Ability of the Australian general public to identify common emergency medical situations: Results of an online survey of a nationally representative sample.

OBJECTIVE: To investigate the Australian general public's ability to identify common medical emergencies as requiring an emergency response. METHODS: An online survey asked participants to identify likely medical treatment pathways they would take for 17 hypothetical medical scenarios (eight emergency and nine non-emergency). The number and type of emergency scenarios participants correctly suggested warranted an emergency medical response was examined. Participants included Australian residents (aged>18 years; n = 5264) who had never worked as an Australian registered medical doctor, nurse or paramedic. RESULTS: Most emergencies were predominately correctly classified as requiring emergency responses (e.g. Severe chest pain, 95% correct). However, non-emergency medical responses were often chosen for some emergency scenarios, such as a child suffering from a scalp haematoma (67%), potential meningococcal disease (57%), a box jellyfish sting (40%), a paracetamol overdose (37%), and mild chest pain (26%). Participants identifying as Aboriginal or Torres Strait Islander suggested a non-emergency response to emergency scenarios 29% more often compared with non-indigenous participants. CONCLUSIONS: Educational interventions targeting specific medical symptoms may work to alleviate delayed emergency medical intervention. This research highlights a particular need for improving symptom identification and healthcare system confidence amongst Aboriginal and Torres Strait Islander populations.

Improving health Professional's knowledge of hepatitis B using cartoon based learning tools: a retrospective analysis of pre and post tests.

BACKGROUND: Hepatitis B serology is complex and a lack of knowledge in interpretation contributes to the inadequate levels of screening and referral for highly effective hepatitis antiviral treatments. This knowledge gap needs to be addressed so that current and future healthcare professionals are more confident in the detection and assessment of hepatitis B to improve the uptake of treatment and reduce long-term complications from the disease. Cartoons have been used effectively as a teaching tool in other settings and were considered as a potentially useful teaching aid in explaining hepatitis B serology. This study examines the impact of cartoons in improving healthcare professionals' knowledge. METHODS: A cartoon based learning tool designed to simplify the complexities of hepatitis B serology was developed as part of an online learning program for medical practitioners, nurses and students in these professions. A retrospective analysis was carried out of pre and post online test results. RESULTS: An average improvement of 96% of correct answers to case study questions in hepatitis B serology was found across all ten questions following the use of an online cartoon based learning tool. CONCLUSION: The data indicates a significant improvement of participants' knowledge of hepatitis B serology from pre-test to post-test immediately following an online cartoon based learning tool. However, further research is required to measure its long term impact.

Aggressive behaviour - prevention and management in the general practice environment.

BACKGROUND: Aggressive behaviour is commonly encountered in the general practice setting and can often be de-escalated using good communication skills. OBJECTIVE: This article provides strategies to reduce and manage early aggression in the general practice environment. DISCUSSION: Aggressive behaviour usually occurs when a person feels unfairly treated. Having a systematic approach to the problem can improve safety for both staff and patients. This includes patient centred practice, identifying and managing the early signs of aggression to prevent escalation, having a plan to seek assistance if required, setting limits using a calm respectful manner and reinforcing limits using behaviour contracts when required. The physical layout of the practice and restraint of aggressive people are beyond the scope of this article.

Influencing behaviour change in general practice - Part 1 - brief intervention and motivational interviewing.

BACKGROUND: Behaviour change toward achieving a healthy lifestyle is important for all Australians, and general practitioners have a key role to play in assisting patients to make these changes. OBJECTIVE: This is the first of a two part series which provides the background to approaches to influencing behaviour change in general practice, from brief interventions to motivational interviewing (MI). The second part of the series will explore motivational interviewing in more detail. DISCUSSION: General practitioners have a key role in changing their patients' health behaviours. There are a range of tools GPs can use to help enhance their patients' motivation to achieve their health goals.

Medical morbidity and severity of depression in a large primary care sample of older Australians: the DEPS-GP project.

OBJECTIVES: To estimate the prevalence of depression among older Australians with common medical morbidities, and to determine the association between poor physical health and depression in this age group. DESIGN: Cross-sectional, postal questionnaire survey. SETTING AND PARTICIPANTS: 20 183 community-dwelling adults aged 60 years and over, under the care of 383 general practitioners participating in the Depression and Early Prevention of Suicide in General Practice (DEPS-GP) project (conducted between 2005 and 2008; the data in this article were collected during the baseline phase of the study in 2005). MAIN OUTCOME MEASURES: Depressive symptoms (measured by the nine-item depression scale of the Patient Health Questionnaire), health status (measured by the 12-item Short Form Health Survey and a medical morbidity inventory), social support (measured by the subjective support subscale from the Duke Social Support Index), and demographic and lifestyle information. RESULTS: 18 190 participants (90.1%) reported having at least one chronic physical health condition, while 1493 (7.1%) experienced clinically significant depression (3.1% major depressive syndrome; 4.0% other depressive syndrome). Most chronic physical illnesses were associated with increased odds of depression, and participants with numerous medical morbidities and a high level of functional impairment were three to four times more likely to have a depressive illness. CONCLUSIONS: Depression is more the exception than the rule in later life, and among those who are medically unwell, the level of associated impairment may determine their risk of depression more than their acquired physical illness. Many of the factors associated with depression in medically ill patients are amenable to treatment, and GPs are in a unique position to address this important public health issue.

Influencing behaviour change in general practice - Part 2 - motivational interviewing approaches.

BACKGROUND: Behaviour change toward achieving a healthy lifestyle is important for all Australians, and general practitioners have a key role to play in assisting patients to make these changes. OBJECTIVE: This is the second of two articles on influencing behaviour change in general practice. This article deals with the 'how to' of motivational interviewing in the general practice setting. DISCUSSION: Motivational interviewing can help build motivation, commitment and confidence to change. General practitioners can use motivational interviewing to help their patients achieve their health goals. Motivational interviewing is not about a set of techniques and questions; it is about creating a climate that facilitates change; it is more about listening than telling, evoking rather than instilling. Motivational interviewing can be done in the brief periods available in consultations over time.

Does general practice Google?

BACKGROUND: Searching websites during consultations with patients has been anecdotally reported to be useful by some medical practitioners. We aimed to investigate how and to what extent medical practitioners use the internet to aid clinical consultations. METHODS: A descriptive study of general practitioners in the Osborne Division of General Practice, Perth, Western Australia (N=132), using a postal questionnaire sent in May and June 2007. RESULTS: Ninety-three percent of those surveyed had broadband access. The majority used the computer for clinical tasks such as prescribing, ordering tests and writing letters. Fifty-six percent used the internet during consultations. The search engine 'Google' was the most commonly cited website. The most frequently mentioned reason for internet use was finding medical information for patients. DISCUSSION: Computers are now available in most general practices. The internet has impacted upon the traditional doctor-patient relationship. More research is needed into how GPs can better search and use the information available on the internet.

The prescribing dilemma of benzodiazepines.

BACKGROUND: Benzodiazepines are the most commonly prescribed psychoactive drug in western societies. While associated with risk and harm, they have a legitimate place in therapeutics. Prescribing practice does not reflect guidelines and guidelines rarely provide the practical strategies required to manage the complex clinical management of conditions such as anxiety, insomnia and drug dependence. OBJECTIVE: This article proposes a model for rational prescribing of benzodiazepines that may be transferable to other therapeutic situations requiring the consideration of complex health, social and system factors. DISCUSSION: Benzodiazepines, like all psychoactive drugs, have their 'good', 'bad' and 'ugly' side. Prescribing decisions are complex along the spectrum of use. Many subtle factors influence how each of us prescribe such as our knowledge of our patients, their medical histories, their personal situations and the individual doctor-patient relationship.

Prevention--building on routine clinical practice.

BACKGROUND: The role of general practice in preventing disease and promoting health is strongly supported by research and health policies. OBJECTIVE: This article examines the role of general practitioners in illness prevention and health promotion activities. DISCUSSION: Despite time and other barriers, such as competing priorities, to the implementation of preventive activities, prevention is part of routine general practice. In providing care for the whole person over a long period of time prevention and treatment are not separate entities and the line between these are necessarily blurred. From a pragmatic point of view, if a practice is to increase its activity in prevention there needs to be a driver that makes this happen and strategies to suit the structure of the individual practice. Introducing small interventions and making use of the practice team is a good place to start in a range of health promotion activities including opportunistic education, brief interventions for patients with disease risk factors, and specific interventions for a known disease.

Teen pregnancy--a program for awareness and health education.

BACKGROUND: Baby Think It Over is a health program that provides Perth adolescents in metropolitan schools with a 'virtual' parenting experience using an infant simulation program. Baby Think It Over seeks to modify attitudes toward teen pregnancy and parenting and to delay pregnancy until the participants have a better understanding of the demands and responsibilities of caring for an infant. At the same time, this program provides an opportunity to introduce adolescents to health services within their community with a particular focus on general practice. OBJECTIVE: This article describes the methodology and qualitative assessment of the program, examines some outcomes associated with its uptake and lessons learnt in its implementation. DISCUSSION: The program demonstrates that divisions of general practice can work together with schools to deliver innovative programs. The value of projects like this is in the community partnerships and social capital that they build across the health and education sector.

Benzodiazepine dependence.

BACKGROUND: Benzodiazepine dependency can occur as a result of treatment for anxiety disorders or sleep disturbance. While benzodiazepine withdrawal can be challenging, cessation of use can be even more difficult if there are other comorbidities such as oestrogen deficiency with vasomotor symptoms and anxiety disorders. OBJECTIVE: This article provides practical information for general practitioners in the management of patients with benzodiazepine dependence. DISCUSSION: Some patients may have common medical presentations and coexisting drug dependence. It is often difficult to separate these two issues. In the case of benzodiazepine dependence, gradual withdrawal over time and nonpharmacological treatment of the symptoms of withdrawal such as anxiety or insomnia is effective. Better outcomes are achieved where the GP discusses and plans strategies well in advance with the patient. Treatment often involves multiple interventions from various health professionals. General practitioners are ideally placed to coordinate such treatment.

Alcohol and other drug use in later life.

BACKGROUND: Problem alcohol and other drug use is rarely suspected in the elderly. However, the elderly are more susceptible to problems related to drug use at lower doses because of age related changes, comorbidities and polypharmacy. Like other age groups, the elderly sometime seek the use of alcohol and other drugs, to help them feel better or to avoid negative feelings such as loneliness and depression. Drug use in the elderly is associated with significant morbidity anid can be masked by other medical problems. OBJECTIVE: This article demonstrates a gradual onset alcohol problem in a longstanding elderly patient, in whom changes in drug or alcohol use may not be easily detected. It also highlights some key differences in drug related presentations in the elderly. DISCUSSION: Some health professionals consider intervention for problem alcohol or other drug use in the elderly ineffective. However, because of the high prevalence of polypharmacy and comorbid pathology, intervention is more likely to result in a significant health improvement. General practitioners have a high level of contact with and are trusted by the elderly, giving them an unparalleled opportunity among health professionals to intervene in problem alcohol and other drug use.

Management of the impaired doctor.

BACKGROUND: The lifetime prevalence of substance abuse disorders among doctors in Australia has been estimated to be approximately 8%. These disorders can interfere with a doctor's ability to function and pose a risk to patient welfare and safety.' OBJECTIVE: This article identifies key indicators to the development of problem alcohol and drug use in a general practitioner, associated possible psychiatric morbidity, work deficits, and the need for colleagues to recognise and respond in a timely manner to resolve these events. DISCUSSION: Where intervention, treatment and monitoring are initiated early in problem drug use, outcomes for the GP are typically positive. Outcomes are better where there is adequate support by friends and colleagues, and where there is a clearly defined management strategy.

When the child with ADHD grows up.

BACKGROUND: There is significant controversy surrounding attention deficit hyperactivity disorder (ADHD). While the existence of this disorder is generally accepted, debate continues in relation to aspects of assessment, as well as the effectiveness and choice of treatment options and their continuation into adult life. Management is further complicated as people with ADHD often have chaotic lives which impedes medication compliance and motivation to continue treatment vacillates. Concern also exists over the misuse of amphetamine-like medications by some patients. OBJECTIVE: This case study does not provide comprehensive information on current diagnosis and ADHD treatment guidelines, but explores the issues and management role of general practitioners treating patients with ADHD. DISCUSSION: The diagnosis of ADHD is common, and many patients are managed using a range of social and behavioural interventions that are commonly combined with pharmacotherapies (provided in the main by psychiatrists and paediatricians). However, while specialists may appropriately choose not to treat where a diagnosis is unclear, or discontinue treatment for reasons such as doubtful response to treatment, possible medication misuse, concurrent illicit drug use or poor motivation, GPs frequently continue to manage ongoing care and the impact of ADHD on the rest of the family. When the specialist formulation suggests there is little to gain from further treatment, the GP is likely to be the sole health professional remaining engaged in support and ongoing management.

Injecting drug use and skin lesions.

BACKGROUND: Many illicit drugs can be injected, with this mode of administration associated with a range of skin morbidities. OBJECTIVE: This article illustrates a dermatological presentation associated with injecting drug use. DISCUSSION: Track marks, injection site marks and skin abscesses are well known to be associated with injecting drug use. However, there are other dermatological manifestations that are less commonly known. Signs may be more subtle, particularly when drug use is recreational and patients do not fit commonly held stereotypes of injecting drug users.

Back pain and opioid seeking behaviour.

BACKGROUND: Back pain is a common presentation associated with opioid seeking behaviour. OBJECTIVE: This case study provides general practitioners with a practical approach to seeing patients with chronic pain whom they suspect of opioid dependence and describes a framework for managing chronic pain and dependence within the general practice setting. DISCUSSION: Back pain, with or without opioid dependence, is commonly encountered in general practice. General practitioners frequently find themselves caught between the desire to treat and relieve symptoms, and not wanting to cause or exacerbate dependence. Clear guidelines and access to support are often lacking.

Cough mixtures: not always for cough.

BACKGROUND: Opioid based cough mixtures are readily available to the public and are generally used safely. However, like alcohol, their use can sometimes be a significant part of a dependence problem. OBJECTIVE: This case study provides practical information for general practitioners in the detection, assessment and management of patients with cough mixture opioid dependence. DISCUSSION: Opioid dependence is generally considered synonymous with heroin dependence or dependence on prescribed opioid analgesics. However, cough mixtures are a readily available source of opioids. People who become dependent on these mixtures commonly do not present for medical assistance until the problem is severe.

Cannabis and psychosis.

BACKGROUND: Cannabis use is commonly identified in people who present with psychosis. OBJECTIVE: This case study aims to provide a practical approach for general practitioners seeing patients with comorbid cannabis and mental health concerns. DISCUSSION: Cannabis related comorbidity is commonly seen in general practice. General practitioners can manage most presentations and help to reduce the likely occurrence of cannabis induced psychosis through the use of psychosocial support, brief interventions and harm minimisation.

Acute pain and opioid seeking behaviour.

BACKGROUND: Acute pain is a common presentation associated with opioid seeking behaviour. OBJECTIVE: This case study provides a practical approach for general practitioners seeing patients with acute pain whom they suspect of seeking opioids because of dependence. DISCUSSION: Acute pain commonly presents as an emergency appointment 'squeezed in' between booked appointments. General practitioners have to make a rapid assessment of the possible underlying causes, relieve pain, and establish a plan for further investigation and management. Furthermore, some opioid dependent people can and do effectively feign acute pain in order to obtain opioid medication.