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Comprehensive Healthcare gets $4 million to open walk-in clinic, improve access to treatment

YAKIMA CO., Wash. -- The need for behavioral health and substance use disorder services is high in Yakima County and people often struggle with getting appointments, but Comprehensive Healthcare is

Washington , District-of-columbia , United-states , Jodi-daly , Human-services-substance-abuse , Department-of-health , Mental-health-services-administration-grant , Yakima-county , Comprehensive-healthcare , Camp-hope , Clinics , Eneral-practice

"CHIME-GP trial of online education for prescribing, pathology and imag" by Christine Metusela, Judy Mullan et al.

Background: There is a need for scalable clinician education in rational medication prescribing and rational ordering of pathology and imaging to help improve patient safety and enable more efficient utilisation of healthcare resources. Our wider study evaluated the effectiveness of a multifaceted education intervention for general practitioners (GPs) in rational prescribing and ordering of pathology and imaging tests, in the context of Australia’s online patient-controlled health record system, My Health Record (MHR), and found evidence for measurable behaviour change in pathology ordering among participants who completed the educational activities. This current study explored the mechanisms of behaviour change brought about by the intervention, with a view to informing the development of similar interventions in the future. Methods: This mixed methods investigation used self-reported questionnaires at baseline and post-education on MHR use and rational prescribing and test ordering. These were analysed using multi-level ordinal logistic regression models. Semi-structured interviews pre- and post-intervention were also conducted and were analysed thematically using the COM-B framework. Results: Of the 106 GPs recruited into the study, 60 completed baseline and 37 completed post-education questionnaires. Nineteen participants were interviewed at baseline and completion. Analysis of questionnaires demonstrated a significant increase in confidence using MHR and in self-reported frequency of MHR use, post-education compared with baseline. There were also similar improvements in confidence across the cohort pre-post education in deprescribing, frequency of review of pathology ordering regimens and evidence-based imaging. The qualitative findings showed an increase in GPs’ perceived capability with, and the use of MHR, at post-education compared with baseline. Participants saw the education as an opportunity for learning, for reinforcing what they already knew, and for motivating change of behaviour in increasing their utilisation of MHR, and ordering fewer unnecessary tests and prescriptions. Conclusions: Our education intervention appeared to provide its effects through providing opportunity, increasing capability and enhancing motivation to increase MHR knowledge and usage, as well as rational prescribing and test ordering behaviour. There were overlapping effects of skills acquisition and confidence across intervention arms, which may have contributed to wider changes in behaviour than the specific topic area addressed in the education. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12620000010998) (09/01/2020).

Australia , My-health-record , Health-record , Australian-new-zealand-clinical-trials-registry , Electronic-health-record , Eneral-practice , Rimary-care , Ational-prescribing , Est-ordering ,

"Provider views of pre-exposure prophylaxis (PrEP) for cisgender women " by Caroline Lade, Catherine MacPhail et al.

Background. HIV pre-exposure prophylaxis (PrEP) in Australia has largely been targeted at gay, bisexual and other men who have sex with men. In the context of HIV elimination, the aim of this qualitative study was to explore PrEP prescribing for Australian cisgender women from the provider's perspective. Methods. Semi-structured interviews were held with Australian prescribers in 2022. Participants were recruited through relevant clinical services, newsletter distribution and snowball sampling. Interviews were audio-recorded, transcribed and analysed thematically. Results. Seventeen prescribers participated, of whom 9 were sexual health physicians and 10 worked in New South Wales. All reported limited clinical experience prescribing PrEP for women. Potential enablers to PrEP prescribing to women included education for women and clinicians, easily identifiable risk factors, individualised risk assessment and expansion of existing services. Barriers were limited PrEP awareness among women and prescribers, difficulties with risk assessment and consult and service limitations. The type of service recommended for PrEP provision varied among participants. Conclusions. Clinician experience of PrEP prescribing to Australian cisgender women is limited, with substantial barriers to access perceived by prescribers. Targeted education to PrEP prescribers, updated national PrEP guidelines to include women as a distinct group and further research regarding women's preferred model of PrEP access are required. Clarity of clinical ownership over PrEP implementation for women and, more broadly, women's sexual health, is essential in order to achieve HIV elimination in Australia.

Australia , Australian , New-south , Eneral-practice , Iv , Mplementation , Re-exposure-prophylaxis , Rep , Rescribers , Revention , Rimary-care

Louisville doctor advises best way to quit smoking in the new year

Talk to your provider if you plan to stop smoking.

Steven-patton , Centers-for-disease , Norton-healthcare , Disease-control , Smoking-in-the-united-states , Ealth-effects-of-tobacco , Abits , Rug-rehabilitation , Eneral-practice , Moking-cessation , Moking , Orton

GP centre won't prescribe 'highly addictive' painkillers due to concerns over illegal drug trade

There have been growing concerns in recent weeks about the sale of opioids and other powerful painkillers.

Rathfarnham , County-south-dublin , Ireland , Dublin , Canada , Irish , Stephen-donnelly , Tony-duffin , Palexia-tapentadol , Christina-finn , Irish-college , Department-of-health

"Randomised trial of general practitioner online education for prescrib" by Andrew Bonney, Conrad Kobel et al.

Introduction Potentially inappropriate medicine prescriptions and low-value diagnostic testing pose risks to patient safety and increases in health system costs. The aim of the Clinical and Healthcare Improvement through My Health Record usage and Education in General Practice study was to evaluate a scalable online quality improvement intervention, integrating online education regarding a national shared electronic health record and rational prescribing, pathology and imaging ordering by Australian general practitioners (GPs). Methods The study was a parallel three-arm randomised trial comprising a prescribing education arm, a pathology education arm and an imaging education arm. Currently practising GPs in Australia were eligible to participate and randomised on a 1:1:1 basis to the study arms after consenting. The response to the intervention in reducing potentially unnecessary medicine prescriptions and tests in each arm was assessed using the other two arms as controls. The primary outcome was the cost per 100 consultations of predefined medication prescriptions, pathology and radiology test ordering 6 months following the intervention, compared with 6 months prior. Outcomes were assessed on intention-to-treat and post hoc per-protocol bases using multilevel regression models, with the analysts blinded to allocation. Results In total, 106 GPs were enrolled and randomised (prescribing n=35, pathology n=36, imaging n=35). Data were available for 97 GPs at the end of trial (prescribing n=33, pathology n=32, imaging n=32) with 44 fully completing the intervention. In intention-to-treat analysis, there were no significant differences in the rates of change in costs across the three arms. Per protocol, there was a statistically significant difference in the rate of change in pathology costs (p=0.03). In the pathology arm, the rate of increase in pathology costs was significantly lower by $A187 (95% CI -$A340, -$A33) than the prescribing arm, and non-significantly $A9 (95% CI -$A128, $A110) lower than the imaging arm. Discussion This study provides some evidence for reductions in costs for low-value pathology test ordering in those that completed the relevant online education. The study experienced slow uptake and low completion of the education intervention during the COVID-19 pandemic. Changes were not significant for the primary endpoint, which included all participants. Improving completion rates and combining real-time feedback on prescribing or test ordering may increase the overall effectiveness of the intervention. Given the purely online delivery of the education, there is scope for upscaling the intervention, which may provide cost-effectiveness benefits. Trial registration number ACTRN12620000010998.

Australia , Australian , My-health-record , Healthcare-improvement , Health-record , General-practice , Methods-the , Continuing-education , Ontinuing-professional-development , Eneral-practice , Ealthcare-quality-improvement

No, antibiotics aren't always needed. Here's how GPs can avoid overprescribing

Developing new antibiotics is important in the fight against antibiotic resistance. But we also need to use the antibiotics we already have much more wisely – GPs play a major role in this.

Australia , Sweden , Australians , Australian , Commonwealth-department-of-health , Australian-centre-for-disease , National-prescribing-service-medicinewise , National-prescribing-service , Pharmaceutical-benefits-scheme , Therapeutic-guidelines , Commonwealth-department

General practice 'in the most difficult position it has ever been in'

Dr Alan Stout, chairman of the Northern Ireland general practitioners committee, was speaking at a conference in Belfast on Saturday.

Northern-ireland , Craigavon , United-kingdom , Robin-swann , Stormont-assembly , Department-of-health , Medical-committee , United-kingdom-government , Bengoa-report , Rafa-bengoa , Bma , Epartment-of-health

"Determinants of access to general practice in a shared care model for " by Juliet Cunningham, Jodie Bailie et al.

Background: Improved management of human immunodeficiency virus (HIV) has resulted in improved life expectancy for people living with HIV and an ageing population with a significant comorbidity burden. Shared care models, involving the co-ordinated liaison between general practitioners and specialist physicians, have been advocated for in Australia to provide comprehensive care. People living with HIV in rural areas have reduced access to general practice and therefore shared care. This study explores the perspectives of people living with HIV on the barriers and enablers to accessing shared care in an Australian rural setting. Methods: In this qualitative study, semi-structured interviews were conducted with adults living with HIV who either resided in or accessed care in a rural area of Australia. Interviews were conducted via video conferencing, phone or face-to-face. Transcripts were imported into NVivo, coded and analysed in alignment with a conceptual framework of healthcare access defined by Levesque and colleagues. Results: Thirteen interviews were conducted in total. Participants’ narratives demonstrated the substantial influence of accessibility to general practice on their ability to engage in effective shared care. Challenges included the perception that general practitioners would not provide additive value to participants’ care, which restricted the ability to both seek and engage in the shared care model. Healthcare beliefs, expectations and experiences with stigma led participants to prioritise the perceived interpersonal qualities of specialist care above a shared care system. Access to shared care was facilitated by continuity of care in general practice but logistical factors such as affordability, transport and availability impacted the ability to access regular high-quality healthcare. Conclusions: Navigating patient priorities and anticipated stigma in general practice within the resource limitations of rural healthcare were barriers to effective shared care. General practitioners’ ability to build rapport and long-term relationships with participants was instrumental in the perception of valuable care. Strategies are required to secure continuity of care with interpersonally skilled general practitioners to ensure provision of quality primary care for people living with HIV, which can be supported by specialist physicians in a shared care model.

Australia , Australian , Access , Eneral-practice , Iv , Rimary-care , Ural-health , Hared-care ,

"Exploring patients' advance care planning needs during the annual 75+ " by Joel Rhee, Mariko Carey et al.

Background: The 75+ health assessment has been identified as a suitable trigger to introduce advance care planning (ACP) to general practice patients. Australian general practitioners (GPs) were surveyed to explore their perceptions, attitudes and practices in introducing ACP during 75+ health assessments. Methods: A cross-sectional postal survey of Australian GPs covering their personal, professional and workplace characteristics, their current practice regarding ACP within a 75+ health assessment, and their attitude towards ACP. Multivariate logistic regression was used to analyse the factors associated with routinely discussing ACP as part of the 75+ health assessment. Results: A total of 185 (19.2%) out of 964 eligible GPs returned a completed survey. Most GPs reported that patients interested in ACP were supported by the GPs or the practice nurse. Two factors, (1) attitude that ACP is an essential component of the 75+ health assessment, and (2) regional or rural location of the practice, had a statistically and clinically significant association with the GP's self-reported discussion of ACP during 75+ health assessments. Conclusions: GPs showed a high level of support and involvement in discussing ACP during 75+ health assessments. ACP support during 75+ health assessments was often provided directly by the GP or via the practice nurse. Given the international evidence that ACP training programs improve skills and knowledge, and foster positive attitudes towards ACP, there is an important need to continue funding ACP training programs for GPs and practice nurses.

Australia , Australian , 75-health-assessment , Dvance-care-planning , Nnual-health-assessment , Ross-sectional-survey , Eneral-practice , Eneral-practitioners , Lder-adults , Rimary-care ,