General Practice and Primary Care - Theses
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ItemWitnessing loss during Lockdown: Nurses and Midwives experience caring for women who suffered miscarriage during the Covid-19 lockdown in Melbourne Australia( 2023-08)This qualitative study explored psychosocial care for women who experienced miscarriage in a public hospital during the Covid-19 pandemic in Melbourne, Australia, and the effects of this on the nurses and midwives who cared for them. Findings showed a movement further away from family-focused care increasing the risk of women feeling isolated, alone and psychologically traumatised. This study also showed the increased distress nurses and midwives felt caring for women experiencing miscarriage during the pandemic on both their own wellbeing and for their patients.
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ItemReproductive genetic carrier screening for cystic fibrosis, fragile X syndrome and spinal muscular atrophy in general practice( 2022)The Royal Australian and New Zealand College of Obstetricians and Gynaecologists and The Royal Australian College of General Practice recommend that information on reproductive genetic carrier screening (RGCS) for at least the most common inherited genetic conditions in our population, that is thalassaemia, cystic fibrosis (CF), spinal muscular atrophy (SMA), and fragile X syndrome (FXS), should be offered to all women planning pregnancy or in early pregnancy regardless of family history or ethnicity. While it is recognized that general practice is an appropriate place to undertake RGCS, little is known about when and how general practitioners are offering RGCS in Australia and what their attitude to screening is. This study, using qualitative and quantitative methods, has investigated when, where, how and why general practitioners (GPs) have participated in a 3-condition RGCS testing for FXS, CF, and SMA, and has measured carrier frequencies for these conditions in the community. GP participation was generally low, with much greater participation among obstetricians. Marked inequity of access to RGCS was identified, with very low rates of screening among socioeconomically disadvantaged women and women from rural and regional areas. GPs offering screening had a positive attitude to the role of general practice in RGCS. They were confident in their counselling skills and reported that the offer of screening was acceptable to their patients. Offering screening as part of preconception care was seen as preferable to antenatal screening. Barriers to offering screening in general practice were low levels of GP education in carrier screening, out of pocket cost of screening, regional or rural locations, and low frequency of preconception care consultations. Addressing the causes of inequity of access to screening in general practice, particularly the out-of-pocket cost of screening, and poor provision of preconception care, will allow more women and couples the opportunity to make informed choices about participation in screening.
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ItemGPimED: General Practice: improving management of Eating Disorders: Can a one hour online educational intervention improve the detection and management of patients with Eating Disorders by General Practice Trainees?( 2020)GPimED: Can a one- hour on-line learning module improve early diagnosis and management of Eating Disorders by General Practice Trainees? PROBLEM STATEMENT Eating disorders are a serious and potentially life-threatening group of illnesses within the community. The literature shows that diagnosis and management of these illnesses are inadequately covered during medical school and subsequent General Practice training. This can result in a delay in diagnosis and appropriate referral thus significantly contributing to patient morbidity and mortality plus increased financial burden on the community. The literature demonstrates that patients with ED present repeatedly to General Practice (GP) with a myriad of signs and symptoms There is often delay in diagnosis due to varied reasons. The literature also finds that this delay coupled with lack of appropriate management can greatly exacerbate the morbidity and potential mortality. For example, within this group of disorders, Anorexia Nervosa (AN) has the highest mortality rate of any psychiatric illness with suicide rates 32 times higher than the general population and a mortality rate of 10%. General Practitioners (GPs) are often time poor and lack the knowledge to adequately manage patients with ED Online education for GPs is becoming more popular as it is cost effective, convenient and allows rural and remote GPs access to educational material they might not otherwise be able to access if it is available only via face to face delivery AIM The aim of this study is to determine whether a one-hour online learning module developed to upskill General Practitioners in the recognition and management of Eating Disorders improves the performance of GP trainees. SIGNFICANCE This study will shed light on the effectiveness of online education in upskilling GP trainees and if the ED module is successful, it may lead to improved treatment of patients with evolving or established eating disorders in the General Practice setting. It will potentially reduce the rates of delayed diagnosis resulting in improved outcomes. The literature indicates that patients with an ED present up to 5 times more frequently to primary care than demographically matched peers. General Practice is thus ideally placed to recognize these patients, to make a timely diagnosis and initiate appropriate investigation, management and referrals. The literature also indicates when diagnosis and appropriate intervention occurs within the first three years of the disorder developing, there is a greater than 40% chance of complete recovery. On November 1st 2019, the Federal Government initiated $110 million in extra funding for increased support for patients with a serious ED. This support can only be accessed if the patient as an Eating Disorder Plan completed is be done by the GP who has performed appropriate screening and provided the requisite history, examination and investigations. METHODS The trial design was a randomized, parallel-group study. Participants were recruited from the Victorian General Practice Training Consortia MCCC and EVGPT. The comparator was a general Youth Mental health module. Baseline surveys including demographic details plus a clinical case designed to assess baseline competence in recognising a probable eating disorder case and management thereafter. Following randomisation to either the ED module arm (intervention) or control arm, follow up surveys were completed after 6 weeks, quantitative evaluation was conducted using clinical scenarios presented as case studies in the format of Key Feature Problems (KFPs) which are a component of the FRACGP examination. RESULTS Despite our best efforts, there were only small number of recruits- 15 respondents with 8 completing all components of the study. Despite the small sample, there was measurable improvement in many parameters assessed cross both arms of the trial. In particular, an increase in the identification of ED as a differential diagnosis and improved referrals to health professionals considered integral to the evidence based best practice multidisciplinary team approach to ED management.
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ItemThe role of physiotherapists in providing nutrition care to improve dietary behaviours( 2020)Background: Non-communicable chronic diseases are the foremost cause of death, illness, and disability in Australia. Poor dietary behaviours contribute significantly to the burden of chronic disease and health care costs. Promoting healthy eating is a crucial step to prevent and manage lifestyle-related chronic diseases. Although extensive evidence-based dietary guidelines are available in Australia, poor dietary habits are common. Nutrition care is nutrition or dietary related advice given by health professionals to improve dietary behaviour of patients. Previous studies among healthcare professionals highlighted a 'lack of time' as a barrier to deliver nutrition care in primary care. Physiotherapists are well positioned for such health promotion in comparison to other primary care practitioners as they often have prolonged and repeated consultations with patients. However, to date, there have been no studies in Australia to explore whether physiotherapists could provide nutrition care to their patients. Aim: This study aims to investigate practices, knowledge, and barriers to providing nutrition care of Australian physiotherapists. Method: Mixed methods were used. A qualitative study was conducted with physiotherapists practicing in Victoria, exploring their practices, knowledge, barriers, and personal behaviours in relation to nutrition. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. For further exploration, results were used to inform the development of a national survey of physiotherapists working in the primary care setting. Survey results were analysed using STATA software and reported using descriptive statistics. Results: 20 physiotherapists were interviewed, and 344 practicing physiotherapists participated in the online survey. Three main themes supported by nine sub-themes emerged from the interview data. Participants were strongly motivated to provide nutrition care given the relevance of nutrition to their patients' conditions. However, they suggested the complexity of nutrition care and a lack of training and knowledge often stopped them from promoting healthy eating in their clinical settings. All interview participants engaged in some level of nutrition care in their physiotherapy settings. The results of the national quantitative study suggest physiotherapists in Australia are engaging in nutrition care commonly by providing a referral to a dietitian (71% of survey participants) and verbal advice (65% of survey participants) to encourage patients to eat healthily. Thirty-eight percent of participants reported encouraging healthy eating with patients regularly. The preferred content for 'basic healthy eating advice' includes drinking water (89%), minimizing intakes of processed (89%) and sugary food (89%) and alcohol (75%), and increasing consumption of fruits and vegetables (68-73%). Eighty percent of survey participants were confident with their knowledge of the Australian Guide to Healthy Eating (AGHE), but only 58% were confident to use AGHE to assist them in evaluating patients' dietary intake. Based on a validated questionnaire, participants' self-perceived competence scores (mean score 63%; very confident) in providing nutrition care, showed they were confident with their nutrition knowledge, skills, communication and counselling practices with favourable attitudes towards providing nutrition care for their patients. Barriers identified by the participants to providing nutrition care included lack of clarity in the scope of practice (60%), lack of nutrition-training (52%), lack of time (48%), patient perception (43%) and lack of resources or materials (41%). They have also identified professional development training in nutrition (78%), encouragement or policy statement from the Australian Physiotherapy Association (APA) (76%), and printed or online materials as resources (70%) as facilitators to providing nutrition care to patients. The majority of participants (83-86%) recognized the impact of diet on NCDs and health, besides being aware of evidence-based information. Ninety-three percent of survey participants agreed that physiotherapists serve as role models for their patients, and 85% agreed that they should assist in improving patients' dietary behaviour. More than half (57%) of the participants were eating according to the Australian Dietary Guidelines (ADG). Conclusion: The findings of this study indicated that almost all participating physiotherapists were currently providing nutrition care, with the majority referring patients to a dietitian and encouraging patients to eat healthily. Nearly forty percent of participants reported encouraging healthy eating with patients regularly. Participants preferred offering basic healthy eating advice focussing on drinking water, minimizing the intake of less healthy food, and less commonly on increasing the consumption of healthy foods. The majority of participants were confident with their knowledge of AGHE, but fewer of them were confident to use the guidelines to assess patients' food consumption. The study also indicated that more than half of the participants were eating healthily in alignment with national dietary guidelines. The study showed that the participants were confident with their nutrition-related knowledge, skills, communication, and expressed favourable attitudes towards providing nutrition care in physiotherapy settings. However, they have highlighted that training and approval of a broader scope of practice as facilitators to further development of this role. Their practice and motivation in providing nutrition care suggest that they are parallel with the international health promotion advocacy towards eradicating NCDs.