RESUMEN
Australia has seen a significant increase in people aged over 65 years accessing general practice services over the last decade. Although people aged 65 years and over comprise 14% of the total population, this age demographic accounts for the largest proportion of general practitioner (GP)-patient encounters. Access to general practice is important for older Australians as the burden of chronic disease increases with age. A geographic information system, ArcGIS, was used to assess geographic access to general practice for older people residing in the regional Queensland towns of Mackay, Townsville and Cairns. Geographic units with high proportions of over 65-year-old people were spatially analysed in relation to proximity to geomapped general practices with a 2-km buffer zone. Modelling of changes in access was performed with the strategic location of a new general practice where gaps existed. Geographic access to general practice for the older population was poorest in Cairns despite a high population density. Addition of a single, strategically placed general practice in Cairns markedly improved access. Socioeconomic analysis suggested that general practices were appropriately located in areas of greatest need. Geographic information systems provide a means to map population characteristics against service locations to assist in strategic development and location of future health services.
Asunto(s)
Planificación en Salud/métodos , Accesibilidad a los Servicios de Salud , Atención Primaria de Salud , Anciano , Australia , Humanos , QueenslandRESUMEN
OBJECTIVE: To evaluate the effectiveness of a 12-week lifestyle program for changes in healthy lifestyle knowledge, health perceptions and body composition of middle-aged, overweight men. METHODS: A participatory, action-based experimental design was employed with a convenience sample (n = 24) of middle-aged men who were supporters of either a local rugby league or rugby union club. Participants attended an introductory session and baseline testing in week one, participated in once-weekly group circuit exercise and lifestyle education sessions for 10 weeks and attended post-testing and project evaluation in week 12. RESULTS: Fourteen participants completed the project. Healthy lifestyle knowledge did not improve significantly. As a combined group there were significant improvements in both physical and mental components of the SF12 questionnaire and in waist girth. The rugby league cohort achieved significant improvement in the SF12 physical component, weight, BMI and waist girth. The rugby union cohort achieved significant improvement in the SF12 mental component and waist girth. Participants reported a variety of health improvement and lifestyle changes following the project and reported appreciation at the involvement of the sporting club. CONCLUSIONS: The men's lifestyle program resulted in significant improvement in body composition, resulting in a reduction in obesity-related disease risk in some participants.
Asunto(s)
Promoción de la Salud , Estilo de Vida , Obesidad/terapia , Conducta de Reducción del Riesgo , Adulto , Anciano , Centros de Acondicionamiento , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Queensland , Encuestas y Cuestionarios , Circunferencia de la CinturaRESUMEN
BACKGROUND: Genital Chlamydia trachomatis infection is prevalent in Australia. Although testing rates are increasing, studies suggest that levels of testing of asymptomatic, sexually active people aged 16-29 years remain relatively low. Various barriers to testing in general practice have been identified. This article reports on one component of a study conducted to gain an understanding of chlamydia management in general practice in northern Queensland. METHODS: Nine general practices participated in a prospective audit over a 3 month period, which recorded the reason for chlamydia testing and if a follow up visit for test results was recommended. RESULTS: A total of 521 patients had chlamydia testing recorded, with females comprising over three-quarters of patients (77%). Asymptomatic presentations accounted for 50% of referrals for testing; of these, less than half had a recommendation for follow up of test results recorded (41%). Patients with a known positive case contact were most often recommended for follow up (59%). DISCUSSION: Half of those undergoing chlamydia testing were asymptomatic, with a third screened at the time of Pap testing. This suggests that general practitioners are appropriately initiating chlamydia screening with Pap tests.There is potential to increase rates of opportunistic testing for asymptomatic women.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Chlamydia , Chlamydia trachomatis/aislamiento & purificación , Manejo de la Enfermedad , Medicina General/métodos , Tamizaje Masivo/métodos , Educación del Paciente como Asunto/métodos , Adolescente , Adulto , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Masculino , Prevalencia , Estudios Prospectivos , Queensland/epidemiología , Derivación y Consulta , Adulto JovenRESUMEN
Type 2 diabetes is a leading cause of death and morbidity and is a health priority in Australia. This randomised controlled trial will explore whether remote access to clinical care, supported by telehealth technologies over high speed broadband, leads to improved diabetes control in a way that benefits patients, carers and clinicians and improves the overall health system. People in the intervention arm of the trial will receive additional diabetes care from a care coordinator nurse via an in-home broadband communication device that can capture clinical measures, provide regular health assessments and videoconference with other health professionals when required. Patients in the control arm of the trial will receive usual care from their GP and participate in the clinical measurement and quality of life components of the evaluation. The trial evaluation will include biomedical, psychological, self-management and quality of life measures. Data on utilisation rates and satisfaction with the technology will be collected and cost -effectiveness analyses undertaken. The role of this technology in health care reform will be explored.
Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Servicios de Atención de Salud a Domicilio/organización & administración , Monitoreo Ambulatorio/métodos , Población Rural , Telemedicina/métodos , Australia , Automonitorización de la Glucosa Sanguínea , Presión Sanguínea , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/economía , Servicios de Atención de Salud a Domicilio/economía , Humanos , Monitoreo Ambulatorio/economía , Educación del Paciente como Asunto/organización & administración , Satisfacción del Paciente , Calidad de Vida , Autocuidado/economía , Autocuidado/métodos , Telemedicina/economía , Comunicación por Videoconferencia/organización & administraciónRESUMEN
BACKGROUND: Most diagnoses of genital Chlamydia trachomatis infection in Queensland are made by general practitioners. This study aimed to describe GP knowledge of recommended guidelines for chlamydia management and ascertain GPs' preferred model for contact tracing. METHODS: A questionnaire completed by 35 GPs in northern Queensland in January 2011. RESULTS: Although the majority of GPs reported treating uncomplicated chlamydia infection correctly with azithromycin, very few (26%) used empirical treatment. Most reported testing for re-infection within 6 weeks of initial positive results, earlier than recommended. The GPs preferred the notifiable disease register to refer the patient directly to a specialist contact tracer. CONCLUSION: General practitioners in this regional location - and probably elsewhere - would benefit from education around the timing of re-testing. Public health units and sexual health services should consider ways of providing a contact tracing service for patients with positive chlamydia results in general practice.
Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones por Chlamydia/tratamiento farmacológico , Trazado de Contacto/estadística & datos numéricos , Medicina Familiar y Comunitaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Actitud del Personal de Salud , Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/efectos de los fármacos , Estudios Transversales , Manejo de la Enfermedad , Medicina Familiar y Comunitaria/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Queensland , Encuestas y CuestionariosRESUMEN
Self-management support (SMS) is an important skill for health professionals providing chronic condition management in the primary health care sector. Training in SMS alone does not always lead to its utilisation. This study aimed to ascertain whether SMS is being used, and to identify barriers and enablers for SMS in practice. Health professionals who underwent SMS training were invited to participate in a semi-structured interview. A response rate of 55% (14 of 24) was achieved. All interviewees rated their understanding of the principles of SMS as moderate or better. In relation to how much they use these principles in their practice, several (5 of 14) said minimally or not at all. The tools they were most likely to use were SMART goals (8 of 14) and decision balance (5 of 14). Core skills that were being used included problem solving (11 of 14), reflective listening (13 of 14), open-ended questions (12 of 14), identifying readiness to change (12 of 14) and goal setting (10 of 14). The most important barriers to implementing SMS were current funding models for health care, lack of space and staff not interested in change. The most highly rated enabling strategies were more training for general practitioners and more training for practice nurses; the lowest rated was more training for receptionists. The increasing prevalence of chronic conditions due to ageing and lifestyle factors must be addressed through new ways of delivering primary health care services. Self-management support is a necessary component of such programs, so identified barriers to SMS must be overcome.
Asunto(s)
Conductas Relacionadas con la Salud , Personal de Salud/educación , Atención Primaria de Salud/métodos , Autocuidado/métodos , Australia , Enfermedad Crónica , Educación Continua/métodos , Promoción de la Salud/métodos , Humanos , Entrevistas como Asunto , Educación del Paciente como Asunto/métodos , Apoyo SocialRESUMEN
BACKGROUND: Parents can be the source of vaccine preventable diseases that their children contract. The vaccination status of parents may not be readily available, and uptake rates are affected by factors such as complexity of vaccination schedules, personal perception of risks, and physician recommendation. METHODS: Parents at eight general practices in North Queensland had immunisation histories recorded and vaccine recommendations made when they brought in their infants for vaccination. They were followed up by practice nurses after 2 months. This article describes parental immunisation status at eight general practices and examines whether parents in these clinics acted on recommendations for vaccination. RESULTS: Vaccination was recommended for 66.1% of parents. Of these parents, 53% complied, resulting in improved up-to-date vaccination status from 33.9-68.9% (p<0.0001). DISCUSSION: Taking an immunisation history from parents and recommending specific vaccinations to them is likely to be a worthwhile intervention to add to general practice consultations for childhood vaccinations. Trialling this intervention in a broader cross section of general practices would be a useful next step.
Asunto(s)
Padres , Cooperación del Paciente/estadística & datos numéricos , Vacunación , Femenino , Medicina General , Humanos , Masculino , Queensland , AutoinformeRESUMEN
The Enhanced Primary Care (EPC) program funds GPs to provide preventative health assessments through a specific set of Medicare item numbers. The study aimed to show whether patients completing these health assessments had better recorded screening rates than those receiving usual care. A retrospective clinical record audit was undertaken in north Queensland general practices by practice nurses from the North Queensland Practice Based Research Network. Comparisons were made between the recorded screening test rates for patients who completed an over-75-years health assessment with those who did not. A questionnaire was also completed by practice nurses and practice principals. Screening tests were recorded more frequently in patients with a completed health assessment: notably urinalysis, visual acuity and faecal occult blood test/colonoscopy. Blood pressure was the most frequently recorded test with or without a health assessment. The questionnaires provided useful information on how health assessments are implemented and whether GPs believe they are useful.
Asunto(s)
Auditoría Clínica , Medicina General , Evaluación Geriátrica , Promoción de la Salud/métodos , Tamizaje Masivo/estadística & datos numéricos , Anciano , Conocimientos, Actitudes y Práctica en Salud , Humanos , Pautas de la Práctica en Enfermería , Pautas de la Práctica en Medicina , Queensland , Estudios RetrospectivosRESUMEN
OBJECTIVE: To define characteristics of vehicle crashes occurring on rural private property in north Queensland with an exploration of associated risk factors. DESIGN: Descriptive analysis of private property crash data collected by the Rural and Remote Road Safety Study. SETTING: Rural and remote north Queensland. PARTICIPANTS: A total of 305 vehicle controllers aged 16 years or over hospitalised at Atherton, Cairns, Mount Isa or Townsville for at least 24 hours as a result of a vehicle crash. MAIN OUTCOME MEASURE: A structured questionnaire completed by participants covering crash details, lifestyle and demographic characteristics, driving history, medical history, alcohol and drug use and attitudes to road use. RESULTS: Overall, 27.9% of interviewees crashed on private property, with the highest proportion of private road crashes occurring in the North West Statistical Division (45%). Risk factors shown to be associated with private property crashes included male sex, riding off-road motorcycle or all-terrain vehicle, first-time driving at that site, lack of licence for vehicle type, recreational use and not wearing a helmet or seatbelt. CONCLUSIONS: Considerable trauma results from vehicle crashes on rural private property. These crashes are not included in most crash data sets, which are limited to public road crashes. Legislation and regulations applicable to private property vehicle use are largely focused on workplace health and safety, yet work-related crashes represent a minority of private property crashes in north Queensland.
Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Instalaciones Públicas , Heridas y Lesiones/etiología , Adulto , Femenino , Humanos , Actividades Recreativas , Masculino , Vehículos a Motor , Propiedad , Queensland/epidemiología , Salud Rural , Heridas y Lesiones/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Acute otitis externa (AOE) is a common condition in North Queensland. Clinical guidelines exist for the management of this condition. This study explores the pattern of causative pathogens and management of AOE by general practitioners in North Queensland. METHODS: Eight general practices in three regional cities of North Queensland participated in the study. The three components were: a retrospective case audit of AOE management, a survey of GPs' self reported usual management, and collection of clinical data and microbiological specimens from new cases. RESULTS: Pseudomonas aeruginosa was the most common causative pathogen in all regions, GPs correctly identified the most common pathogens, there was variation in the use of oral antibiotics between regions (15.8-36.6%), ear syringing is commonly used in managing AOE (51.3%), and most patients (68.9%) required only one GP appointment. DISCUSSION: General practitioners have good knowledge of the causative pathogens for AOE in their region. While clinical guidelines are generally followed, there is some variation in the prescription of oral antibiotics and use of ear syringing in managing this condition.
Asunto(s)
Otitis Externa/terapia , Médicos de Familia/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Enfermedad Aguda , Administración Tópica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Otitis Externa/diagnóstico , Otitis Externa/microbiología , Médicos de Familia/normas , Pseudomonas aeruginosa/aislamiento & purificación , Queensland , Estudios Retrospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To assess the suitability of Queensland's graduated licensing system in the context of rural and remote Queensland. DESIGN: Age-based comparison of crash data collected by the Rural and Remote Road Safety Study (RRRSS). SETTING: Rural and remote North Queensland. PARTICIPANTS: A total of 367 vehicle controllers aged 16 years or over hospitalised at Townsville, Cairns or Mount Isa for at least 24 hours, or killed, as a result of a vehicle crash. MEASUREMENTS: Specific RRRSS variables are assessed in relation to Queensland's graduated licensing program, including rates of unlicensed driving/riding, late night crashes, crashes with multiple passengers, contributing factors in crashes and vehicle types involved. RESULTS: While people between 16 and 24 years of age comprise 16% of the target population, 25% of crashes meeting RRRSS criteria involved a vehicle controller in that age group. 12.8% of all cases involved an unlicensed driver/rider, within which 66% were below 25 years of age. Young drivers/riders were represented in 50% of crashes occurring between 11:00 p.m. and 5:00 a.m., and 33% of crashes in vehicles with multiple passengers. Motorcyclists represented about 40% of cases in both age groups. There were no significant differences between age groups in vehicle types used, or circumstances that contributed to crashes. CONCLUSIONS: The general overrepresentation of young drivers/riders in rural and remote North Queensland supports tailored interventions, such as graduated licensing. However, while some measures in the legislation are well supported, problems surrounding unlicensed driving/riding might be exacerbated.
Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Conducción de Automóvil/legislación & jurisprudencia , Concesión de Licencias/legislación & jurisprudencia , Población Rural/estadística & datos numéricos , Accidentes de Tránsito/mortalidad , Adolescente , Distribución por Edad , Factores de Edad , Conducción de Automóvil/psicología , Sistema de Vigilancia de Factor de Riesgo Conductual , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Concesión de Licencias/estadística & datos numéricos , Masculino , Vehículos a Motor/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Queensland/epidemiología , Asunción de Riesgos , Seguridad , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To describe the experience of the paramedics doing the population health component of the Graduate Certificate in Rural and Remote Paramedic Practice. DESIGN: Analysis of paramedics' reported opinions about the course and its impact. SETTING: Primary care. PARTICIPANTS: Data were obtained from de-identified surveys submitted by the paramedics at the beginning and the end of the population health component of the course. RESULTS: All paramedics felt that after the course they were more committed to undertaking population health activities in their work and were better prepared to do so. As a result of undertaking the course, 73% of students have already changed their practice. Seventy-five per cent agreed that doing the course would increase the likelihood of staying in rural and remote areas and all agreed that doing the course resulted in increased job satisfaction. The majority (87%) of the students rated the course as excellent or very good and all of them said that they would recommend the course to others. CONCLUSIONS: These results suggest that rural and remote paramedics have the opportunity and desire to incorporate more health promotion and prevention into their practice and that this course has provided them with the skills and knowledge to do so. The curriculum is based on National Health Priority Areas focusing in particular on lifestyle change to prevent and manage chronic disease. This means that in rural and remote areas, all health professionals can use a common framework to work together to enhance primary health care and chronic disease management as a multidisciplinary team.
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Técnicos Medios en Salud/educación , Certificación , Medicina Comunitaria/educación , Educación de Postgrado , Promoción de la Salud , Área sin Atención Médica , Atención Primaria de Salud , Prevención Primaria/educación , Rol Profesional , Servicios de Salud Rural , Técnicos Medios en Salud/psicología , Actitud del Personal de Salud , Selección de Profesión , Enfermedad Crónica/terapia , Educación Basada en Competencias , Curriculum , Humanos , Satisfacción en el Trabajo , Evaluación de Necesidades , Ubicación de la Práctica Profesional , Evaluación de Programas y Proyectos de Salud , Queensland , Factores de Riesgo , Servicios de Salud Rural/normas , Recursos HumanosRESUMEN
A local general practice was contracted to provide the school-based immunisation program over two years in Mount Isa, Queensland. The schedule was for female Year 10, 11 and 12 students to receive three doses of human papilloma virus (HPV) vaccination (Gardasil). This was provided as part of the broader immunisation program that involved providing Year 8 students with two doses of hepatitis B vaccination and one dose of varicella-zoster, and Year 10 students with one dose of diphtheria-tetanus-pertussis (DTPa). Data were collected on the number of consent forms returned and how many declined vaccination, how many students were vaccinated and those requiring catch-up vaccinations, as well as the total number completing the full course of immunisations. Adverse events were also recorded. The total cohort of girls eligible for HPV vaccination was 304 (consented to vaccination--275 (90%), declined vaccination--13 (4%), coverage for first HPV dose--89%, coverage for second HPV dose--88%, coverage for third HPV dose--79%). When compared with other adolescent vaccinations given concurrently as part of the broader vaccination program, HPV coverage was higher. There were only three significant adverse events. Three girls fainted at the time of immunisation but recovered immediately. The HPV immunisation had a good uptake and was well tolerated. Integrating school immunisation provision with general practice provides continuity with preschool immunisations and provides a convenient location for parents to bring children who have missed out on immunisations or would like to discuss the immunisation program
Asunto(s)
Vacunación Masiva/métodos , Vacunas contra Papillomavirus/inmunología , Servicios de Salud Escolar , Adolescente , Niño , Medicina Familiar y Comunitaria , Femenino , Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11 , 16, 18 , Humanos , Esquemas de Inmunización , Infecciones por Papillomavirus/inmunología , Consentimiento Paterno/estadística & datos numéricos , Queensland/epidemiología , Población RuralRESUMEN
BACKGROUND: There is twice the morbidity and mortality resulting from vehicle related trauma in rural and remote areas than in metropolitan areas. Little is known about Australian rural general practitioners' management of those affected. METHODS: Seventeen rural GPs in North Queensland participated in semi-structured interviews for this exploratory study of the management of patients presenting with acute or chronic vehicle related trauma. Responses were analysed quantitatively and thematically. RESULTS: General practitioners reported more presentations of chronic than acute vehicle related trauma. Common injuries were soft tissue injury, whiplash and chronic pain syndromes. Vehicles most often involved were motorbikes, passenger cars and bicycles. Surgeons and physiotherapists were the most difficult service providers to access. Better coordination of rehabilitation and community support services is required. DISCUSSION: General practitioners in rural North Queensland manage patients with chronic vehicle related trauma without adequate access to specialised rehabilitation services. More training of GPs and practice staff and improved coordination of these services are required.