The Living with Asthma Survey suggests that national asthma management goals are not being achieved in a high proportion of patients, with evidence for both underprescribing and underusage of preventer medication. Achieving closer alignment between medical and patient perspectives is an important goal of asthma education and management in order to help bridge the gap between current concepts of best practice and the reality of persistently poor asthma outcomes.
The measurement of quality in any clinical discipline depends, in part, on a comparison with an accepted standard. Currently, such standards do not exist for the management of many common clinical situations in Australian general practice. As part of the General Practice Evaluation Programme, a group of Illawarra general practitioners (GPs) selected 'GP management of the menopause and asthma' for in-depth study, and were able to arrive at a consensus on 'principles of practice' and 'minimal acceptable care' for these conditions through a series of focus (research) group meetings. However, the process by which these standards were derived was felt, of itself, to be a valuable means of: (i) reducing professional isolation; (ii) promoting quality assurance; (iii) introducing peer review; (iv) introducing clinical audit; and (v) providing meaningful and targeted continuing medical education appropriate to Australian general practice. This paper describes the focus group methodology used in this process.
This discussion paper describes a scoping exercise and literature review commissioned by the International Primary Care Respiratory Group (IPCRG) to inform their E-Quality programme which seeks to support small-scale educational projects to improve respiratory management in primary care. Our narrative review synthesises information from three sources: publications concerning the global context and health systems development; a literature search of Medline, CINAHL and Cochrane databases; and a series of eight interviews conducted with members of the IPCRG faculty. Educational interventions sit within complex healthcare, economic, and policy contexts. It is essential that any development project considers the local circumstances in terms of economic resources, political circumstances, organisation and administrative capacities, as well as the specific quality issue to be addressed. There is limited evidence (in terms of changed clinician behaviour and/or improved health outcomes) regarding the merits of different educational and quality improvement approaches. Features of educational interventions that were most likely to show some evidence of effectiveness included being carefully designed, multifaceted, engaged health professionals in their learning, provided ongoing support, were sensitive to local circumstances, and delivered in combination with other quality improvement strategies. To be effective, educational interventions must consider the complex healthcare systems within which they operate. The criteria for the IPCRG E-Quality awards thus require applicants not only to describe their proposed educational initiative but also to consider the practical and local barriers to successful implementation, and to propose a robust evaluation in terms of changed clinician behaviour or improved health outcomes.
Breathlessness in advanced disease is a common problem, with the majority of people experiencing breathlessness in the weeks before death. The thrust of the new British Thoracic Society guidelines for home oxygen in adults is that oxygen therapy for home use is most useful in chronic hypoxaemia. However, clinicians make individual clinical decisions, cognisant of the guidelines but ultimately determined by what relieves the symptoms of the individual most effectively.
Introduction: At the Amsterdam IPCRG conference in 2002, information was presented on the ''3+ visit plan''. It has now been in the community for more than 3 years and has been evaluated. This information will be presented. The ''3+ visit plan'' was an initiative of the General Practitioners Asthma Group, a committee of the National Asthma Council Australia. In summary, it organises all the required elements of recommended asthma care into a series of visits. Since the introduction in November 2001, there have been 85,000 ''3+ visit plan'' completions. In addition to the plan itself, there have been a number of educational initiatives relating to the plan but are really an educational program about asthma management in primary care. Conclusions: There have been 4 papers published in peer-reviewed journals relating to the ''3+ visit plan'' [1-4]. Barriers; There is a consistent theme in the published papers that any new program is difficult to implement in a primary health care system that is under stress. Benefits; Where Primary Health care teams have chosen to implement the ''3+ visit plan'' it has made a measurable difference to patient care.
Surely the statement that "general practice is an important context to deliver brief interventions for smokers" is unambiguous.Our editorial, based on a recognition that smoking prevalence rates have stopped declining, is a plea for public health practitioners 10 think beyond the square. As the editorial made clear, we argue for new research into other populations and not for the implementation of programs of unproven effectiveness in these populations.Ward et al. argue that our assertion that "relatively few young, blue collar workers visit their general practitioner" is refutable. This is an important point. Smoking prevalence is inversely correlated with socio-economic status. The data that would refute our assertion would compare frequency of visits to a general practitioner in young, blue collar workers and young, white collar workers. Ward et al. have not provided these data. Until they do so, our assertion stands.Ward et al. are fully justified in emphasising the lack of rigorously acquired evidence in support o f the effectiveness o f workplace-based programs inAustralia. One possible reason why evidence of effectiveness of workplace based or prison based programs might not exist is that such evidence has not been sought. The appropriate response to the lack of such evidence in the face of arguments as to why such programs might be effective is to undertake the relevant research. That is precisely what we recommended.General practice has been, is, and will remain an important venue for providing brief interventions to promote smoking cessation and less immoderate drinking. We agree with Ward et al. that a variety of approaches to improve outcomes from G P based interventions have been implemented with generally less successful outcomes that desired. While it is important that efforts to improve outcomes from GP-based interventions are continued, this should not preclude the search for interventions based on other populations which might complement advances in GP based interventions.
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