General Practice

Magic bullets for insomnia? Patients' use and experiences of newer (Z drugs) versus older (benzodiazepine) hypnotics for sleep problems in primary care

by A. Niroshan Siriwardena

Assessing general practice knowledge base--the applied knowledge test.

by Liz Farmer

Sturmberg JP, Farmer EA Aust Fam Physician. 2008 Aug;37(8):659-61.

The Royal Australian College of General Practitioners (RACGP) Fellowship examination assesses competence for... more The Royal Australian College of General Practitioners (RACGP) Fellowship examination assesses competence for unsupervised clinical practice anywhere in Australia through three segments, each with a unique focus. The applied knowledge test (AKT) is a written examination that tests candidates' applied clinical knowledge. Other segments assess clinical problem solving skills and ability to perform in a clinical situation. Approximately 400-500 candidates sit each administration of the RACGP examination, which is held twice yearly throughout Australia.

Standards and performance Attainment and maintenance of professional capabilities

by Liz Farmer

Sturmberg JP, Atkinson K, Farmer EA Aust Fam Physician. 2005 May;34(5):371-3. Review.

The nature of The Royal Australian College of General Practitioners (RACGP) examination came under scrutiny in a... more The nature of The Royal Australian College of General Practitioners (RACGP) examination came under scrutiny in a recent debate among RACGP members, some of who suggested exploring an alternative pathway for assessment linked to continuing medical education. This article outlines key issues underpinning the examination that is part of the requirements for attaining Fellowship of the RACGP (FRACGP). It provides an overview of the theory and practice of assessment for general practice. The RACGP examination has an international reputation for quality, validity and reliability, a reason why the RACGP has been asked to assist many others in establishing and/or reviewing their own examination processes.

How to pass RACGP KFP exams: twelve tips for success in a Key Feature Problems (KFP) Examination

by Liz Farmer

Workshop document for FRACGP KFP candidates

This is a short unpublished document I have used in teaching designed to help candidates sitting a Key Features... more This is a short unpublished document I have used in teaching designed to help candidates sitting a Key Features Problems examination (KFP or KFC).This is a living document; do you have any tips of your own? If so leave me a comment and I will add them.

Assessing general practice clinical decision making skills - The key features approach

by Liz Farmer

Farmer EA, Hinchy J.Aust Fam Physician. 2005 Dec;34(12):1059-61.

The key feature problem (KFP) is an innovative assessment format that tests clinical decision making skills by... more The key feature problem (KFP) is an innovative assessment format that tests clinical decision making skills by focussing on only the critical steps -- or 'key features' -- of each decision, thereby increasing the number of problems that can be answered in a 3 hour examination. It has been used successfully in The Royal Australian College of General Practitioners Examination for Fellowship and is gaining in popularity in other high stakes testing settings. This article describes how the KFP paper is designed and constructed, how the pass mark is set, and how the approach performs.

Adaptability: building an academic workforce with GPs

by Liz Farmer

Pearson R, Bonney A, Farmer EA AUSTRALIAN FAMILY PHYSICIANVOL.40,NO.1/2,JANUARY/FEBRUARY2011

Engaging rural preceptors in new longitudinal community clerkships during workforce shortage: a qualitative study

by Liz Farmer

Hudson JN, Weston K, Farmer EA. BMC Family Practice 2011, 12:103

Abstract
Background: In keeping with its mission to produce doctors for rural and regional Australia, the... more Abstract
Background: In keeping with its mission to produce doctors for rural and regional Australia, the University of Wollongong, Graduate School of Medicine has established an innovative model of clinical education. This includes a 12-month integrated community-based clerkship in a regional or rural setting, offering senior students longitudinal participation in a ‘community of practice’ with access to continuity of patient care experiences, continuity of supervision and curriculum, and individualised personal and professional development. This required developing new teaching sites, based on attracting preceptors and providing them with educational and physical infrastructure. A major challenge was severe health workforce shortages.
Methods: Before the new clerkship started, we interviewed 28 general practitioners to determine why they engaged as clerkship preceptors. Independent researchers conducted semi-structured interviews. Responses were transcribed for inductive qualitative content analysis.
Results: The new model motivated preceptors to engage because it enhanced their opportunities to contribute to authentic learning when compared with the perceived limitations of short-term attachments. Preceptors appreciated the significant recognition of the value of general practice teaching and the honour of major involvement in the university. They predicted that the initiative would have positive effects on general practitioner morale and improve the quality of their practice. Other themes included the doctors’ commitment to their profession, ‘handing on’ to the next generation and helping their community to attract doctors in the future.
Conclusions: Supervisors perceive that new models of clinical education offer alternative solutions to health care education, delivery and workforce. The longitudinal relationship between preceptor, student and community was seen as offering reciprocal benefits. General practitioners are committed to refining practice and ensuring generation of new members in their profession. They are motivated to engage in novel regional and rural longitudinal clinical clerkships as they perceive that they offer students an authentic learning experience and are a potential strategy to help address workforce shortages and maldistribution.

Multimorbidity in primary care: a systematic review of prospective cohort studies

by Frances Mair

Authors: France, Emma F1; Wyke, Sally2; Gunn, Jane M3; Mair, Frances S4; McLean, Gary4; Mercer, Stewart W4
Source: British Journal of General Practice, Volume 62, Number 597, April 2012 , pp. e297-e307(11)
Publisher: Royal College of General Practitioners

Abstract:
Background
Primary care increasingly deals with patients with multimorbidity, but relevant... more Abstract:
Background
Primary care increasingly deals with patients with multimorbidity, but relevant evidence-based interventions are scarce. Knowledge about multimorbidity over time is required to inform the development of effective interventions.
Aim
This review identifies prospective cohort studies of multimorbidity in primary care to determine: their nature, scope and key findings; the methodologies used; and gaps in knowledge.
Design
Systematic review.
Method
Studies were identified by searching electronic databases, reviewing citations, and writing to authors. Searches were limited to adult populations with no restrictions on publication date or language. In total, 996 articles were identified and screened.
Results
Of the 996 articles, six detailing five completed prospective cohort studies were selected as appropriate. Three of the studies were undertaken in the US and two in The Netherlands; none was nationally representative. The main focus of the studies was: healthcare utilisation and/or costs (n = 3); patients' physical functioning (n = 1); and risk factors for developing multimorbidity (n = 1). The conditions that were included varied widely. The findings of these studies showed that multimorbidity increased healthcare costs (n = 2), inpatient admission (n = 1), death rates (n = 1), and service use (n = 3), and reduced physical functioning (n = 1). One study identified psychosocial risk factors for multimorbidity. No study used random sampling, sample sizes were relatively small (414-3745 patients at baseline), and study duration was relatively short (1-4 years). No study focused on prevalence, treatment use, patient safety, service models, cultural or socioeconomic factors, and patient experience, and no study collected qualitative data.
Conclusion
Few longitudinal studies based in primary care have investigated multimorbidity. Further large, long-term prospective studies are required to inform healthcare commissioning, planning, and delivery.

How Family Physicians Are Funded In Canada

by Carmel Martin

Determinants of Common Mental Disorders Detection by General Practitioners in the Primary Health Care in Brazil

by Luís Fernando Tófoli

Authors: Daniel A. Gonçalves, Sandra Fortes, Luís Fernando Tófoli, Mônica Rodrigues Campos, Jair de Jesus Mari

Objective: Common Mental Disorders (CMD) are highly prevalent among patients attending primary care. Many of these... more Objective: Common Mental Disorders (CMD) are highly prevalent among patients attending primary care. Many of these disorders remain unrecognized by general practitioners (GPs), with the detection rates varying from 30 to 60%. This study aims to evaluate the CMD detection rates by Primary Heath Care (PHC) practitioners in Brazil—and factors that affect CMD detection. Methods: A cross sectional study was conducted with users of five PHC units in the city of Petrópolis. The CMD prevalence of psychiatric morbidity was estimated by the General Health Questionnaire-12, and the physician's CMD detection was evaluated by a questionnaire completed by GPs after each consultation. Results: Seven hundred and fourteen subjects participated of the study, and 400 (56%) were screened positive using GHQ-12 cut-off point of 2/3. GPs diagnosed 379 people with CMD (53.1%), and 256(36%) subjects were detected by both GHQ and the GPs with an OR of 3.04 (95%CI 2.23-4.13). CMD detection accuracy by GPs was 65%. There was a strong association between the detection of CMD and the report of medically unexplained physical symptoms by GPs. Being female, married, and a frequent service user was also related to higher detection rates. Conclusion: CMD detection rate was similar to those reported worldwide, but contrary to other studies, the presence of MUS increased detection rates. The high frequency of CMD in Primary Health Care highlights the need for improving GP and health worker's training in order to enable them to accurately recognize and treat psychological distress with evidence-based interventions.

Physicians' and pharmacies' overview of patients' medication. An analysis of fidelity coefficients

by Anton Pottegård

The introduction of integrated out-of-hours arrangements in England: A discrete choice experiment of public preferences for alternative models of care

by Joanne Turnbull

Gerard K, Lattimer L, Surridge H, George S, Turnbull J, Burgess A, Lathlean J, Smith H. The introduction of integrated out-of-hours arrangements in England: A discrete choice experiment of public preferences for alternative models of care, Health Expectations, 2006; 9: 1-10.

What type of eye drops should be given to a toddler with conjunctivitis?

by Peter Griffiths

Dual job holding General Practitioners: The effect of patient shortage

by Geir Godager

Does Quality Influence Choice of General Practitioner? An Analysis of Matched Doctor-Patient Panel Data

by Geir Godager

Birds of a Feather Flock Together: A Study of Doctor-Patient Matching

by Geir Godager

Explaining variation in GP referral rates for x-rays for back pain

by Rachel Baker

Antimicrobial management of urinary tract infection in general practice in Ireland.

by Akke Vellinga

management, UTI, antimicrobial prescribing

Background
Urinary tract infections (UTIs) are the second most common bacterial infections in general practice... more Background
Urinary tract infections (UTIs) are the second most common bacterial infections in general practice and a frequent indication for prescription of antimicrobials. Increasing concern about the association between the use of antimicrobials and acquired antimicrobial resistance has highlighted the need for rational pharmacotherapy of common infections in general practice.
Methods
Management of urinary tract infections in general practice was studied prospectively over 8 weeks. Patients presenting with suspected UTI submitted a urine sample and were enrolled with an opt-out methodology. Data were collected on demographic variables, previous antimicrobial use and urine samples. Appropriateness of different treatment scenarios was assessed by comparing treatment with the laboratory report of the urine sample.
Results
A total of 22 practices participated in the study and included 866 patients. Bacteriuria was established for 21% of the patients, pyuria without bacteriuria for 9% and 70% showed no laboratory evidence of UTI.  An antimicrobial agent was prescribed to 56% (481) of the patients, of whom 33% had an isolate, 11% with pyuria only and 56% without laboratory evidence of UTI. When taking all patients into account, 14% patients had an isolate identified and were prescribed an antimicrobial to which the isolate was susceptible. The agents most commonly prescribed for UTI were co-amoxyclav (33%), trimethoprim (26%) and fluoroquinolones (17%). Variation between practices in antimicrobial prescribing  as well as in their preference for certain antimicrobials, was observed.
Treatment as prescribed by the GP was interpreted as appropriate for 55% of the patients. Three different treatment scenarios were simulated, i.e. if all patients who received an antimicrobial were treated with nitrofurantoin, trimethoprim or ciprofloxacin only. Treatment as prescribed by the GP was no more effective than treatment with nitrofurantoin for all patients given an antimicrobial or treatment with ciprofloxacin in all patients. Prescribing cost was lower for nitrofurantoin. Empirical treatment of all patients with trimethoprim only was less effective due to the higher resistance levels.
Conclusions
There appears to be considerable scope to reduce the frequency and increase the quality of antimicrobial prescribing for patients with suspected UTI.

GP FUNDING–VIEWPOINTS How Family Physicians Are Funded In Canada

by Carmel Martin

Patient demands, lack of reciprocity, and burnout: A five-year longitudinal study among general practitioners

by Arnold Bakker