Reducing avoidable admissions in rural community palliative care: a pilot study of care coordination by General Practice registrars.

OBJECTIVE: To investigate the feasibility of using a General Practice registrar (GPR) to coordinate rural palliative care services. DESIGN: A quasi-experimental design was used. Intervention group participants received the GPR service, which involved liaison among the patient, family, General Practitioner, specialist palliative care team and community nurses. Specified risk assessment, care planning and continuity of care were provided. Patients in the comparison group received the standard service. SETTING: Rural community palliative care. PARTICIPANTS: One hundred and ninety-one rural community palliative care patients (99 intervention and 92 control patients). MAIN OUTCOME MEASURES: Hospital admissions per 100 patient-days, bed-days per 100 patient-days and proportion of deaths at home. RESULTS: Patients receiving standard care were twice as likely to spend ≥8 bed-days in hospital (OR 2.09 (95%CI 1.10-3.97); P = 0.02) and were more likely to have ≥ 2 admissions to hospital (OR 3.37 (95%CI 1.83-6.21); P < 0.001), per 100 patient-days than the intervention group after adjusting for diagnosis group (cancer or not) and residence in residential aged care. Controls were significantly less likely to die at home than the intervention group (OR 0.41 (95%CI 0.20-0.86); P = 0.02). CONCLUSION: This is a small proof of concept pilot study limited by lack of randomisation. The results demonstrate the feasibility of using a GPR to manage continuity of care for rural community palliative care patients. Given the potential confounding factors, further investigation via a larger randomised trial is required.

How effective and acceptable is Web 2.0 Balint group participation for general practitioners and general practitioner registrars in regional Australia? A pilot study.

OBJECTIVE: General practitioners (GPs) and general practice registrars report work-related stress. Balint groups may improve coping mechanisms. However, attendance at a face-to-face Balint group is difficult for rural doctors due to distance constraints. The study aim was to evaluate online Balint groups for rural doctors and determine effect size for a full-scale trial. DESIGN: A mixed-methods approach, including a pre-post controlled trial and thematic analysis of qualitative data. SETTING: Rural primary care. PARTICIPANTS: Thirteen GPs and 8 general practice registrars completed the study. INTERVENTIONS: Balint groups were delivered over 8-9 fortnightly online sessions. GPs and GP registrars participated in separate groups. Data were collected on work-related affect, psychological medicine skills and professional isolation using the Warr's Work-Related Affect Scale, the Psychological Medicine Inventory, and a professional isolation scale. MAIN OUTCOME MEASURES: Change scores on Warr's Work-Related Affect Scale, the Psychological Medicine Inventory, and a professional isolation scale. RESULTS: Balint participants' scores were significantly higher post-intervention on the Psychological Medicine Inventory (mean 6.49 (±0.20) versus 5.43 (±0.26); P < 0.01) and Warr's Work-Related Affect (mean 4.09 (±0.09) versus 3.60 (±0.12); P < 0.01) scales than control group scores. Effect size on these scales ranged from 0.46 to 0.50. The greatest challenge was technical problems related to insufficient broadband speed. CONCLUSIONS: Online Balint groups appear to improve rural doctors' psychological medicine skills and work-related affect. New data on effect size will inform a full-scale trial. Improved national broadband infrastructure may enhance online support opportunities for rural doctors.

Two HEADSSS are better than one - a biopsychosocial screening tool for use when treating other doctors.

BACKGROUND: This is the fourth article in a series exploring issues involved in treating other doctors. The first article discussed potential barriers faced by doctors when seeking medical care for themselves. The second article looked at strategies for minimising these barriers before the consultation takes place, and the third explored strategies for use during a consultation when the patient is another doctor. OBJECTIVE: In this article, a model for a biopsychosocial screening tool for use as a prompt when treating other doctors is discussed. DISCUSSION: Many of the challenges involved in doctors treating other doctors revolve around communication, not only what is said, but also what remains unsaid. It can be tempting for the treating doctor to collude with the patient doctor resulting in less than ideal medical care. Use of a biopsychosocial screening tool and normalising the process of asking questions on potentially sensitive topics can reduce the risk of collusion.

Optimising the medical care of doctors. Part 2--before the consultation.

Best practice principles would suggest that the patient doctor contact the treating doctor before seeing them for the first time to ask if they would be willing to take them on as a patient.

Barriers to good health care.

BACKGROUND: Being a doctor to a colleague is a great honour for any medical practitioner. However, it also presents many challenges. These challenges will be discussed in a series of articles looking at how to best be a doctor for other doctors. OBJECTIVE: This article, the first in the series, explores potential barriers to good medical care when the patient is a doctor. Subsequent articles in the series will discuss strategies for overcoming these barriers. DISCUSSION: There are many barriers to doctors receiving ideal medical care These barriers include issues around boundaries, embarrassment, confidentiality, payment for services and medicolegal issues. Having an awareness of these barriers can help treating doctors to offer the best possible care to those colleagues who choose to see them as patients.

Optimising the medical care of doctors - part 3 - during the consultation.

This is the third in a series of articles exploring issues involved in doctors treating other doctors. The first article looked at barriers to good medical care when the patient is a doctor. The second article discussed strategies that can be used before the consultation takes place. Particular emphasis was put on the value of the patient doctor contacting the treating doctor before the first consultation. This article will focus on strategies that can be used by the treating doctor during the consultation to facilitate best possible communication. While these strategies could be applied in any consultation, an explanation of why they are particularly important when the patient is a doctor will be offered.

A road to humanity.

Working as a doctor has many rewards, but there are also many challenges. One of the greatest challenges is being able to respond appropriately to the human suffering of our patients without becoming emotionally overwhelmed by it. Most doctors I know have developed some form of defence mechanism to help them cope with this dilemma. We often discuss this issue at the burnout prevention workshops, which I run, and I'd like to share one of my strategies.

Wellbeing. Part 1--what is it?

This is the first in a series of articles which will explore the nondisease focused model of medicine--the notion of promoting wellness. The primary intention is to encourage the reader to reflect on their own wellbeing, and to gain some strategies to assist them in improving it where necessary. However, all the principles outlined here can also be used to help our patients in achieving similar outcomes.