General-practitioner-led alcohol and other drugs withdrawal: Supporting patient choice, safety and success.

BACKGROUND: Alcohol or other drug (AOD) withdrawal is a common reason for patients to seek treatment. Ambulatory, or 'home-based', AOD withdrawal for patients who are low risk is a useful intervention for general practitioners (GPs) to help empower their patients to improve their health and make meaningful change to their AOD use. OBJECTIVE: This article explores the themes of patient choice, safety and optimising success in GP-led withdrawal. The four-step framework of 'who', 'prepare', 'withdrawal' and 'follow-up' outlines how to best support patients in the general practice setting to undertake a withdrawal. DISCUSSION: There are many benefits to a GP-led, home-based AOD withdrawal. The strategies to facilitate choice and safety and to optimise withdrawal success described in the article include careful patient selection, preparing the patient using domains of whole-person care, clarifying the patient's goals and stage of change, support during withdrawal and fostering long-term treatment in general practice.

Engaging patients who use alcohol and other drugs: A practical approach.

BACKGROUND: The treatment of alcohol and other drugs (AOD)-related issues is an essential skill for all general practitioners (GPs). The ongoing harm and significant burden of disease experienced by people who use AOD, as well as the impact of this on their families and communities, displays the need for engagement and upskilling in this clinical area. OBJECTIVE: Provide GPs with a clear and practical approach to supporting patients who use AOD. DISCUSSION: Historically, AOD use has been associated with shame, societal judgement and a punitive treatment approach. These factors have been shown to adversely affect treatment outcomes, including a significant delay to, and low engagement with, treatment. An approach focusing on rapport and the therapeutic alliance is best practice and incorporates a strengths-based approach of whole-person, trauma-informed care and motivational interviewing to support behaviour change.

Impact of Australian general practice alcohol and other drugs education: a qualitative evaluation.

BACKGROUND: Many GPs are challenged to deliver safe and effective care for patients who use alcohol and other drugs (AOD). The Royal Australian College of General Practitioners (RACGP) developed the AOD GP Education Programme to support Australian GPs and optimise AOD care in the community. How the programme impacted GP participants is not yet fully understood. AIM: To explore the views and experiences of GP participants who completed the AOD GP Education Programme, and AOD experts who were involved in the programme as a presenter or mentor. DESIGN & SETTING: Situated in the constructivist paradigm, this qualitive descriptive study engaged GPs across Australia. METHOD: This study employed semi-structured, online, focus groups interviews. Data were analysed thematically. RESULTS: Five focus groups were held with a total of 35 GP participants. Five themes developed, which illustrated that the study participants viewed the programme design as comprehensive and flexible. It has also been shown that participants' individual learning needs were addressed. Impacts of the programme on clinical practice included the following: confidence to care for patients who use AOD; confidence to collaborate with colleagues in delivery of AOD care; confidence to develop AOD professional networks in their community setting; and confidence to manage complex AOD presentations. CONCLUSION: Participants described the AOD programme as a high quality and positive educational experience. The prioritisation of core treatment skills (whole-person care and structured approaches to behavioural change) was a feature of the professional development programme. The AOD programme design is a practical model to implement for future AOD GP education and continuing professional development.

A survey of hepatitis C management by Victorian GPs after PBS-listing of direct-acting antiviral therapy.

BACKGROUND: To increase access to hepatitis C virus (HCV) treatment, the Pharmaceutical Benefits Scheme (PBS) enabled general practitioners (GPs) to prescribe direct-acting antiviral (DAA) therapy. We conducted a survey to identify GPs' knowledge and management of HCV. METHODS: A questionnaire consisting of 20 items about HCV knowledge and management was sent to 1000 GPs. RESULTS: One hundred and ninety-one GPs (19.1%) responded; 74% answered correctly that antibody and RNA positivity is diagnostic of HCV. Only 12% could directly request transient elastography. Although 53% of respondents reported interest in prescribing DAAs, 72% continued to refer all patients to specialists. Fifty-five per cent were unsure if people who currently inject drugs were eligible for treatment. DISCUSSION: Most respondents were interested in prescribing DAAs, but education, access to transient elastography and clear consultation pathways are required to translate this interest into increased treatment availability. PBS eligibility of current injectors needs promotion.

The inherited chronic pain patient.

BACKGROUND: The 'inherited' patient, where a patient switches to a new doctor, is a common and potentially challenging scenario, especially where drugs of dependence are involved. There are few resources to guide general practitioners (GPs) with an approach that ensures compassion and rational clinical decision-making. OBJECTIVE: The aim of this article is to guide GPs in an approach to taking over the care of an inherited patient and focuses on considerations of rational prescribing. DISCUSSION: In taking over the care of a new patient's pharmacotherapy, GPs need to proactively assess how rational and legal the 'inherited' medications are, and decide whether to continue, modify or cease. Our knowledge of the role and risks of drugs of dependence has evolved considerably over the past decade. GPs, therefore, need to carefully consider the ongoing role of these medications for new and existing patients.

Hair and nails.

BACKGROUND: Hair and nails are elements of dermatology that can often be omitted from the dermatological assessment. However, there are common and distressing hair and nail conditions that require diagnosis and management. OBJECTIVE: This article considers common and important hair and nail presentations to general practice. General and specific conditions will be discussed. DISCUSSION: Hair conditions may have significant psychological implications. This article considers assessment and management of conditions of too much hair, hair loss or hair in the wrong places. It also considers the common nail conditions seen in general practice and provides a guide to diagnosis and management.

Navigating general practice. The use of geographic information systems.

Geographic information systems (GIS) are powerful tools for managing, analysing and mapping geographical and associated data. In the health care setting, GIS can be used to map and graph health care provider and social and environmental data. This article uses two hypothetical cases to explore applications of GIS in general practice.

Addiction medicine--training for general practice registrars.

INTRODUCTION: Illicit drug use is a significant problem within Australia. However, GPs are reluctant to treat these problems due to a perceived lack of knowledge and confidence. METHOD: All advanced general practice registrars training through the Victorian Metropolitan Alliance in 2004 attended a 1 day pilot addiction medicine workshop, followed by completion of a questionnaire to assess the acceptability of the training and its impact on their knowledge and confidence. RESULTS: Forty-six general practice registrars attended the workshops with all but one (98%) completing the postworkshop questionnaire. More than 90% of registrars agreed that the material presented was relevant to their work and that they felt more confident dealing with addiction issues in practice. DISCUSSION: Addiction medicine training is relevant to the work of doctors training to become GPs and can increase knowledge and confidence. More extensive research is needed to assess whether this increase in knowledge and confidence is sustained over time and is translated into practice.