76 research outputs found
Exploring the role of the general practitioner in obesity management in Australian primary care
As obesity prevalence continues to rise, approximately one third
of patients seen by Australian
general practitioners (GPs) are living with obesity. General
practice is the cornerstone of primary
care in Australia with 85% of the population seeing a GP at least
annually. The current role of the GP
in obesity management focuses on care co-ordination with
guidelines encouraging the referral of
patients to allied health services, including dietitians and
exercise physiologists. But multidisciplinary
team care is not always available due to factors such as location
and cost, or patients
may have a preference for working more closely with their GP.
Currently there are no weight
management programs where care is delivered by a GP. This
doctoral work explores the current role
of the GP in obesity management in Australia, outlines an
intervention development study for a GPdelivered
weight management program, and presents the findings of a
feasibility trial of the
program.
Following the UK Medical Research Councilâs Guidelines for the
Development of a Complex
Intervention, a GP-delivered weight management program was
developed. The draft program was
based on Australian evidence-based guidelines for obesity
management and used a qualitative
approach to engage stakeholders to refine the program materials.
Following this intervention development, a six-month feasibility
trial was undertaken in five general
practices involving 11 GPs and 23 patients. Guided by
Normalisation Process Theory, both
quantitative and qualitative data were collected. Both GPs and
patients reported high rates of
acceptability and feasibility, and there was a low dropout rate
with only three patients withdrawing.
Based on the theoretical framework of Bordin, patients and GPs
with a strong therapeutic alliance
had better program retention and there was a trend to improvement
in some health outcomes.
Social cognitive theory suggests that âperformance masteryâ
is the most effective way to develop
self-efficacy. This was demonstrated in the feasibility trial
with both qualitative and quantitative data
showing the GPs improved self-efficacy for obesity management.
Based on the findings in the feasibility trial, a modified
approach to obesity management in primary
care is suggested with a greater emphasis on therapeutic
relationship, person-centredness, and the
explicit recognition that care occurs over time and not within
one consultation. A GP-delivered
weight management program in Australia was demonstrated to be
feasible and acceptable to both
patients and their GPs. Future research will focus on a
pseudo-cluster randomised controlled trial for
effectiveness, alongside further development of a measure for
therapeutic alliance in general
practice for research, teaching, and clinical purposes
A collaborative process for developing a weight management toolkit for general practitioners in Australiaâan intervention development study using the Knowledge To Action framework
BACKGROUND:
Obesity is commonly seen in the Australian general practice population; however, few resources are specifically targeted at GPs working with these patients. The National Health and Medical Research Council (Australia) guideline for managing patients who are overweight and obese supports the involvement of a regular health professional. As 85 % of the population visit a GP annually, resources to support GPs working with this patient population are needed.
This study describes the collaborative process used to develop an obesity management programme based on current Australian guidelines for GPs and their patients to be used in primary care. The Knowledge To Action framework was applied to develop a weight management toolkit for GPs based on current Australian guidelines. This draft was then reviewed by clinical GPs, GP registrars, consumer representatives and allied health professionals using focus groups and interviews. The participants gave feedback on the content, layout and acceptability of the documents. The feedback from the stakeholder groups was evaluated, and changes were incorporated into the final documents. A graphic designer was contracted to assist with the layout to improve useability and attractiveness of the documents.
RESULTS:
A total of 38 participants gave feedback on the draft weight management programme, and the research team amalgamated their responses to further improve the documents. The general response from GPs and consumer representatives was positive with most conveying their wish to try the programme themselves.
CONCLUSIONS:
âThe Change Programâ is a practical tool for Australian GPs to use with their patients who are overweight or obese. It was developed in collaboration with GPs, allied health professionals and consumer stakeholders based on current Australian guidelines. It is currently being piloted in five general practices.This work was funded by a research grant from the Royal Australian College
of General Practitioners/Independent Practitioner Network Pty Ltd Research
Grant
The Change Program: A pilot implementation trial of a general practitioner-delivered weight management program in primary care
This pilot study aims to evaluate the feasibility of a GP-delivered weight management program for overweight and obese adults in primary care. The project team will receive both qualitative and quantitative feedback from participating GPs and their patients regarding the usefulness, practicality and implementation of the program that has been developed.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy
To own or not to own: How can we best educate general practice registrars about practice ownership?
Background Despite low uptake of practice ownership by recent trainees, research has shown that registrars are interested in learning about practice ownership. We aimed to determine how registrars would prefer to learn these skills during general practic
Metabolic syndrome and weight management programs in primary care: a comparison of three international healthcare systems
Lifestyle behaviours are contributing to the increasing incidence of chronic disease across all developed countries. Australia, Canada and the UK have had different approaches to the role of primary care in the prevention and management of lifestyle-related diseases. Both obesity and metabolic syndrome have been targeted by programs to reduce individual risk for chronic disease such as type 2 diabetes. Three interventions are described- for either obesity or metabolic syndrome - that have varying levels of involvement of GPs and other primary care professionals. The structure of a healthcare system for example, financing and physical locations of primary care clinicians, shapes the development of primary care interventions. The type of clinicians involved in interventions, whether they work alone or in teams, is influenced by the primary care setting and resource availability. Australian clinicians and policymakers should take into account the healthcare system where interventions arc developed when translating interventions to the Australian context
Exploring the psychometric properties of the Working Alliance Inventory in general practice : a cross-sectional study
Contains fulltext :
232432.pdf (Publisherâs version ) (Open Access)BACKGROUND: The therapeutic alliance is a framework from psychology that describes three components: goals, tasks, and bond. The Working Alliance Inventory adapted for general practice (WAI-GP) measures the strength of the therapeutic alliance between the patient and the clinician, and it could be useful in both research and clinical settings. AIM: To determine if the patient score on WAI-GP can delineate the three components (goals, tasks, and bond), and to test concurrent validity with the Consultation and Relational Empathy (CARE) measure and the Patient Perception of Patient-Centredness (PPPC) measure. DESIGN & SETTING: A cross-sectional study took place in 12 general practice waiting rooms in Australia. METHOD: The research instruments included the 12-item WAI-GP (the patient version), the CARE and PPPC measures, plus a survey of demographics and reason for consultation. To perform a principal components factor analysis of the WAI-GP, this dataset was combined with an existing dataset. The Spearman rank correlation was used to determine concurrent validity between the WAI-GP and the CARE and PPPC measures. RESULTS: Participants (97-99%) reported a strong positive alliance after the consultation (average WAI-GP mean 4.27 ± 0.67 out of 5, n = 146). Factor analysis could not separate the three components (one factor, eigenvalue >1; Cronbach's α = 0.957; n = 281). Concurrent validity was supported by moderate correlations with the other measures (PPPC Ï = -0.51, P<0.005, CARE Ï = 0.56, P<0.005). CONCLUSION: Three components could not be identified, but the WAI-GP has a high internal consistency and concurrent validity with moderate correlations with the CARE and PPPC. A more diverse sample may better distinguish the three components leading to more specific feedback to clinicians on their consultation practices
Hidden curriculum within nutrition education in medical schools
Introduction Previous attempts to enhance medical nutrition education have typically focussed on studentsâ acquiring nutrition knowledge or skills. Given that medical training uses an apprenticeship model of training, surprisingly few studies have explored the âhidden curriculumâ that students experience regarding expectations of behaviour, roles and responsibilities regarding nutrition. This study explored medical studentsâ perceptions and experiences regarding medical nutrition education, focussing on the context in which nutrition teaching has been provided, the presented place of nutrition within medicine and their subsequent views on their role in providing nutrition care.
Methods Individual semi-structured qualitative interviews were conducted with 14 postgraduate medical students at different stages of their medical degree in Australia. The interviews were conducted using case studies followed by interview questions. Data were audio recorded, transcribed, coded and then underwent inductive thematic analysis.
Results Three themes were discovered (i) Valuing nutrition in the medical management of patients whereby students perceived nutrition to be a foundational and central component of ideal medical management for patients, particularly those with chronic disease; (ii) Fluctuating emphasis on nutrition which showed that students experienced diversity in the importance placed on nutrition by others and (iii) Working with others whereby students expressed their understanding of their role in nutrition and the roles of team members such as dietitians.
Conclusion To enhance medical nutrition education, consideration needs to extend beyond counting dedicated teaching hours and mapping nutrition content, to a more contextual understanding of the situated learning that occurs for medical students.This research project was supported by the Royal Australian College
of General Practitioners with funding from the Australian Government under the
Australian General Practice Training programme
Digital Health Tools and Patients with Drug Use Disorders: Qualitative Patient Experience Study of the Electronic Case - Finding and Help Assessment Tool (eCHAT)
Background: One of the promises of digital health is to better engage patients and improve care for vulnerable populations. Patients with drug use disorders are a vulnerable population who often do not receive the care they need, both for their drug use disorders as well as their other health care needs. Appropriate primary care for patients with drug use disorders needs to be patient-centered, holistic, highly accessible, and engaging. The electronic Case-finding and Help Assessment Tool (eCHAT) was designed as a patient-centered tool for the identification and measurement of problematic health behaviors and mood states.
Objective: The aim of this study was to explore the patient experience of eCHAT at an Australian family medicine clinic for patients with drug use disorders.
Methods: A total of 12 semistructured interviews were conducted with patients, two interviews were conducted with doctors, and one focus group was conducted with patient advocates who were former patients of the clinic where the study took place. The transcripts were analyzed using inductive thematic analysis.
Results: The key themes identified from the interviews and the focus group were as follows: (1) eCHAT helped reduce stigma related to drug use in the doctor-patient consultation, (2) restricted answer options impacted the ability of patients to tell their stories, (3) patient-related response factors, (4) increased efficiency in the consultation process, and (5) divergence in level of concern around security and privacy.
Conclusions: eCHAT has the potential to help vulnerable patients in primary care to engage more with their doctors and reduce experiences of stigma. eCHAT may be a useful digital health intervention in a family medicine clinic for patients with drug use disorders. It has the potential to improve patient engagement and access to health care, which are crucial areas of need in this vulnerable population. However, it is important to clearly communicate the privacy risk of digital health tools and to implement eCHAT such that it will add value to, rather than displace, in-person consultations with the family doctor.This research project was supported by the
Royal Australian College of General Practitioners with funding from the Australian Government under the Australian General
Practice Training Progra
Role of the family doctor in the management of adults with obesity: a scoping review
Objectives Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology.
Setting Primary care. Adult patients.
Included papers Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 nonduplicate papers were identified and 225 articles included after full-text review.
Primary and secondary outcome measures Data were extracted on the family doctors' involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned.
Results 110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations.
Conclusions There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development
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