Health inequalities, physician citizens and professional medical associations: an Australian case study

<p>Abstract</p> <p>Background</p> <p>As socioeconomic health inequalities persist and widen, the health effects of adversity are a constant presence in the daily work of physicians. Gruen and colleagues suggest that, in responding to important population health issues such as this, defining those areas of professional obligation in contrast to professional aspiration should be on the basis of evidence and feasibility. Drawing this line between obligation and aspiration is a part of the work of professional medical colleges and associations, and in doing so they must respond to members as well as a range of other interest groups. Our aim was to explore the usefulness of Gruen's model of physician responsibility in defining how professional medical colleges and associations should lead the profession in responding to socioeconomic health inequalities.</p> <p>Methods</p> <p>We report a case study of how the Royal Australian College of General Practitioners is responding to the issue of health inequalities through its work. We undertook a consultation (80 interviews with stakeholders internal and external to the College and two focus groups with general practitioners) and program and policy review of core programs of College interest and responsibility: general practitioner training and setting of practice standards, as well as its work in public advocacy.</p> <p>Results</p> <p>Some strategies within each of these College program areas were seen as legitimate professional obligations in responding to socioeconomic health inequality. However, other strategies, while potentially professional obligations within Gruen's model, were nevertheless contested. The key difference between these lay in different moral orientations. Actions where agreement existed were based on an ethos of care and compassion. Actions that were contested were based on an ethos of justice and human rights.</p> <p>Conclusion</p> <p>Colleges and professional medical associations have a role in explicitly leading a debate about values, engaging both external stakeholder and practicing member constituencies. This is an important and necessary step in defining an agreed role for the profession in addressing health inequalities.</p

Impact of geography on the control of type 2 diabetes mellitus: a review of geocoded clinical data from general practice

Objective: To review the clinical data for people with diabetes mellitus with reference to their location and clinical care in a general practice in Australia. Materials and methods: Patient data were extracted from a general practice in Western Australia. Iterative data-cleansing steps were taken. Data were grouped into Statistical Area level 1 (SA1), designated as the smallest geographical area associated with the Census of Population and Housing. The data were analysed to identify if SA1s with people aged 70 years and older, and with relatively high glycosylated haemoglobin (HbA1c) were significantly clustered, and whether this was associated with their medical consultation rate and treatment. The analysis included Cluster and Outlier Analysis using Moran’s I test. Results: The overall median age of the population was 70 years with more males than females, 53% and 47%, respectively. Older people (\u3e70 years) with relatively high HbA1c comprised 9.3% of all people with diabetes in the sample, and were clustered around two ‘hotspot’ locations. These 111 patients do not attend the practice more or less often than people with diabetes living elsewhere in the practice ( p=0.098). There was some evidence that they were more likely to be recorded as having consulted with regard to other chronic diseases. The average number of prescribed medicines over a 13-month time period, per person in the hotspots, was 4.6 compared with 5.1 in other locations ( p=0.26). Their prescribed therapy was deemed to be consistent with the management of people with diabetes in other locations with reference to the relevant diabetes guidelines. Conclusions: Older patients with relatively high HbA1c are clustered in two locations within the practice area. Their hyperglycaemia and ongoing cardiovascular risk indicates causes other than therapeutic inertia. The causes may be related to the social determinants of health, which are influenced by geography

Increasing the knowledge, identification and treatment of osteoporosis through education and shared decision-making with residents living in a retirement village community

Objective: This pilot study explored whether individual goal setting in a retirement village setting could improve strategies to strengthen bones in an ageing population and help prevent osteoporosis. Methods: A two-phased osteoporosis prevention program was developed, piloted and evaluated involving a group education session followed by the development of individualised Bone Plans based upon personal understanding of individual fracture risk and lifestyle factors. Results: A significant improvement in knowledge and understanding of factors to prevent and manage osteoporosis was achieved, and changes in lifestyle behaviours were sustained at six months. Conclusion: Success was due to education by specialist medical and health personnel, flexibility of goal setting, use of group sessions and location of the program within the retirement community setting. The ‘Mind Your Bones’ program is a feasible and acceptable way to translate preventative bone health messages to a large number of people via the retirement village network

A tale of two cities: academic service research teaching and community practice partnerships delivering for disadvantaged Australian communities

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.An innovative team approach and integration of care across sectors, including general practices, community health services, allied health professionals and hospitals, can deliver high-quality comprehensive care in disadvantaged areas while providing teaching and research opportunities and community service. Academic general practice departments are committed to supporting and evaluating such models. A governance infrastructure that encourages strong partnerships across health care sectors is essential. With broad health partnership support, bulk-billing is viable in an Australian general practice team model providing health care to the disadvantaged.Claire L Jackson and John E Marle

Protecting the privacy of individual general practice patient electronic records for geospatial epidemiology research

Background: General practitioner (GP) practices in Australia are increasingly storing patient information in electronic databases. These practice databases can be accessed by clinical audit software to generate reports that inform clinical or population health decision making and public health surveillance. Many audit software applications also have the capacity to generate de-identified patient unit record data. However, the de-identified nature of the extracted data means that these records often lack geographic information. Without spatial references, it is impossible to build maps reflecting the spatial distribution of patients with particular conditions and needs. Links to socioeconomic, demographic, environmental or other geographically based information are also not possible. In some cases, relatively coarse geographies such as postcode are available, but these are of limited use and researchers cannot undertake precision spatial analyses such as calculating travel times. Methods: We describe a method that allows researchers to implement meaningful mapping and spatial epidemiological analyses of practice level patient data while preserving privacy. Results: This solution has been piloted in a diabetes risk research project in the patient population of a practice in Adelaide. Conclusions and Implications: The method offers researchers a powerful means of analysing geographic clinic data in a privacy-protected manner

Job satisfaction of staff and the team environment in Australian general practice

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.Objective: To study the work satisfaction of general practice staff, the differences between types of staff, and the individual and organisational factors associated with work satisfaction. Design, setting and participants: Cross-sectional multipractice study based on a self-completed job satisfaction survey of 626 practice staff in 96 general practices in Australia between 16 December 2003 and 8 October 2004. Main outcome measures: Job satisfaction scores for all staff and for general practitioners alone; relationship between job satisfaction and the team climate, practice size, particular jobs within practices, demographic characteristics of participants, and geographical location of practices. Results: The response rate was 65%. Job satisfaction was high, with a mean score of 5.66 (95% CI, 5.60–5.72). Multilevel analysis showed that all general practice staff were highly satisfied if they worked in a practice with a good team climate. Practice managers reported the highest satisfaction with their work. Practice size and individual characteristics such as the sex of the participant were unrelated to job satisfaction. GPs tended to have lower satisfaction than other staff in relation to income, recognition for good work and hours of work. Rural GPs were more satisfied. Conclusions: Most general practice staff are satisfied with their work. Facilitating teamwork may be a key strategy for both recruitment and retention of the general practice workforce, especially staff who are not GPs.Mark F Harris, Judy G Proudfoot, Upali W Jayasinghe, Christine H Holton, Gawaine P Powell Davies, Cheryl L Amoroso, Tanya K Bubner and Justin J Beilb