The International Classification of Primary Care

peer reviewedThe WONCA International Classification Committee (WICC) was set up by the WONCA Council in Melbourne in 1972 on the occasion of the Fifth World Conference (1). WONCA recognized the need for classifying and analysing data derived from clinical encounters with patients that was quite unique to family medicine. This would become increasingly important with the advent of electronic health records. From an initial small group led by Henk Lamberts and Maurice Wood (°), a tool which would become the ICPC was progressively developed and in 1987, the three existing classification systems, the International Classification of Health Problems in Primary Care (ICHPPC-2), ICPC-Process and Reason for Encounter - were merged into a single one; the ICPC. ICPC-2 was published in 1998 by the WONCA International Classification Committee, after several years of revision and cross-mapping with the International Classification of Diseases (ICD) – 10 (2). ICPC-2 is maintained by WICC and an updated version is edited on the sit

The tRNAscan-SE, snoscan and snoGPS web servers for the detection of tRNAs and snoRNAs

Transfer RNAs (tRNAs) and small nucleolar RNAs (snoRNAs) are two of the largest classes of non-protein-coding RNAs. Conventional gene finders that detect protein-coding genes do not find tRNA and snoRNA genes because they lack the codon structure and statistical signatures of protein-coding genes. Previously, we developed tRNAscan-SE, snoscan and snoGPS for the detection of tRNAs, methylation-guide snoRNAs and pseudouridylation-guide snoRNAs, respectively. tRNAscan-SE is routinely applied to completed genomes, resulting in the identification of thousands of tRNA genes. Snoscan has successfully detected methylation-guide snoRNAs in a variety of eukaryotes and archaea, and snoGPS has identified novel pseudouridylation-guide snoRNAs in yeast and mammals. Although these programs have been quite successful at RNA gene detection, their use has been limited by the need to install and configure the software packages on UNIX workstations. Here, we describe online implementations of these RNA detection tools that make these programs accessible to a wider range of research biologists. The tRNAscan-SE, snoscan and snoGPS servers are available at , and , respectively

The use of information technology to enhance diabetes management in primary care: a literature review

Background Evidence suggests that a more structured approach to diabetes care can lead to better health outcomes. We needed to develop an evidence based conceptual framework for the Chronic Disease Management Network (CDM-Net) project which aims to use information technology (IT) to optimally support diabetes care in the Barwon region of Victoria, Australia. Objective This review aims to demonstrate the benefits of IT in supporting a systematic approach to diabetes management in general practice and to increase our understanding of perceived barriers to and facilitators to the use of IT in this context. Methods The literature review was based on articles extracted from relevant databases by using search terms related to type 2 diabetes and IT. Eligible papers were those based on original studies which evaluated some form of IT intervention in medical practice and were published after 1996 in the English language. Studies evaluating the use of telemedicine were excluded. Findings IT has been used to provide support to patients, enhance changes in healthcare delivery and provide clinicians with access to expertise and timely, useful data about individual patients and populations. IT use has been associated with a corresponding improvement in measures of diabetes care including HbA1c, blood pressure and lipids, and in the frequency of eye and foot exams. Important barriers to using IT in diabetes care include confidentiality concerns, inadequate funding, workforce shortages, lack of time and anxiety about change. Adequate training and integration into the usual process of care are essential facilitators to implementing IT. Conclusions IT can be used to improve diabetes care by promoting a productive and informative interaction between the patient and the care team

GP and nurses' perceptions of how after hours care for people receiving palliative care at home could be improved: a mixed methods study

<p>Abstract</p> <p>Background</p> <p>Primary health care providers play a dominant role in the provision of palliative care (PC) in Australia but many gaps in after hours service remain. In some rural areas only 19% of people receiving palliative care achieve their goal of dying at home. This study, which builds on an earlier qualitative phase of the project, investigates the gaps in care from the perspective of general practitioners (GPs) and PC nurses.</p> <p>Methods</p> <p>Questionnaires, developed from the outcomes of the earlier phase, and containing both structured and open ended questions, were distributed through Divisions of General Practice (1 urban, 1 rural, 1 mixed) to GPs (n = 524) and through a special interest group to palliative care nurses (n = 122) in both rural and urban areas.</p> <p>Results</p> <p>Questionnaires were returned by 114 GPs (22%) and 52 nurses (43%). The majority of GPs were associated with a practice which provided some after hours services but PC was not a strong focus for most. This was reflected in low levels of PC training, limited awareness of the existence of after hours triage services in their area, and of the availability of Enhanced Primary Care (EPC) Medicare items for care planning for palliative patients. However, more than half of both nurses and GPs were aware of accessible PC resources.</p> <p>Factors such as poor communication and limited availability of after hours services were identified the as most likely to impact negatively on service provision. Strategies considered most likely to improve after hours services were individual patient protocols, palliative care trained respite carers and regular multidisciplinary meetings that included the GP.</p> <p>Conclusion</p> <p>While some of the identified gaps can only be met by long term funding and policy change, educational tools for use in training programs in PC for health professionals, which focus on the utilisation of EPC Medicare items in palliative care planning, the development of advance care plans and good communication between members of multidisciplinary teams, which include the GP, may enhance after hours service provision for patients receiving palliative care at home. The role of locums in after PC is an area for further research</p

Do GPs use electronic mental health resources? A qualitative study

BACKGROUNDThe Better Outcomes in Mental Health Care (BOMHC) initiative encourages general practitioners to use electronic mental health resources (EMHRs) during consultation with patients requiring psychological assistance. However, there is little data on GPs&rsquo; acceptance and use of EMHRs.METHODSemistructured interviews were conducted with 27 GPs to determine their attitude toward EMHRs, and their use during consultation with patients.RESULTSFew GPs reported frequently using EMHRs in consultation. Identified barriers to use included lack of familiarity with information technology, and insufficient knowledge of available resources. Identified advantages of electronic resources included high patient acceptance, time efficiency, and improved quality of information.DISCUSSIONGeneral practitioners recognise several advantages of utilising electronic resources for managing patients with mental illness. However, GPs are not sufficiently familiar with electronic resources to use them effectively. This could be overcome by education.<br /

Minimally disruptive medicine is needed for patients with multimorbidity: time to develop computerised medical record systems to meet this requirement

Background Minimally disruptive medicine (MDM) is proposed as a method for more appropriately managing people with multiple chronic disease. Much clinical management is currently single disease focussed, with people with multimorbidity being managed according to multiple single disease guidelines. Current initiatives to improve care include education about individual conditions and creating an environment where multiple guidelines might be simultaneously supported. The patientcentred medical home (PCMH) is an example of the latter. However, educational programmes and PCMH may increase the burden on patients.Problem The cumulative workload for patients in managing the impact of multiple disease-specific guidelines is only relatively recently recognised. There is an intellectual vacuum as to how best to manage multimorbidity and how informatics might support implementing MDM. There is currently no alternative to multiple singlecondition- specific guidelines and a lack of certainty, should the treatment burden need to be reduced, as to which guideline might be ‘dropped’.Action The best information about multimorbidity is recorded in primary care computerised medical record (CMR) systems and in an increasing number of integrated care organisations. CMR systems have the potential to flag individuals who might be in greatest need. However, CMR systems may also provide insights into whether there are ameliorating factors that might make it easier for them to be resilient to the burden of care. Data from such CMR systems might be used to develop the evidence base about how to better manage multimorbidity.Conclusions There is potential for these information systems to help reduce the management burden on patients and clinicians. However, substantial investment in research-driven CMR development is needed if we are to achieve this

Guidelines for computer security in general practice

Background As general practice becomes increasingly computerised, data security becomes increasingly important for both patient health and the efficient operation of the practice. Objective To develop guidelines for computer security in general practice based on a literature review, an analysis of available information on current practice and a series of key stakeholder interviews. While the guideline was produced in the context of Australian general practice, we have developed a template that is also relevant for other countries. Method Current data on computer security measures was sought from Australian divisions of general practice. Semi-structured interviews were conducted with general practitioners (GPs), the medical software industry, senior managers within government responsible for health IT (information technology) initiatives, technical IT experts, divisions of general practice and a member of a health information consumer group. The respondents were asked to assess both the likelihood and the consequences of potential risks in computer security being breached. Results The study suggested that the most important computer security issues in general practice were: the need for a nominated IT security coordinator; having written IT policies, including a practice disaster recovery plan; controlling access to different levels of electronic data; doing and testing backups; protecting against viruses and other malicious codes; installing firewalls; undertaking routine maintenance of hardware and software; and securing electronic communication, for example via encryption. This information led to the production of computer security guidelines, including a one-page summary checklist, which were subsequently distributed to all GPs in Australia. Conclusions This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake

A bibliometric analysis of Australian general practice publications from 1980 to 2007 using PubMed

Background We analysed Australian general practice (GP) publications in PubMed from 1980 to 2007 to determine journals, authors, publication types, national health priority areas (NHPA) and compared the results with those from three specialities (public health, cardiology and medical informatics) and two countries (the UK and New Zealand). Method Australian GP publications were downloaded in MEDLINE format using PubMed queries and were written to a Microsoft Access database using a software application. Search Query Language and online PubMed queries were used for further analysis. Results There were 4777 publications from1980 to 2007. Australian Family Physician (38.1%) and the Medical Journal of Australia (17.6%) contributed 55.7% of publications.Reviews (12.7%), letters (6.6%), clinical trials (6.5%) and systematic reviews (5%) were the main PubMed publication types. Thirty five percent of publications addressed National Health Priority Areas with material on mental health (13.7%), neoplasms (6.5%) and cardiovascular conditions (5.9%). The comparable numbers of publications for the three specialities were: public health - 80 911, cardiology - 15 130 and medical informatics - 3338; total country GP comparisons were: UK - 14 658 and New Zealand - 1111. Discussion Australian GP publications have shown an impressive growth from 1980 to 2007 with a 15- fold increase. This increase may be due in part to the actions of the Australian government over the past decade to financially support research in primary care, as well as the maturing of academic general practice. This analysis can assist governments, researchers, policy makers and others to target resources so that further developments can be encouraged, supported and monitored