Epidemiology of melanoma in rural southern Queensland.

OBJECTIVE: The objective of this study is to define the epidemiology of melanoma in rural communities in southern Queensland. DESIGN: The design used was a 6-year clinical record audit of melanoma cases identified by billing records and electronic clinical records, confirmed and typed with histology. SETTING AND PARTICIPANTS: This study was based on seven agricultural communities on the Darling Downs with patients presenting to local primary care clinics. MAIN OUTCOME MEASURES: Outcomes measured were confirmed type, depth and anatomic distribution of melanoma identified at these practices during the study period. RESULTS: The results from 317 cases of melanoma found anatomic distribution was significantly different (χ2  = 9.6, P < 0.05) to that reported previously from the Queensland Cancer Registry. A high proportion (87%) of melanoma diagnosed by these general practitioners were 1 mm or less when treated. CONCLUSIONS: Conclusions drawn from these findings are that melanoma risk is not so much lesser in rural, inland communities compared with coastal and metropolitan regions, but different. Differences may relate to comprehensive data capture available in rural community studies and to different sun exposure and protection behaviours. The higher proportion of melanoma identified at early stages suggests rural primary care is an effective method of secondary prevention.

Defibrillators--their use in general practice.

During the development of The Royal Australian College of General Practitioners Standards for general practices (3rd edition) in 2005, the unflagged (nonessential) indicator 'the practice has a defibrillator' was tested in a survey of 200 practices Australia wide. Defibrillators were present in 18% of these general practices: 20.5% of surveyed practices thought it was feasible to have a defibrillator and 32.5% thought it was acceptable to have one. With that feedback, the committee dropped this indicator from the final standards document.

Principles for supporting task substitution in Australian general practice.

The workforce crisis in Australian general practice provides an impetus to consider new roles for other health professionals. Any innovations need to be appraised in advance for their potential risks and benefits. We propose six principles for this appraisal. These are the need for the new roles to: support the relationship between patients and their general practitioners; be clearly defined, aligned with competency and with relevant professional registration; be supported by practice systems providing safeguards against medical error; be underpinned by a system ensuring informed patient consent to activities being undertaken by members of the general practice team; be supported by effective medical indemnity insurance and be supported with appropriate financing.