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After the publication of this protocol [1], our collaborator Prima Health solutions advised us of their intent to withdraw from the study.

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OBJECTIVES: The incidences of non-communicable diseases including cardiovascular diseases (CVDs) is increasing in Bangladesh. The reasons for this increasing trend need to be explored. The aim of this study is to assess the risk of CVDs among a peripheral rural Bangladeshi population and to explore the sociodemographic, anthropometric and clinical variables associated with increased risk. STUDY DESIGN: Cohort study. METHODS: From a cohort of 190,471 individuals of all ages, originally included in a diabetic eye disease program initiated in 2008-2009, a purposive sub-cohort of 66,710 individuals, aged 31-74 years was recruited. During 2011-2012 these participants were assessed for CVDs using the WHO's risk assessment tool designed for primary care settings in low resource societies. Participant characteristics associated with higher risk were explored using univariable and multivariable regression analysis. RESULTS: Out of all (95.5% participation rate) participants 1170 (1.84%) were found to be at high risk for CVD. The prevalence of hypertension (HTN), pre-HTN, obesity, underweight and self-reported DM were 8.9%, 15.2%, 9.6%, 7.8% and 0.5% respectively, among the study population. In multivariable regression analysis female sex, older age, temporary housing structure (i.e., tin shed), extremes of BMI (both underweight and obese) and central obesity were associated with higher risk for CVDs. CONCLUSIONS: The prevalence of CVD risk factors and high CVD risk individuals in this cohort was found to be lower than previous studies. It may be the effects of urbanization are yet to reach this relatively traditional rural population. This study adds to the literature on use of the WHO risk assessment tool.

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AIM: The study aimed to evaluate what effect the introduction of the enhanced primary care (EPC) health assessments has on the management of elderly patients. METHOD: The study was conducted across five Divisions of General Practice in South West Sydney. Twenty-one general practitioners participated in the study following response to an initial faxed questionnaire survey. An audit of patients' health assessments in conjunction with their records was conducted between June and August 2000. RESULTS: There were significant increase in the documentation of nonmedical problems and of patients' immunisation status. However, there was no increase in plans to refer patients to psychologists, mental health teams or social workers. Also no assessments resulted in a case conference and very few in a care plan. DISCUSSION: Health assessments are unlikely to improve clinical outcomes if they do not result in multidisciplinary care, including care plans, for patients with psychosocial and functional needs. CONCLUSION: Support strategies need to be implemented which assist general practitioners' management of psychosocial and functional problems.

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OBJECTIVE: To investigate the issues for general practitioners surrounding the implementation of the Enhanced Primary Care (EPC) Medicare items for health assessments, care planning and case conferencing. DESIGN: Qualitative study of GPs' responses to a semistructured face-to-face interview. PARTICIPANTS AND SETTING: 30 GPs in the South Western Sydney Area. MAIN OUTCOME MEASURES: GPs' perceptions regarding barriers to coordination of care; use of the EPC items; difficulties with implementation; suggestions for improving EPC implementation; and coordination of care in general practice. RESULTS: Five main categories of response were identified to each area of questioning: time, organisation, communication, education, and resources. GPs expressed difficulties incorporating use of the items into their daily practice without support. CONCLUSIONS: Implementation of the EPC items not only facilitates integration between GPs and other healthcare professionals, it also depends upon other forms of integration to succeed. A facilitator and a structured framework to address issues are required to assist their implementation.

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BACKGROUND: Despite ongoing concern about adverse effects and dependence on benzodiazepines, approximately 2% of Australians are still taking them on a regular basis. The aim of this study was to evaluate the effectiveness of an educational outreach or 'academic detailing' program about prescribing of benzodiazepines. METHOD: In this randomised trial general practice registrars (n = 157) in New South Wales were allocated to an intervention group (n = 79), which received a 20 minute educational outreach visit; or a control group (n = 78) which received an intervention on an unrelated topic. Prescribing behaviour was monitored by a pre-intervention and two post-intervention practice activity surveys. MAIN OUTCOME MEASURES: These were the rate of benzodiazepine prescribing for all indications, for anxiety and for sleep disorders. RESULTS: Overall benzodiazepine prescribing by the intervention group declined from 2.3 to 1.7 per 100 encounters, while the control group also declined from 2.2 to 1.6 per 100 encounters. Analysis of variance showed this was a significant drop over time (P = 0.042) but there was no difference between groups (P = 0.99). The prescribing decrease observed was in continuing rather than initial prescriptions. CONCLUSIONS: A marked decrease in benzodiazepine prescribing was seen over the course of the study in both intervention and control groups but no differential effect due to the educational outreach visit was found.

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Education on rational prescribing is receiving increased emphasis but the effectiveness of this education is not well researched. This study used a randomised trial to evaluate a seminar for general practice trainees on rational prescribing of antibiotics and benzodiazepines, two important areas of general practice prescribing. Results show a decrease in prescribing of antibiotics by the group of trainees attending the seminar but no effect on an already low level of benzodiazepine prescribing. The study provides evidence that group educational approaches to influencing prescribing behaviour can be effective.

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OBJECTIVE: To study the prescribing of antibiotics and benzodiazepines by a group of general practice trainees. METHODS: Forty-six trainees in their general practice term with the Royal Australian College of General Practitioners Training Program and 495 experienced general practitioners were compared with regard to patients managed, prescribing of antibiotics for respiratory tract infections and prescribing of benzodiazepines for anxiety, sleep disorders and depression. RESULTS: Trainees saw more young patients and patients with acute respiratory infections, and fewer patients with psychological problems, than the experienced practitioners. Trainees prescribed antibiotics less often for undifferentiated upper respiratory tract infection and their prescribing for tonsillitis was more frequently in agreement with prescribing guidelines. Trainees were less likely to prescribe a benzodiazepine for anxiety or sleep problems. CONCLUSIONS: General practice trainees were relatively conservative prescribers of antibiotics and benzodiazepines. At times both groups did not prescribe in accordance with antibiotic prescribing guidelines and an appreciable number of patients continue to be prescribed benzodiazepines on a long term basis.

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