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OBJECTIVES: To determine how many children had health problems identified by the Healthy Kids Check (HKC) and whether this resulted in changes to clinical management. DESIGN, SETTING AND PARTICIPANTS: A medical records audit from two Queensland general practices, identifying 557 files of children who undertook an HKC between January 2010 and May 2013. MAIN OUTCOME MEASURES: Child health problems identified in the medical records before, during and after the HKC. RESULTS: Most children in our sample had no problems detected in their medical record (56%), 21% had problems detected during the HKC assessment, 19% had problems detected before, and 4% after. Most frequent health concerns detected during the HKC were speech and language (20%), toileting, hearing and vision (15% each), and behavioural problems (9%). Of the 116 children with problems detected during the HKC, 19 (3% of the total sample) had these confirmed, which resulted in a change of management. No further action was recorded for 9% of children. Missing data from reviews or referral outcomes for 8% precluded analyses of these outcomes. We estimated that the change in clinical management to children with health concerns directly relating to the HKC ranged between 3% and 11%. CONCLUSIONS: Overall, data suggest that general practitioners are diligent in detecting and managing child health problems. Some of these problems were detected only during the HKC appointment, resulting in change of management for some children. Further studies are required to estimate the full benefits and harms, and particularly the false negatives and true positives, of the HKC.

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Australia continues to explore methods to restructure primary health care services to meet stressors within the health system. The primary health care strategy and its support for larger general practices and multidisciplinary team contributions, raise opportunities for re-engineering general practice services.

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BACKGROUND: Skin cancer is common in Australia and its increasing incidence has been matched by an increase in specifically focused skin cancer clinics staffed by general practitioners. This study compares the management of skin cancer in general practice with that of skin cancer clinic networks. METHODS: Analysis of billing data relating to management of skin cancer from 1 July 2005 to 30 June 2006 in three Queensland general practices (metropolitan, provincial, and rural) representing 23 100 patients and 23 doctors. As far as possible, methods were matched to those used in two published studies of skin cancer clinics. RESULTS: Of the 1417 skin cancers: 31 melanomas and 1361 nonmelanoma skin cancers (NMSC) were treated by excision, and 25 NMSC were treated nonsurgically. The biopsy to treatment ratio in general practice was 0.7 and the number needed to treat (NNT) was 39, compared with 3.1 and 29 in one skin cancer clinic network and 0.5 and 24 in the other. Eighty-seven percent of skin cancer excisions were closed by primary repair and 54% of all excised lesions were malignant, compared with 42 and 60% in one network and 76 and 46% in the other, respectively. DISCUSSION: The benign to malignant excision rate was similar in general practice and the skin cancer clinic networks, but one network reported very different rates of biopsy and complex wound closure. This raises questions as to whether outcomes are improved by these measures. These results demonstrate the usefulness of three billing data outcome measures in comparing activity in different clinical settings. However, the billing based NNT may not be a useful measure.

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OBJECTIVE: To assess the impact of structured diabetes care in a rural general practice. DESIGN AND SETTING: A cohort study of structured diabetes care (care plans, multidisciplinary involvement and regular patient recall) in a large general practice in a medium-sized Australian rural town. Medical care followed each doctor's usual practice. PARTICIPANTS: The first 404 consecutive patients with type 2 diabetes who consented to take part in the program were evaluated 24 months after enrolment in July 2002 to December 2003. MAIN OUTCOME MEASURES: Change in cardiovascular disease risk factors (waist circumference, body mass index, serum lipid levels, blood pressure); change in indicators of risks associated with poorly controlled diabetes (glycated haemoglobin [HbA1c] concentration, foot lesions, clinically significant hypoglycaemia); change in 5-year cardiovascular disease risk. RESULTS: Women had a lower 5-year risk of a cardiovascular event at enrolment than men. Structured care was associated with statistically significant reductions in mean cardiovascular disease risk factors (waist circumference, - 2.6 cm; blood pressure [systolic, - 3 mmHg; diastolic - 7 mmHg]; and serum lipid levels [total cholesterol, - 0.5 mmol/L; HDL cholesterol, 0.02 mmol/L; LDL cholesterol, - 0.4 mmol/L; triglycerides, - 0.3 mmol/L]); and improvements in indicators of diabetic control (proportion with severe hypoglycaemic events, - 2.2%; proportion with foot lesions, - 14%). The greatest improvements in risk factors occurred in patients with the highest calculated cardiovascular risk. There was a statistically significant increase in the proportion of patients with "ideal" blood pressure (systolic, < 130 mmHg; diastolic, < 80 mmHg) and LDL cholesterol level (< 2.5 mmol/L) of 6.4% and 20.5%, respectively. CONCLUSIONS: Implementing structured care in this rural general practice coincided with improved risk factor management, and may have contributed to the improvement. The greatest benefits were in patients with high cardiovascular risk.

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