ABSTRACT
AIM: The aim of this study was to evaluate the attitudes and practices of Australian general practitioners (GPs) regarding infant gastro-oesophageal reflux disease (GORD) diagnosis and management. METHODS: A national cross-sectional survey, involving a random sample of currently practising Australian GPs (n = 2319) was undertaken between July and September 2011. GPs attitudes and management of infant GORD were surveyed via an online and paper-based 41-item questionnaire. RESULTS: In total, 400 responses were analysed (17.24% response rate). The majority of GPs employed empirical trials of acid-suppression medication and/or lifestyle modifications to diagnose infant GORD. GPs frequently recommended dietary modification despite the belief that they were only moderately effective at best. In addition, GPs frequently prescribed acid-suppression medication, despite concerns regarding their safety in the infant population. Other GP concerns included the lack of clinical guidelines and education for GPs about infant GORD, as well as the level of evidence available for the safety and efficacy of diagnostic tests and treatments. CONCLUSION: Despite the important role Australian GPs play in the diagnosis and management of infant GORD, high-level evidence-based guidelines for GPs are lacking. Consequently, GPs engage in diagnostic and management practices despite their concerns regarding the safety and effectiveness.
Subject(s)
Gastroesophageal Reflux/drug therapy , General Practitioners/psychology , Health Knowledge, Attitudes, Practice , Adult , Aged , Aged, 80 and over , Australia , Cross-Sectional Studies , Health Care Surveys , Humans , Infant , Middle Aged , Proton Pump Inhibitors/therapeutic useABSTRACT
BACKGROUND: Numerous studies have assessed the effectiveness of online continuing medical education (CME) designed to improve healthcare professionals' care of patients. The effects of online educational interventions targeted at general practitioners (GP), however, have not been systematically reviewed. METHODS: A computer search was conducted through seven databases for studies assessing changes in GPs' knowledge and practice, or patient outcomes following an online educational intervention. RESULTS: Eleven studies met the eligibility criteria. Most studies (8/11, 72.7%) found a significant improvement in at least one of the following outcomes: satisfaction, knowledge or practice change. There was little evidence for the impact of online CME on patient outcomes. Variability in study design, characteristics of online and outcome measures limited conclusions on the effects of online CME. DISCUSSION: Online CME could improve GP satisfaction, knowledge and practices but there are very few well-designed studies that focus on this delivery method of GP education.
Subject(s)
Clinical Competence/standards , Education, Medical, Continuing/methods , Education, Medical, Continuing/standards , General Practitioners/education , Humans , InternetABSTRACT
BACKGROUND: Many male reproductive system problems could be perceived as being embarrassing, which may be one of the reasons that they are often not identified in general practice. OBJECTIVE: This article provides an overview of some common problems affecting the male reproductive system, and outlines current treatment options. DISCUSSION: Erectile dysfunction, premature ejaculation, loss of libido, testicular cancer and prostate disease may cause embarrassment to the patient and, occasionally, the general practitioner. We describe how patients affected by these conditions may present to general practice, and discuss the reasons why they may not present. We also discuss how GPs can overcome difficulties in identifying and dealing with their male patients suffering from male reproductive system issues.
Subject(s)
Disease Management , Genital Diseases, Male , Reproduction/physiology , Australia/epidemiology , Genital Diseases, Male/epidemiology , Genital Diseases, Male/physiopathology , Genital Diseases, Male/therapy , Humans , Male , Morbidity/trendsABSTRACT
BACKGROUND: This study evaluated a clinical audit and evidence based practice guide designed to improve general practitioners' assessment and management of erectile dysfunction. METHOD: A self selected sample of 25 GPs audited their assessment and management of 1354 patients at risk of, or being treated for, erectile dysfunction. RESULTS: General practitioners reported several significant improvements across the audit period: GP initiated discussions about erectile dysfunction with 'at risk' patients nearly doubled. An 18% increase in psychological history taking with 'at risk' patients. A 19% increase in assessment of current erectile dysfunction patients' needs and preferences for treatment. Decreased specialist referrals. Increased provision of phosphodiesterase inhibitor samples. CONCLUSION: This clinical audit and practice guide was developed specifically and uniquely for GPs in Australia. Findings provide some support for the combined use of the clinical audit and practice guide to elicit positive changes in erectile dysfunction assessment and management.
Subject(s)
Erectile Dysfunction , Family Practice , Guidelines as Topic , Australia , Erectile Dysfunction/drug therapy , Erectile Dysfunction/therapy , Evidence-Based Medicine , Humans , Male , Medical Audit , Middle AgedABSTRACT
BACKGROUND: General practitioners undertake ongoing education in many areas. A train-the-trainer (TTT) approach may be an option for facilitation of continuing professional development (CPD) activities. METHODS: With the aim of training GPs to facilitate peer CPD activities, Monash University's Department of General Practice undertook a national TTT program on men's sexual and reproductive health. Over a 3 year period, 40 'GP trainers' were trained to facilitate education sessions on the topics of androgen deficiency, erectile dysfunction, prostate cancer and male infertility for 568 GPs from 33 Australian divisions of general practice. RESULTS: Evaluation of this program showed that GP trainers were a valuable resource for conducting training programs for GPs, being experienced role models who could provide relevant and practical training to their colleagues. DISCUSSION: While resource intensive, the TTT model provided an effective means of improving GP knowledge and clinical practice on men's sexual and reproductive health.
Subject(s)
Competency-Based Education/organization & administration , Education, Medical, Continuing/organization & administration , Education, Medical, Graduate/organization & administration , Family Practice/education , Male Urogenital Diseases/diagnosis , Male Urogenital Diseases/therapy , Australia , Clinical Audit , Humans , Male , Male Urogenital Diseases/complications , Program EvaluationABSTRACT
BACKGROUND: This program examined the impact of clinical guidelines and a 3 year self audit process on general practitioners' diagnosis and management of gastro-oesophageal reflux disease. METHODS: Nine hundred and sixty-six Australian GPs participated in a retrospective five step clinical audit reporting on data for 28,622 patients. RESULTS: General practitioners demonstrated significant improvements in their diagnosis and management of gastro-oesophageal reflux disease across the audit period, including: a significant 3% decrease in use of endoscopy; improved GP assessment and identification fo risk factors and exacerbants; significant increase in GP recommendations for patient weight loss and dietary changes (7 and 10% respectively); a significant 4% reduction in patient use of medications that may exacerbate reflux symptoms. DISCUSSION: The findings provide a snapshot of current diagnostic and management practices in Australian general practice, and highlight the benefits of clinical audit as a tool for eliciting evidence based, guideline driven practice change.
