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Turnock A, Fielding A, Moad D, Tapley A, Davey A, Holliday E, Ball J, Bentley M, FitzGerald K, Kirby C, Spike N, van Driel ML, Magin P. The prevalence and associations of Australian early-career general practitioners' provision of after-hours care. Aust J Rural Health 2023; 31:906-913. [PMID: 37488936 DOI: 10.1111/ajr.13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Access to after-hours care (AHC) is an important aspect of general practice service provision. OBJECTIVE To establish the prevalence and associations of early-career GPs' provision of AHC. DESIGN An analysis of data from the New alumni Experiences of Training and independent Unsupervised Practice (NEXT-UP) cross-sectional questionnaire-based study. Participants were early-career GPs (6-month to 2-year post-Fellowship) following the completion of GP vocational training in NSW, the ACT, Victoria or Tasmania. The outcome factor was 'current provision of after-hours care'. Associations of the outcome were established using multivariable logistic regression. FINDINGS Three hundred and fifty-four early-career GPs participated (response rate 28%). Of these, 322 had responses available for analysis of currently performing AHC. Of these observations, 128 (40%) reported current provision of AHC (55% of rural participants and 32% of urban participants). On multivariable analysis, participants who provided any AHC during training were more likely to be providing AHC (odds ratio (OR) 5.51, [95% confidence interval (CI) 2.80-10.80], p < 0.001). Current rural location and in-training rural experience were strongly associated with currently providing AHC in univariable but not multivariable analysis. DISCUSSION Early-career GPs who provided AHC during training, compared with those who did not, were more than five times more likely to provide after-hours care in their first 2 years after gaining Fellowship, suggesting participation in AHC during training may have a role in preparing registrars to provide AHC as independent practitioners. CONCLUSION These findings may inform future GP vocational training policy and practice concerning registrars' provision of AHC during training.
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Affiliation(s)
- Allison Turnock
- University of Tasmania, School of Medicine, Hobart, Tasmania, Australia
- Department of Health, Hobart, Tasmania, Australia
| | - Alison Fielding
- GP Synergy, NSW & ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
| | - Dominica Moad
- GP Synergy, NSW & ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
| | - Amanda Tapley
- GP Synergy, NSW & ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
| | - Andrew Davey
- GP Synergy, NSW & ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
| | - Elizabeth Holliday
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
| | - Jean Ball
- Hunter Medical Research Institute (HMRI), Clinical Research Design and Statistical Support Unit (CReDITSS), New Lambton Heights, New South Wales, Australia
| | - Michael Bentley
- General Practice Training Tasmania (GPTT), Hobart, Tasmania, Australia
| | - Kristen FitzGerald
- University of Tasmania, School of Medicine, Hobart, Tasmania, Australia
- General Practice Training Tasmania (GPTT), Hobart, Tasmania, Australia
| | - Catherine Kirby
- Eastern Victoria General Practice Training (EVGPT), Hawthorn, Victoria, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT), Hawthorn, Victoria, Australia
- Monash University, School of Rural Health, Churchill, Victoria, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Victoria, Australia
| | - Mieke L van Driel
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
| | - Parker Magin
- GP Synergy, NSW & ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
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Goller JL, De Livera AM, Donovan B, Fairley CK, Low N, Hocking JS. Epididymitis rates in Australian hospitals 2009-2018: ecological analysis. Sex Transm Infect 2020; 97:387-390. [PMID: 32727927 DOI: 10.1136/sextrans-2020-054473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/01/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate rates of acute epididymitis diagnosed in Australian hospital settings. METHODS Yearly hospital admission and emergency department (ED) rates of epididymitis as primary diagnoses were calculated for 15-44-year-old men for three states (Victoria, New South Wales, Queensland) from 2009 to 2014 using population denominators. Zero inflated Poisson regression models were used to analyse variation in rates by year, age, and residential area. Additionally, we investigated national epididymitis admission trends from 2009 to 2018 using generalised linear models. RESULTS Between 2009 and 2014, there was a total of 7375 admissions and 17 281 ED presentations for which epididymitis was the main reason for care. Most epididymitis diagnoses (94.0% in admissions, 99.7% in EDs) were without abscess, and 2.5% of admissions were for chlamydial epididymitis. Almost a quarter (23.3%) of epididymitis diagnosed in EDs resulted in hospital admission. In 2014, the epididymitis rate per 100 000 men was 38.7 in admissions and 91.9 in EDs. Comparing 2014 with 2009, the overall epididymitis diagnosis rate increased in admissions by 32% (adjusted incident rate ratio (aIRR) 1.32, 95% CI 1.20 to 1.44) and in ED attendances by 40% (aIRR 1.40, 95% CI 1.31 to 1.49). By age, the highest rates were among men 35-44 years in admissions and men 15-24 years in EDs. National admission rates of epididymitis during 2009-2018 showed a similar pattern. CONCLUSION Rates of epididymitis diagnosis in hospital admission and ED presentations increased. Different age-related rates in these settings suggest a different aetiology or differential severity by age group.
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Affiliation(s)
- Jane L Goller
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alysha M De Livera
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Basil Donovan
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, Australia.,Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Hysenbegasi M, Hubloue I, Vanobberghen R, Kartounian J, Devroey D. Evolution over 11 years of the characteristics of walk-in patients at the emergency department of a university hospital in Brussels. J Med Life 2019; 12:34-42. [PMID: 31123523 PMCID: PMC6527410 DOI: 10.25122/jml-2018-0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Walk-in patients who do not require urgent treatment at an emergency department (ED) are a known and long-standing problem. This study aims to investigate the characteristics of walk-in patients visiting the ED over time. During four days in June 2012, all walk-in patients attending the ED of the University Hospital Brussels between 8 AM and 11 PM were recorded. A similar registration took place in the same ED in June 2001. Patients completed a questionnaire about their characteristics and the reason for the encounter. Data of both study periods were compared. The mean age of the patients attending the ED was significantly lower in 2001 (40.9 years) than in 2012 (43.9 years) (p=0,02). In 2001, 81% of the participants had Belgian nationality, but in 2012 this proportion increased to 90% (p=0.008). In 2001 as well as in 2012, 21% of the participants had a referral from their family physician (FP) (p=0.9). The proportion of patients that were aware that FP could also handle some emergencies increased from 17% in 2001 to 29% in 2012 (p=0.003). More patients had complaints that begun less than 24h before they attended the ED (48% in 2001 and 58% in 2012) (p=0.03). The walk-in patients at the ED are getting slightly older and are attending the ED faster after the onset of the complaints. More patients judge their complaints as urgent. However, more patients are getting aware that FP also could handle some emergencies.
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Affiliation(s)
- Merita Hysenbegasi
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Belgium
| | - Ives Hubloue
- Department of Emergency Medicine UZ Brussel and Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Belgium
| | - Rita Vanobberghen
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Belgium
| | - Jan Kartounian
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Belgium
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Belgium
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Dawson J, Rigby-Brown A, Adams L, Baker R, Fernando J, Forrest A, Kirkwood A, Murray R, West M, Wike P, Wilde M. Developing and evaluating a tool to measure general practice productivity: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Systems for measuring the performance of general practices are extremely limited.
Objectives
The aim was to develop, pilot test and evaluate a measure of productivity that can be applied across all typical general practices in England, and that may result in improvements in practice, thereby leading to better patient outcomes.
Methods
Stage 1 – the approach used was based on the Productivity Measurement and Enhancement System (ProMES). Through 16 workshops with 80 general practice staff and 72 patient representatives, the objectives of general practices were identified, as were indicators that could measure these objectives and systems to convert the indicators into an effectiveness score and a productivity index. This was followed by a consensus exercise involving a face-to-face meeting with 16 stakeholders and an online survey with 27 respondents. An online version of the tool [termed the General Practice Effectiveness Tool (GPET)] and detailed guidance were created. Stage 2 – 51 practices were trained to use the GPET for up to 6 months, entering data on each indicator monthly and getting automated feedback on changes in effectiveness over time. The feasibility and acceptability of the GPET were examined via 38 telephone interviews with practice representatives, an online survey of practice managers and two focus groups with patient representatives.
Results
The workshops resulted in 11 objectives across four performance areas: (1) clinical care, (2) practice management, (3) patient focus and (4) external focus. These were measured by 52 indicators, gathered from clinical information systems, practice records, checklists, a short patient questionnaire and a short staff questionnaire. The consensus exercise suggested that this model was appropriate, but that the tool would be of more benefit in tracking productivity within practices than in performance management. Thirty-eight out of 51 practices provided monthly data, but only 28 practices did so for the full period. Limited time and personnel changes made participation difficult for some. Over the pilot period, practice effectiveness increased significantly. Perceptions of the GPET were varied. Usefulness was given an average rating of 4.5 out of 10.0. Ease of use was more positive, scoring 5.6 out of 10.0. Five indicators were highlighted as problematic to gather, and 27% of practices had difficulties entering data. Feedback from interviews suggested difficulties using the online system and finding time to make use of feedback. Most practices could not provide sufficient monthly financial data to calculate a conventional productivity index.
Limitations
It was not possible to create a measure that provides comparability between all practices, and most practices could not provide sufficient financial data to create a productivity index, leaving an effectiveness measure instead. Having a relatively small number of practices, with no control group, limited this study, and there was a limited timescale for the testing and evaluation.
Implications
The GPET has demonstrated some viability as a tool to aid practice improvement. The model devised could serve as a basis for measuring effectiveness in general practice more widely.
Future work
Some additional research is needed to refine the GPET. Enhanced testing with a control sample would evaluate whether or not it is the use of the GPET that leads to improved performance.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jeremy Dawson
- Sheffield University Management School, The University of Sheffield, Sheffield, UK
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Anna Rigby-Brown
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Lee Adams
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Richard Baker
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Amanda Forrest
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Anna Kirkwood
- The Medical School, The University of Sheffield, Sheffield, UK
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van Gaans D, Dent E. Issues of accessibility to health services by older Australians: a review. Public Health Rev 2018; 39:20. [PMID: 30027001 PMCID: PMC6047130 DOI: 10.1186/s40985-018-0097-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This review provides an in-depth investigation into the difficulties facing older Australians when accessing health care services. METHODS A literature search was conducted in December 2016 using Academic Premier to identify relevant publications. Key search terms were accessibility, health service, older people and Australia. Papers published between 1999 and 2016 were included. Statements of accessibility were extracted and then grouped using the five dimensions of accessibility by Penchansky and Thomas (1981): availability, accessibility, accommodation, affordability and acceptability. RESULTS Forty-one papers were included. Availability issues identified were inadequate health care services, particularly for culturally and linguistically diverse (CALD) populations and those residing in rural areas. Accessibility issues included difficulties accessing transport to health care services, which in turn restricted choice of appointment time. Issues of accommodation identified were long waiting times for appointments with both general practitioners and medical specialists. Affordability was a common problem, compounded by multi-morbidity requiring high health care use. Issues of acceptability centred on the role of the family, feelings of shame when receiving care from a non-family member, traditional practices and gender sensitivity. CONCLUSIONS The contribution of factors to health service accessibility varies according to an older person's geographical local and their accessibility to transport, as well as their level of multi-morbidity and cultural background. Improving access to health services could be improved by matching services to the population that they serve.
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Affiliation(s)
- Deborah van Gaans
- Centre for Population Health Research, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia Australia
| | - Elsa Dent
- Centre for Positive Ageing and Wellbeing, Torrens University Australia, Adelaide, South Australia Australia
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria Australia
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Goller JL, De Livera AM, Guy RJ, Low N, Donovan B, Law M, Kaldor JM, Fairley CK, Hocking JS. Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009-2014: ecological analysis of hospital data. Sex Transm Infect 2018; 94:534-541. [PMID: 29720385 DOI: 10.1136/sextrans-2017-053423] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/08/2018] [Accepted: 04/07/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To analyse yearly rates of pelvic inflammatory disease (PID) and ectopic pregnancy (EP) diagnosed in hospital settings in Australia from 2009 to 2014. METHODS We calculated yearly PID and EP diagnosis rates in three states (Victoria, New South Wales, Queensland) for women aged 15-44 years using hospital admissions and emergency department (ED) attendance data, with population and live birth denominators. We stratified PID diagnoses as chlamydial-related or gonorrhoeal-related (Chlamydia trachomatis (CT)-related or Neisseria gonorrhoeae (NG)-related), acute, unspecified and chronic, and analysed variations by year, age and residential area using Poisson regression models. RESULTS For PID, the rate of all admissions in 2014 was 63.3 per 100 000 women (95% CI 60.8 to 65.9) and of all presentations in EDs was 97.0 per 100 000 women (95% CI 93.9 to 100.2). Comparing 2014 with 2009, the rate of all PID admissions did not change, but the rate of all presentations in EDs increased (adjusted incidence rate ratio (aIRR) 1.34, 95% CI 1.24 to 1.45), and for admissions by PID category was higher for CT-related or NG-related PID (aIRR 1.73, 95% CI 1.31 to 2.28) and unspecified PID (aIRR 1.09, 95% CI 1.00 to 1.19), and lower for chronic PID (aIRR 0.84, 95% CI 0.74 to 0.95). For EP, in 2014 the rate of all admissions was 17.4 (95% CI 16.9 to 17.9) per 1000 live births and of all ED presentations was 15.6 (95% CI 15.1 to 16.1). Comparing 2014 with 2009, the rates of all EP admissions (aIRR 1.06, 95% CI 1.04 to 1.08) and rates in EDs (aIRR 1.24, 95% CI 1.18 to 1.31) were higher. CONCLUSIONS PID and EP remain important causes of hospital admissions for female STI-associated complications. Hospital EDs care for more PID cases than inpatient departments, particularly for young women. Updated primary care data are needed to better understand PID epidemiology and healthcare usage.
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Affiliation(s)
- Jane L Goller
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Alysha M De Livera
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca J Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University and Melbourne Sexual Health Centre, Carlton, Victoria, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, Victoria, Australia
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Payne K, Dutton T, Weal K, Earle M, Wilson R, Bailey J. An after hours gp clinic in regional Australia: appropriateness of presentations and impact on local emergency department presentations. BMC FAMILY PRACTICE 2017; 18:86. [PMID: 28893200 PMCID: PMC5594615 DOI: 10.1186/s12875-017-0657-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/05/2017] [Indexed: 11/21/2022]
Abstract
Background After hours general practice clinics provide medical attention for clients with non-emergency situations but are seeking immediate treatment and unable to wait for a general practitioner during routine opening hours. Evidence on the impact that after hours clinics have on emergency department presentations is equivocal. This study explored outcomes of the Bathurst After Hours General Practice Clinic (BAHGPC). Specifically it examined: clients’ perceived urgency of, and satisfaction with their presentation to the BAHGPC; general practitioners’ perception of the appropriateness of presentations to the BAHGPC; and whether the frequency of non-urgent and semi-urgent emergency department presentations at Bathurst Base Hospital has changed since the opening of the BAHGPC. Methods Clients presenting to the BAHGPC from 01/02/2015 to 30/06/2015 were asked to participate in the client presentation survey and follow-up satisfaction survey. General practitioner surveys were completed for individual clients from 01/12/2014 to 30/06/2015 to document the appropriateness of each presentation. Descriptive statistics are used to describe survey responses. Thematic analysis was applied for qualitative responses. Emergency department presentations were retrieved from the Emergency Department Data Collection. A comparison of presentations in the two years prior and subsequent to the opening of the BAHGPC was conducted using independent T-tests and Chi-square tests to compare mean presentations and proportional data for the different time periods examined. Results Most clients (76%) presenting to the BAHGPC classified their visit as essential. General practitioners considered most presentations to be appropriate (87%). Sixty percent (60%) of clients would have gone to the emergency department had the BAHGPC not been operational. Client satisfaction was high and 99% would use the clinic again. A significant reduction in total non-urgent presentations to the Emergency Department occurred in the two years since the opening of the BAHGPC clinic compared to the two years prior (418.5 vs. 245.5; P < 0.05). Conclusions There was concordance between general practitioners and clients regarding the appropriateness of presentations to the BAHGPC. The findings of this study highlight that after hours general practitioner clinics are an essential service in regional areas and contribute to reducing the burden of non-urgent presentations to the local emergency department. Electronic supplementary material The online version of this article (10.1186/s12875-017-0657-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristy Payne
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Tegan Dutton
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Kate Weal
- Marathon Health, Bathurst, NSW, Australia
| | | | - Ross Wilson
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia.
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Yeung A, Temple-Smith M, Spark S, Guy R, Fairley CK, Law M, Wood A, Smith K, Donovan B, Kaldor J, Gunn J, Pirotta M, Carter R, Hocking J. Improving chlamydia knowledge should lead to increased chlamydia testing among Australian general practitioners: a cross-sectional study of chlamydia testing uptake in general practice. BMC Infect Dis 2014; 14:584. [PMID: 25409698 PMCID: PMC4228271 DOI: 10.1186/s12879-014-0584-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 10/23/2014] [Indexed: 11/22/2022] Open
Abstract
Background Female general practitioners (GPs) have higher chlamydia testing rates than male GPs, yet it is unclear whether this is due to lack of knowledge among male GPs or because female GPs consult and test more female patients. Methods GPs completed a survey about their demographic details and knowledge about genital chlamydia. Chlamydia testing and consultation data for patients aged 16-29 years were extracted from the medical records software for each GP and linked to their survey responses. Chi-square tests were used to determine differences in a GP’s knowledge and demographics. Two multivariable models that adjusted for the gender of the patient were used to investigate associations between a GP and their chlamydia testing rates ― Model 1 included GPs’ characteristics such as age and gender, Model 2 excluded these characteristics to specifically examine any associations with knowledge. Results Female GPs were more likely than male GPs to know when to re-test a patient after a negative chlamydia test (18.8% versus 9.7%, p = 0.01), the correct symptoms suggestive of PID (80.5% versus 67.8%, p = 0.01) and the correct tests for diagnosing PID (57.1% versus 42.6%, p = 0.01). Female GPs tested 6.5% of patients, while male GPs tested 2.2% (p < 0.01). Model 1 found factors associated with chlamydia testing were being a female GP (OR = 2.5, 95% CI: 1.9, 3.3) and working in a metropolitan clinic (OR = 3.2; 95% CI: 2.4, 4.3). Model 2 showed that chlamydia testing increased as knowledge of testing guidelines improved (3-5 correct answers – AOR = 2.0, 95% CI: 1.0, 4.2; 6+ correct answers – AOR = 2.9, 95% CI: 1.4, 6.2). Conclusions Higher rates of chlamydia testing are strongly associated with GPs who are female, based in a metropolitan clinic and among those with more knowledge of the recommended guidelines. Improving chlamydia knowledge among male GPs may increase chlamydia testing. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0584-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Yeung
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Victoria, Australia.
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Muscatello DJ, Amin J, MacIntyre CR, Newall AT, Rawlinson WD, Sintchenko V, Gilmour R, Thackway S. Inaccurate ascertainment of morbidity and mortality due to influenza in administrative databases: a population-based record linkage study. PLoS One 2014; 9:e98446. [PMID: 24875306 PMCID: PMC4038604 DOI: 10.1371/journal.pone.0098446] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 05/02/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Historically, counting influenza recorded in administrative health outcome databases has been considered insufficient to estimate influenza attributable morbidity and mortality in populations. We used database record linkage to evaluate whether modern databases have similar limitations. METHODS Person-level records were linked across databases of laboratory notified influenza, emergency department (ED) presentations, hospital admissions and death registrations, from the population (∼6.9 million) of New South Wales (NSW), Australia, 2005 to 2008. RESULTS There were 2568 virologically diagnosed influenza infections notified. Among those, 25% of 40 who died, 49% of 1451 with a hospital admission and 7% of 1742 with an ED presentation had influenza recorded on the respective database record. Compared with persons aged ≥65 years and residents of regional and remote areas, respectively, children and residents of major cities were more likely to have influenza coded on their admission record. Compared with older persons and admitted patients, respectively, working age persons and non-admitted persons were more likely to have influenza coded on their ED record. On both ED and admission records, persons with influenza type A infection were more likely than those with type B infection to have influenza coded. Among death registrations, hospital admissions and ED presentations with influenza recorded as a cause of illness, 15%, 28% and 1.4%, respectively, also had laboratory notified influenza. Time trends in counts of influenza recorded on the ED, admission and death databases reflected the trend in counts of virologically diagnosed influenza. CONCLUSIONS A minority of the death, hospital admission and ED records for persons with a virologically diagnosed influenza infection identified influenza as a cause of illness. Few database records with influenza recorded as a cause had laboratory confirmation. The databases have limited value for estimating incidence of influenza outcomes, but can be used for monitoring variation in incidence over time.
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Affiliation(s)
- David J. Muscatello
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, North Sydney, W, Australia
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, New South Wales, Australia
| | - Janaki Amin
- The Kirby Institute, The University of New South Wales, Coogee, New South Wales, Australia
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, New South Wales, Australia
| | - Anthony T. Newall
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, New South Wales, Australia
| | - William D. Rawlinson
- South East Area Laboratory Service, The Prince of Wales Hospital, Randwick, New South Wales, Australia
- Faculty of Medicine, The University of New South Wales, New South Wales, Australia
| | - Vitali Sintchenko
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Pathology West – Institute for Clinical Pathology and Medical Research, Westmead, New South Wales, Australia
| | - Robin Gilmour
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, North Sydney, W, Australia
| | - Sarah Thackway
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, North Sydney, W, Australia
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