The likelihood of general practitioners referring patients to physiotherapists is low for some health problems: secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) observational study.

QUESTIONS: Which health problems do medical general practitioners (GPs) most commonly refer to physiotherapists? What is the likelihood of GPs referring patients for specific health problems? DESIGN: Secondary analysis of data from the Bettering the Evaluation and Care of Health (BEACH) study, which is a national observational study of Australian general practice clinical activity. PARTICIPANTS: People at GP encounters between April 2010 and March 2015. OUTCOME MEASURES: The outcomes were the proportion of all (new) health problems that were referred to a physiotherapist, the distribution of health problems referred to physiotherapists, and the likelihood of referral of (all and new) specific health problems to physiotherapists. RESULTS: There were 6904 referrals to a physiotherapist from 775893 GP encounters, which equated to 0.89% (95% CI 0.86 to 0.92). Among the 286858 new health problems, 2987 were referred to a physiotherapist (1.04%, 95% CI 0.99 to 1.09). The health problems that were most commonly referred were back complaints (18.6%), sprains (10.3%) and osteoarthritis (8.6%). However, when these three problems presented as a new health problem, the likelihood of referral was low (14.4, 11.9 and 5.4%, respectively). The new health problems most likely to result in a referral were acquired deformity of the spine (which includes kyphoscoliosis, kyphosis, lordosis and scoliosis) (17.7%, 95% CI 8.2 to 27.2) and neck complaints (17.4%, 95% CI 14.3 to 20.6). CONCLUSIONS: Most referrals made to physiotherapists were for musculoskeletal problems. However, even among the most commonly referred problems (such as back complaints and osteoarthritis), the likelihood of referral was low when they presented as a new problem. There is an opportunity to increase referrals from general practice to physiotherapy for many common conditions with effective physiotherapy interventions. [Dennis S, Watts I, Pan Y, Britt H (2018) The likelihood of general practitioners referring patients to physiotherapists is low for some health problems: secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) observational study. Journal of Physiotherapy 64: 177-181].

Who do Australian general practitioners refer to physiotherapy?

BACKGROUND: Physiotherapy plays an important role in the health of many Australians. The aims of this study were to assess changes in the rate of general practitioner (GP) referral to physiotherapists in Australia from 1998 to 2014, and to determine patient characteristics associated with increased likelihood of such referral. METHODS: Secondary analysis was undertaken of data from the Bettering the Evaluation and Care of Health program using weighted encounter data years 1998-99 to 2014-15 inclusive. RESULTS: The rate of GP referral to physiotherapists remained steady until 2010, when referrals increased. Patients were more likely to be referred to physiotherapy if they had a Department of Veterans' Affairs card; did not have a Health Care Card; were female aged 45-64 years; or male aged 25-44 years. Musculoskeletal problems accounted for 80% of referrals, but only 6.8% of all musculoskeletal problems managed were referred. DISCUSSION: Allied health Medicare Benefits Schedule item numbers have increased referrals to physiotherapy. However, there are some population groups who are not referred but might benefit from physiotherapy.

Expert perspectives on the contribution of HIV general practice nursing to the 'extraordinary story' of HIV medicine in Australia.

AIM: This paper explores cultural and professional dynamics of HIV general practice nursing in Australia. It highlights specific contributions that HIV general practice nurses make to HIV medicine and considers how nurses' clinical practice has been shaped by past experiences of the AIDS crisis and subsequent developments in HIV medicine. BACKGROUND: In international contexts, nurses in HIV medicine commonly work as part of shared-care teams. In recent years, HIV general practice nursing has become a prioritised area for primary health care in Australia. METHODS: Data for this analysis were drawn from 45 in-depth, semi-structured interviews conducted with nurses and general practitioners (GPs) who provide HIV care in general practice, and key informants who work in policy, advocacy or education and training of the HIV general practice workforce. FINDINGS: Viewed through a socio-ecological framework of social capital, descriptive content analysis highlights a unique and strong HIV health professional identity, which emerged out of the adverse conditions experienced by nurses, GPs and allied health professionals during the 1980s AIDS crisis. Participants reported that today, HIV general practice nursing includes information provision, HIV treatment side-effect management, teaching patients methods to increase adherence to HIV treatments and capacity building with allied health professionals. Participants reported that HIV general practice nurses can reduce the clinical burden on GPs, ameliorate patients' exposure to HIV health care-related stigma and discrimination and facilitate the emergence of a comprehensive and personalised model of shared primary health care based on trust and rapport, which is desired by people with HIV. This study's findings support the future expansion of the role of HIV general practice nurses in Australia and internationally. General practice nursing will become increasingly important in the scaling up of HIV testing and in caring for increasing numbers of people living with HIV.

Designing practices - using evidence to do better.

The physical layout of general practices has generally been overlooked in research on safety in the health system. This article provides an overview of the evidence that is available on physical design, and the implications of this research for general practice.

The pigments from Pinnacle Point Cave 13B, Western Cape, South Africa.

Earth pigments from the three excavations at Pinnacle Point Cave 13B (Western Cape Province, South Africa), spanning the terminal middle Pleistocene and earlier late Pleistocene, are described and analyzed. Qualitative geological categorization primarily rested on textural, fabric, and iron enrichment attributes. Comprehensive recovery allowed identification of non-anthropic pigmentaceous materials, questionable pigments, and 380 pigments (1.08 kg). Less chemically altered pigments were typically fine-grained sedimentary (FGS) rocks, tending to be soft, highly micaceous, prone to laminar fragmentation, and with reddish-brown streaks of intermediate nuance. More iron-enriched forms tended to be harder, denser, poorly micaceous, and with redder streaks of more saturated nuance. Some still qualified as FGS forms, but a large number were categorized as sandstone or iron oxide. Despite some temporal change in raw material profiles, circumstantial evidence suggests primarily local procurement from one outcrop throughout the sequence. Definitely utilized pieces (12.7%) were overwhelmingly ground. Unusual forms of modification include several notched pieces and a deliberately scraped 'chevron.' Controlling for fragmentation, streak properties of utilized versus unutilized pieces were used to investigate selective criteria. There was robust evidence for preferential grinding of the reddest materials, strongly suggestive evidence for saturation and darkness being subordinate selective criteria, and some indication of more intensive grinding of materials with the reddest, most saturated, and darkest streaks, and for some deliberate heating of pigments. These findings challenge the initial stages of color lexicalization predicted by the various versions of the basic color term (BCT) hypothesis, they provide grounds for rejecting hafting as a general explanatory hypothesis, and they cannot be accounted for by incidental heating. The results are more consistent with agreed upon canons of ornamentation than with individual display. It is concluded that the material was processed to produce saturated red pigment powders. On theoretical grounds, these are presumed to have served primarily as body paints in ritual performance.

Engraved ochres from the Middle Stone Age levels at Blombos Cave, South Africa.

Powerful categories of evidence for symbolically mediated behaviour, variously described as 'modern' or 'cognitively modern' human behaviour, are geometric or iconographic representations. After 40,000 years ago such evidence is well documented in much of the Old World and is widely considered as typifying 'modern human culture,' but earlier evidence is rare. In Africa, this includes two deliberately engraved ochre pieces from c. 75,000 year old levels at Blombos Cave, Western Cape, South Africa and the greater than 55,000 year old incised ostrich egg shell from the Diepkloof shelter, located in the same province. Here we report on thirteen additional pieces of incised ochre recovered from c. 75,000-100,000 year old levels at Blombos Cave. These finds, taken together with other engraved objects reported from other southern African sites, suggest that symbolic intent and tradition were present in this region at an earlier date than previously thought.

Primary health care reform: equity is the key.

Equity must be the basis of primary health care if reform is to deliver the outcomes we all want.

Price fixing in general practice.

Dr Bev Young has just finished packing up her office. This is her last day in her Preston practice of 19 years. Bev enjoys the autonomy of being a solo general practitioner, but lately she finds managing the practice increasingly stressful. Teaming up with a fellow GP seemed a good alternative.

Early human use of marine resources and pigment in South Africa during the Middle Pleistocene.

Genetic and anatomical evidence suggests that Homo sapiens arose in Africa between 200 and 100 thousand years (kyr) ago, and recent evidence indicates symbolic behaviour may have appeared approximately 135-75 kyr ago. From 195-130 kyr ago, the world was in a fluctuating but predominantly glacial stage (marine isotope stage MIS6); much of Africa was cooler and drier, and dated archaeological sites are rare. Here we show that by approximately 164 kyr ago (+/-12 kyr) at Pinnacle Point (on the south coast of South Africa) humans expanded their diet to include marine resources, perhaps as a response to these harsh environmental conditions. The earliest previous evidence for human use of marine resources and coastal habitats was dated to approximately 125 kyr ago. Coincident with this diet and habitat expansion is an early use and modification of pigment, probably for symbolic behaviour, as well as the production of bladelet stone tool technology, previously dated to post-70 kyr ago. Shellfish may have been crucial to the survival of these early humans as they expanded their home ranges to include coastlines and followed the shifting position of the coast when sea level fluctuated over the length of MIS6.

The educational needs of nurses working in Australian general practices.

OBJECTIVE: To describe the educational needs of nurses working in general medical practice in Australia. DESIGN: Survey research combining qualitative and quantitative data collected via telephone interview. SUBJECTS: 222 enrolled (RN Division 2 in Victoria) and registered nurses (RN Division 1 in Victoria) working in general practice in rural and urban areas of Australia. RESULTS: Nurses identified a number of educational areas of high importance including communication skills (94.1%); infection control (93.7%); confidentiality and national privacy legislation (93.7%); legal and ethical issues (91.9%); first aid and CPR (91.4%); wound (91.0%); care cold chain monitoring (90.0%); sterilisation (90.0%); and triage (90%). Barriers to education were identified including lack of time due to work (21.9%); costs of courses (17.3%); distance to education (13.9%); and lack of time due to family commitments (13.1%). More rural/remote nurses identified distance as a barrier (20.5%) than urban nurses (3.6%). DISCUSSION: cussion: The education areas that were rated as important by a high number of the nurses appeared to relate directly to the activities nurses currently undertake in Australian general practice. Barriers to education may reflect the workforce characteristics of general practice nurses and/or the capacity of general practices to finance training for employees. CONCLUSIONS: As a growing specialty of nursing in Australia, general practice nursing should be supported by a solid foundation of ongoing education and training that is tailored to the current needs of nursing in general practices and reflects appropriate delivery options to overcome barriers to training.

Financing and the quality framework.

BACKGROUND: Using a quality framework can assist in the design of payment arrangements to ensure that the optimal effects of health funding are achieved. OBJECTIVE: This article examines the finance domain of The Royal Australian College of General Practitioners Quality Framework for Australian General Practice. DISCUSSION: The quality of the care general practitioners and their teams provide is affected by the way the GPs and team members are paid, both within the practice and through programs such as the Medicare Benefits Schedule. These payment arrangements do not always promote high quality and can have unintended negative consequences.

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.

Field testing a complaints register proposal as a requirement of Australian general practice.

OBJECTIVE: To investigate the feasibility, achievement and acceptance of indicators of quality general practice in the RACGP Standards for general practices (third edition), using complaints registers as a case study. DESIGN, SETTING AND PARTICIPANTS: A purposive sample of convenience of 200 general practices (stratified according to location and size) participated in a field test of quality and safety proposals during an accreditation survey visit between October 2004 and February 2005. Included was a test of the proposal for a complaints register (a document where complaints made to the practice are recorded). MAIN OUTCOME MEASURES: Achievement of the complaints register proposal, assessed by accreditation surveyors; questionnaire rating of the feasibility and acceptance of the proposal. RESULTS: Few practices used a formal complaints register (79/200; 39.5%), with large practices more likely (12/20; 60.0%) and very remote practices less likely (1/11; 9.1%) to use one. The proposal for complaints registers was rated feasible by 123 general practices (61.5%) and rated acceptable by 121 general practices (60.5%). CONCLUSIONS: The proposal for complaints registers in general practice, while popular with policymakers, gained limited support when tested in Australian general practice. This shows the need for a balance between the expectations of policymakers, the need to increase performance by setting standards, and the practicalities of every-day general practice.

General practice nursing education in Australia.

The quality of care delivered by nurses working in Australian general practices rests on a strong foundation of nursing educatlon and training. A national study of nurses working in general practice was conducted using qualitative and quantitative research techniques to explore their role and educational needs. Results from this research suggest that education for general practice nurses is seen by nurses and General Practitioners to be largely non-formal in nature and is seen by GPs and nurses to be tailored towards general practice nursing needs. Such education is often available locally through general practice support organisations; is strongly focused on National Health Priority Areas and clinical care; and is more appropriate for registered rather than enrolled nurses. The educational opportunities currently available to support nursing in general practice are largely ad hoc and vary in relation to quality, appropriateness and accessibility. Nurses working in general practices in Australia need a system of ongoing training and education to support their responsibilities and foster the development of the position as a viable career option for nurses.

The changing face of nurses in Australian general practice.

OBJECTIVE: To describe the workforce characteristics and current responsibilities of nurses working in Australian general practice settings. DESIGN: Survey research combining qualitative and quantitative data collected through telephone interview. SUBJECTS: 222 enrolled (RN Division 2 in Victoria) and registered nurses (RN Division 1 in Victoria) working in general practice in rural and urban areas of Australia. RESULTS: General practice nurses in Australia are likely to be RNs (84.7%) who work on a part-time basis (75.3%) in a medium to large practice (93.7%). Often the nurse has worked less than five full time equivalent years (52.3%) in a general practice environment and is likely to work in a practice where at least one other nurse works (64.4%). The nurse is likely to have some post-basic formal education (65.9%), and to have participated in professional development in the past two years (94.9%). The nurse performs a diverse range of activities within the general practice. No substantial differences were found in the workforce characteristics or role of urban and rural general practice nurses. CONCLUSION: It appears that nurses working in general practice are no longer the 'handmaiden' to the doctor but are professionals who perform a vast range of clinical, administrative and organisational responsibilities within the general practice primary health care setting.

Close-packed C(70)(3-) phases - synthesis, structure, and electronic properties.

The high symmetry and resulting electronic degeneracy of the C(60)(3)(-) anion is viewed as the key molecular feature in the high superconducting transition temperatures of fulleride and oxidized fullerene systems. The experimental evaluation of this hypothesis requires the synthesis of face-centered cubic (fcc) trivalent fulleride anion salts derived from higher fullerenes such as C(70), which have thus far proved elusive with only stable A(1)C(70), A(4)C(70), and A(6)C(70) phases known. In this paper, we report the synthesis of fcc A(3)C(70) phases stabilized by size-matching the tetrahedral site with the sodium cation. The structures are strongly dependent on the cooling protocol due to the existence of metastable partially or completely orientationally disordered phases. EPR data indicate that the phases are metallic but not superconducting. The densities of states at the Fermi level appear too low to give superconductivity at above 5 K, consistent with recent observations that four electrons per C(70) anion are required for superconductivity. Size-matching on both the octahedral and tetrahedral sites is required for A(3)C(70) stability - K(2)CsC(70) is only stable at elevated temperature and Na(2)C(70) is unstable, the composition corresponding to C(70) and a sodium-rich trigonal phase.

Emergence of modern human behavior: Middle Stone Age engravings from South Africa.

In the Eurasian Upper Paleolithic after about 35,000 years ago, abstract or depictional images provide evidence for cognitive abilities considered integral to modern human behavior. Here we report on two abstract representations engraved on pieces of red ochre recovered from the Middle Stone Age layers at Blombos Cave in South Africa. A mean date of 77,000 years was obtained for the layers containing the engraved ochres by thermoluminescence dating of burnt lithics, and the stratigraphic integrity was confirmed by an optically stimulated luminescence age of 70,000 years on an overlying dune. These engravings support the emergence of modern human behavior in Africa at least 35,000 years before the start of the Upper Paleolithic.