General Practice and Primary Care - Theses

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    Influences on opioid pharmacotherapy prescribing in general practice in Victoria
    LONGMAN, CHRISTINE ANNE ( 2009)
    Opioid dependence is a chronic relapsing condition resulting in significant individual and community harms, for which the most effective treatment is long term opioid pharmacotherapy (OP). In contrast to other Australian states and territories, in Victoria, 80-85 % of OP prescribing is undertaken by GPs, and while demand for this treatment is difficult to estimate, all evidence indicates that the current and future GP workforce is inadequate to meet projected need. GPs have shown a reluctance to become actively involved in the treatment of patients with drug dependence, especially where illicit drugs are involved. In order to prescribe OP, Australian medical practitioners are required to complete a specific training program. Little is known of the reasons why GPs decline to undertake this training, and why the majority who complete training, subsequently prescribe to very few or no patients. Using in-depth interviews and an analysis of existing data from the Victorian Department of Human Services, this thesis not only explores why GPs are unwilling to complete OP training, and why many subsequently fail to prescribe, but also identifies both barriers and facilitators which influence GPs in their decisions regarding these issues. The results have not only provided new information on the reasons GPs decline the offer of training but also supported existing research.
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    Factors that influence general practitioner involvement in health assessment of children and young people living in out-of-home care in Victoria
    Webster, Susan Margaret ( 2009)
    BACKGROUND: General Practitioners (GPs) have valuable medical knowledge and experience to contribute to early needs identification, treatment and health care planning for vulnerable children and young people. Children in out-of-home care are among the most vulnerable in Australia. The number of children in out-of-home care has doubled since 1998. The majority have experienced child abuse or neglect. Such children are more likely than average to experience complex and chronic health problems. In 2005 the Royal Australasian College of Physicians (RACP) highlighted the need for increased attention to the health of these children and recommended regular health assessment. In late 2007, the Victorian Department of Human Services (DHS) announced new initiatives, offering GPs a fee-for-service to provide comprehensive health assessments for children entering out-of-home care. However, standardised, comprehensive health assessments are an uncommon task for GPs. There is no published research in Australia about health assessment or health care of such children in general practice settings. Studies in the UK have found barriers to engagement of GPs with children in out-of-home care but these are not necessarily transferable to the Australian context. AIM: The aim of this qualitative study was to explore factors which influence the willingness and readiness of GPs in Victoria to undertake health assessments for children entering out-of-home care. METHOD: A purposive sample of twenty GPs took part in individual, in-depth interviews. The Quality framework for Australian general practice1 provided a theoretical model for developing the interview themes. Transcripts of tape-recorded interviews, as well as a summary report of preliminary study findings, were provided to each participant for feedback. RESULTS: Several issues influencing GPs were identified, including ethical concerns, training and professional development needs, medico-legal concerns, workforce and financial pressures and communication problems with the child protection sector. While the study results are consistent with overseas research, GP views about continuity of health care for children in out-of-home care emerged as a new issue with important policy implications for government and for child welfare agencies. This study also offers new insights into GPs‟ ideas about appropriate dimensions of a comprehensive assessment in a general practice setting, and which components GPs may delegate to a practice nurse. STRENGTHS AND LIMITATIONS: The study was strengthened by the inclusion of a diversity of GPs across career stages, practice types and geographical areas. As this was a relatively small study, it was not possible to explore GP issues relating to health assessment of particular sub-groups, such as Aboriginal children. This is limiting, as Aboriginal children are over-represented in the population of children in out-of-home care and there may be additional issues in providing culturally sensitive health assessments. CONCLUSION: This has been the first in-depth study in Australia of GP perspectives about systematic health assessments for children who are subject to child protection. The findings indicate policy makers will not only need to understand the complex business factors influencing GPs if sustainable GP engagement is to be achieved, but also address GP professional and ethical concerns such as continuity of health care. This study is an important contribution to furthering understanding about reasons for the relatively low GP uptake of systematic health assessments for at-risk population groups.