groups of patients ...

Practising GPs teaching medical students evidence based medicine: a questionnaire survey

BACKGROUND: The characteristics of practising general practitioners who teach evidence based medicine (EBM) during their clinical work – and their attitudes toward it – are poorly known. METHODS: One hundred and twenty-two Canberra GPs who previously had medical students attend their practice were sent a questionnaire on their education, experience, knowledge, confidence, and attitudes toward teaching EBM. RESULTS: Eighty-three (68%) GPs responded, 13% had postgraduate EBM training, and 20% taught EBM. A further 28% of GPs denied they were teachers of EBM but had asked students to find evidence to answer questions about patient care. Seventy-six percent of GPs could understand and explain at least one EBM term, and 17% over five terms. Most GPs welcomed EBM into their clinical work and agreed EBM improved students’ learning. Barriers to teaching included a perceived lack of time, staff support, and the need for more EBM teacher training. DISCUSSION: Although few GPs had trained in EBM, many were teaching it. University teaching programs should build on GP confidence in EBM teaching

Measuring the quality of general practice in New Zealand

The quality of the service provided by a general practice is the degree to which it conforms to some kind of standard of care. In New Zealand this standard has been developed as part of a framework comprising a set of activities with the common objective of improving the quality of care provided by general practices. The Royal New Zealand College of General Practitioners (RNZCGP) recently developed a framework for measuring quality. It measures factors that affect patients, physical factors affecting the practice, practice systems, practice and patient information management, quality improvement, and professional developmen

Patients and tests: a study into patient understanding of blood tests ordered by their doctor

Patient understanding of diagnostic tests is important in general practice. This study describes how patients understand information about their tests, using blood tests as an example

Developing a teaching research culture for general practice registrars in Australia: a literature review

OBJECTIVE: To ascertain the issues all general practice educators need to understand when educating GP registrars to learn about research. STUDY DESIGN: A review of MEDLINE [1996–2007], six websites and key informants produced 302 publications, which reduced to 35 articles, 7 books, and 9 policy documents. Results: Key themes that emerged from a thematic analysis of the literature that GP educators need to consider when teaching registrars about research were [i] the need to understand that learning research is influenced by attitudes; [ii] the need to address organisational constraints on learning research; [iii] the need to identify the educational barriers on learning research; [iv] the need to understand there are gaps in GP research content – especially from GP registrars; And [v] the need to understand the value of research on the GP registrar's educational cycle of learning, which develops in a culture that allows research to flourish. CONCLUSION: Australian GP registrars will observe a research culture only if they encounter clinician-researchers paid to practice and conduct research in their general practice

Sore throat management in New Zealand general practice

Aim: To describe the sore throat management practices by New Zealand general practitioners (GPs) and compare the rate of sore throat presentation over time. Method: Data were collected from the National Primary Medical Care Survey carried out over 2001/2002. Analyses were done on patients who presented to the GP with the symptom of a sore throat as one of their reasons for visit. A systematic review of the New Zealand literature was done for sore throat presentation to GPs since 1966. Results: There were 10,506 records of visits gathered from 246 GPs and 335 patients presented sore throat as a reason for visit. Patients presented sore throat at a rate (SE) of 3.6 (0.26) per 100 encounters and varied by age (p=0.004), but not by socioeconomic deprivation (p=0.415) or by ethnic group (p=0.165). Patients’ perceived urgency of visit had a greater impact in the rate of presentation for the 0–4 year age group than in the at-risk age group of 5–14 years (p=0.001). GPs recorded a ‘Read code’ diagnosis at a rate of 59.2 (3.96) recordings per 100 encounters. Among the 306 recorded diagnoses, 11.4% were explicit recordings of viral diagnoses. 7.6% of GPs ranked themselves as ‘moderately’ and 2.3% as ‘highly’ uncertain of their diagnosis. Throats swabs were taken at a rate of 6.6 (1.68) swabs per 100 encounters. Antibiotic prescribing rate was higher when sore throat was recorded as a reason for visit than not (p<0.001). There were no significant differences in throat swabs taken for sore throat patients prescribed an antibiotic or not (p=0.623). No Pacific person had a throat swab taken. Patients with sore throat who were Maori (73.5 [7.2]) or Pacific people (80.2 [17.3]) were more likely to be prescribed an antibiotic than Europeans (57.4 [4.62]). Since 1966, there were 16 New Zealand studies of patients presenting with respiratory disorders to their GP. Seven of these studies measured GP management of sore throat, and only 3 of these measured the rate of patients’ sore throat symptom presentation. The rate of patients’ sore throat presentation remained similar when compared with the Waikato study of 1991 (2.8%) that had a similar methodology. Conclusion: Sore throat continues to be a common symptom that GPs manage in their work. Ethnic differences may have a part to play in how GPs manage sore throat. More research is needed to discover those factors that would encourage a greater proportion at-risk 5–14 year old children to attend their GP with sore throat

Infant feeding practices and nut allergy over time in Australian school entrant children

Aim. To measure the association between infant feeding practices and parent-reported nut allergy in school entrant children. Method. The Kindergarten Health Check Questionnaire was delivered to all 110 Australian Capital Territory (ACT) primary schools between 2006 and 2009. Retrospective analyses were undertaken of the data collected from the kindergarten population. Results. Of 15142 children a strong allergic reaction to peanuts and other nuts was reported in 487 (3.2%) and 307 (3.9%), children, respectively. There was a positive association between parent reported nut allergy and breast feeding (OR = 1.53; 1.11–2.11) and having a regular general practitioner (GP) (OR = 1.42; 1.05–1.92). A protective effect was found in children who were fed foods other than breast milk in the first six months (OR = 0.71; 0.60–0.84). Conclusion. Children were at an increased risk of developing a parent-reported nut allergy if they were breast fed in the first six months of life

Psychological problems in New Zealand primary health care: a report on the pilot phase of the Mental Health and General Practice Investigation (MaGPIe)

Aim: To carry out a pilot study in two regions in order to investigate prevalence of psychological problems in primary care in New Zealand. Method: General Practitioners (GPs) within two geographic regions were randomly selected. All adult attenders at their practice on selected days were administered a short questionnaire, the GHQ-12, which assesses the presence of psychological symptoms. The GP recorded the reasons for each consultation, and was interviewed at the end of each day about selected patients, to determine their opinion about the type of psychological problems experienced. Results: Three-quarters of selected GPs (76%) agreed to participate. 96% of patients attending their GP agreed to complete the GHQ. Scores from 385 completed GHQ screening questionnaires suggested that 23.4% of GP patients had significant psychological symptoms. When GPs were asked about the main reason for consultation, they identified only 5.7% of current consultations as being for psychological reasons. In contrast, the GPs thought that 20.6% of patients described having some symptoms which were either mildly, moderately or completely psychological in the current consultation, and recognised that 17.4% of their patients had a mild, moderate or severe case of psychological disorder over the past twelve months. Conclusion: GPs identified one in five of their patients as having symptoms which were mildly, moderately or completely psychological, although psychological factors were the main reason for consultation in only one patient in twenty. Previous reports of very low rates of psychological problems among GP attenders in New Zealand have been thought to indicate major differences in access to health care or prevalence of common mental disorders within primary care services in this country. However, the apparently low rates of conspicuous mental disorder in New Zealand general practices may be better explained as an artifact of the type of questions asked

Attitudes of teachers to evidence based medicine

AIM: To describe the attitudes of general practitioners and specialist clinical teachers toward teaching evidence based medicine (EBM). PARTICIPANTS AND METHODS: Questionnaire survey of 114 general practitioner and 162 specialist university teachers teaching EBM. RESULTS: Two hundred and six (80%) teachers responded; 196 regularly consulted with patients, 21% had received training, and 40% taught EBM. Those with formal training (68%) taught more often than without (32%) (p=0.0001), 27% had taught EBM for over 5 years. More GPs (57%) than specialists (40%) asked students to assist in finding evidence (p=0.036). Most welcomed EBM and were confident in teaching it. Barriers included antagonism to EBM philosophy, shortage of time, and a need for training in teaching EBM. DISCUSSION: Although not all trained, GPs and specialists teach EBM, enjoy doing so, and want to increase their ability to teach it

Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study

BACKGROUND: In response to the escalating burden of chronic illness in Australia, recent health policies have emphasised the promotion of patient self-management and better preventive care. A notable omission from these policies is the acknowledgment that patients with chronic illness tend to have co-morbid conditions. Our objectives were: to identify the common challenges co-morbidity poses to patients and carers in their experiences of self-management; to detail the views and perceptions of health professionals about these challenges; and to discuss policy options to improve health care for people with co-morbid chronic illness. The method included semistructured interviews and focus groups with 129 purposively sampled participants. Participants were people with Type 2 diabetes, chronic obstructive pulmonary disease and/or chronic heart failure as well as carers and health care professionals. Content analysis of the interview data was conducted using NVivo7 software. RESULTS: Patients and their carers found co-morbidity influenced their capacity to manage chronic illness in three ways. First, co-morbidity created barriers to patients acting on risk factors; second, it complicated the process of recognising the early symptoms of deterioration of each condition, and third, it complicated their capacity to manage medication. CONCLUSION: Findings highlight challenges that patients with multiple chronic conditions face in relation to preventive care and self-management. Future clinical policy initiatives need to move away from single illness orientation toward strategies that meet the needs of people with co-morbid conditions and strengthen their capacity to self-manage. These patients will benefit directly from specialised education and services that cater to the needs of people with clusters of co-morbidities.NHMRC, Australian National University, University of Sydney, Menzies Centre for Health Polic