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Objective: To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. Design, setting and participants: Cross‐sectional questionnaire survey mailed to all members (n = 1085) of three urban divisions of general practice in New South Wales in August and September 2004. The three divisions were chosen to provide a range of socioeconomic status (SES) demographics. Main outcome measures: Occupational violence towards general practitioners during the previous 12 months. Results: 528 GPs returned questionnaires (49% response rate). Of these, 63.7% had experienced violence in the previous year. The most common forms of violence were “low level” violence — verbal abuse (42.1%), property damage/theft (28.6%) and threats (23.1%). A smaller proportion of GPs had experienced “high level” violence, such as sexual harassment (9.3%) and physical abuse (2.7%). On univariate analysis, violence was significantly more likely towards female GPs (P < 0.001), less experienced GPs (P = 0.003) and GPs working in a lower SES status area (P < 0.001), and among practice populations encompassing greater social disadvantage (P = 0.006), mental health problems (P < 0.001), and drug‐ and alcohol‐related problems (P < 0.001). Experience of violence was greater for younger GPs (P = 0.005) and those providing after‐hours care (P = 0.033 for after‐hours home visits). On multivariate analysis, a significant association persisted between high level violence and lower SES area (odds ratio [OR], 2.86), being female (OR, 5.87), having practice populations with more drug‐related problems (OR, 5.77), and providing home visits during business hours (OR, 4.76). More experienced GPs encountered less violence (OR, 0.77) for every additional 5 years of practice. Conclusion: Occupational violence is a considerable problem in Australian urban general practice. Formal education programs in preventing and managing violence would be appropriate for GPs and doctors‐in‐training.

Am J Public Health 2000 90:1431–5 A cross‐sectional, door‐to‐door community survey was used to gather self‐report data on Pap smear and cholesterol screening from 195 rural Australian individuals randomly selected from population statistics. Trained interviewers used a standard reporting form to collect information on screening results, knowledge of recommended screening frequency, and demographics. The two regional pathology laboratories were queried about consenting patients. Adequate screening was defined as any smear within 2 years. Of 146 women eligible for validation of Pap smears, the sensitivity of a self‐report of inadequate screening was 45%, the specificity was 98%, the negative predictive value was 72%, and the positive predictive value was 93%. For example, 93% of women who said they had not had a Pap smear in at least 2 years in fact had not, while only 72% of those who claimed to have had a smear within 2 years actually had. Among 91 women reporting Pap results, more than half of those with abnormalities were missed by self‐report. The accuracy of recall was not associated with knowledge or demographic factors. Comment: Although its use of a rural, Australian population limits the ability to generalize the conclusions of the report for the population in the United States, the results of this study are consistent with those of previous ones: women tend to overestimate the frequency of their Pap smears and to minimize their recall of abnormalities. Self‐report should not be used in studies of the adequacy of Pap smear screening, and it should not be relied on to determine who is eligible for screening at 3‐year intervals by virtue of three prior normal smears. (LSM)

This study's finding of GPs' self-reported restriction of practice and withdrawal from home visits and after-hours calls in response to risk of violence represents a significant primary health care issue. GPs' decision to provide after-hours calls and home visits is complex, and the finding of lack of significant association of experiences of violence with provision of home visits and after-hours calls is likely to be due to the cross-sectional nature of the study.

Magin P, Adams J, Ireland M, Joy E, Heaney S and Darab S. The response of general practitioners to the threat of violence in their practices: results from a qualitative study. Family Practice 2006; 23: 273-278. Background. Violence directed towards GPs has been recognized as a significant problem in the UK. In Australian urban general practice, no study has previously examined this topic.Objective. The objective of this study was to investigate the responses of Australian urban GPs to experiences of violence and to perceptions of risk of violence.Methods. Design: A qualitative study of data collected from two sources-focus group discussions and qualitative questionnaire responses. Focus group discussions were audiotaped and transcribed. Questionnaires offered the opportunity for respondents to make qualitative comments. The focus group transcripts and qualitative questionnaire responses were coded independently by members of the research team and subjected to thematic analysis. Setting: Three urban Divisions of General Practice in New South Wales, Australia. Subjects: Focus groups were conducted with male and female GPs comprising a range of ages, socioeconomic practice catchments and practice structures. Questionnaires were distributed to all GPs in the three divisions.Results. The GPs in this study perceived themselves as being at significant risk of occupational violence. Despite responses to violence being largely ad hoc and uncoordinated, a coherent schema of GPs' responses to the threat of violence is apparent in the data. This has been characterized as encompassing primary, secondary and tertiary responses, and reflects a continuum of proactive to reactive responses. Conclusion. The findings will have implications for further research and for policy in the area.