Publications (14) View all
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Article: A cluster randomised controlled trial of vascular risk factor management in general practice.
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ABSTRACT: To evaluate the impact of a lifestyle intervention in Australian general practice to reduce the risk of vascular disease. Stratified cluster randomised controlled trial among 30 general practices in New South Wales from July 2008 to January 2010. Patients aged 40-64 years were invited to participate. The subgroup who were 40-55 years of age were included only if they had either hypertension or dyslipidaemia. A general practice-based health-check with brief lifestyle counselling and referral of high-risk patients to a program consisting of one to two individual visits with an exercise physiologist or dietitian, and six group sessions. Outcomes at baseline, 6 and 12 months included the behavioural and physiological risk factors for vascular disease - self-reported diet and physical activity, and measured weight, body mass index, waist circumference, blood lipid and blood sugar levels, and blood pressure. Of the 3128 patients who were invited, 958 patients (30.6%) responded and 814 were eligible to participate. Of these, 699 commenced the study, and 655 remained in the study at 12 months. Physical activity levels increased to a greater extent in the intervention group than the control group at 6 and 12 months (P = 0.005). There were no other changes in behavioural or physiological outcomes or in estimated absolute risk of cardiovascular disease at 12 months. Of the 384 enrolled in the intervention group, 117 patients (30.5%) attended the minimum number of group program sessions and lost more weight (mean weight loss, 1.06 kg) than those who did not attend the minimum number of sessions (mean weight gain, 0.73 kg). While patients who received counselling by their general practitioner increased self-reported physical activity, only those who attended the group sessions sustained an improvement in weight. However, more research is needed to determine whether group programs offer significant benefits over individual counselling in general practice. Australian New Zealand Clinical Trials Registry ACTRN12607000423415.The Medical journal of Australia 10/2012; 197(7):387-93. · 2.81 Impact Factor -
Article: Lifestyle risk factors in general practice - routine assessment and management.
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ABSTRACT: Evidence based guidelines recommend that adults be assessed for modifiable lifestyle risk factors: smoking, nutrition, alcohol and physical activity (SNAP) regularly. This article discusses the routine practices of GPs regarding assessment and management of these risk factors. General practitioners participating in two randomised controlled trials completed questionnaires about their assessment and management of SNAP risk factors. Over half of the GPs usually assessed smoking and alcohol, and assessed a patient's readiness to change before offering advice. Diet and activity were assessed less frequently, with only 22% usually assessing diet and 28% usually assessing activity. Referral rates were low, with less than 10% of GPs reporting that they usually referred patients to programs. Less than 20% of GPs reported having difficulty referring to programs. Chronic disease risk factors are common in the Australian population, and GPs are ideally placed to offer assessment, advice and referral to services and programs. Recent changes to Medicare rebates for prevention activity may encourage a greater focus on prevention.Australian family physician 12/2010; 39(12):950-3. · 0.73 Impact Factor -
Article: Cardiovascular absolute risk assessment and management - engagement and outcomes in general practice patients.
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ABSTRACT: Despite a decline in recent decades, cardiovascular disease (CVD) remains the major cause of death and disability in Australia. To improve primary prevention of CVD, many clinical guidelines recommend using cardiovascular absolute risk (CVAR) assessment to guide risk factor management. Cardiovascular absolute risk assessment predicts the overall risk of a cardiovascular event over a given time period (usually 5 or 10 years). However, use of CVAR is limited and has not been incorporated well in routine general practice. There has been little research on CVAR implementation and an effective implementation strategy has been lacking.Australian family physician 12/2010; 39(12):954-8. · 0.73 Impact Factor -
Article: Finding common ground? Evaluating an intervention to improve teamwork among primary health-care professionals.
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ABSTRACT: Multidisciplinary care has been shown as the most effective option for chronic disease. The aim of the Team-link study was to assess the effectiveness of an intervention to improve teamwork among general practitioners (GPs), practice staff and allied health professionals (AHPs). This paper describes changes to teamwork using qualitative data collected in the study. Qualitative data about changes in internal and external professional collaboration were collected from facilitators' observations, GPs' reports and responses to a survey of AHPs assessing multidisciplinary teamwork. Multidisciplinary teams within general practices and external collaborations with AHPs including dietitians, diabetic educators, exercise physiologists, podiatrists, psychologists and physiotherapists. GPs, practice nurses, practice staff, AHPs. A 6-month intervention consisting of an educational workshop and structured facilitation using specially designed materials, backed up by informal telephone support, was delivered to 26 practices. Data were analysed thematically using an approach based on identifying actors and associated collaborative actions. New and enhanced communication pathways were observed between GPs, practice staff, patients and AHPs following the intervention. The enhanced information sharing expedited communication and improved interprofessional collaboration within general practices and with AHPs. There was evidence of increased patient participation and empowerment in the care process and improved collaboration by practice staff and allied health providers. The Team-link intervention improved professional collaboration among GPs, practice staff, AHPs and patients, increasing understanding and trust and enhancing multidisciplinary teamwork for chronic disease care in primary care settings.International Journal for Quality in Health Care 10/2010; 22(6):519-24. · 1.96 Impact Factor -
Article: Prerequisites for implementing cardiovascular absolute risk assessment in general practice: a qualitative study of Australian general practitioners' and patients' views.
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ABSTRACT: Although recommended in clinical practice guidelines, cardiovascular absolute risk (CVAR) assessment is still used infrequently in Australian general practice. One reason is the lack of an implementation strategy. Given the lack of published reports on the implementation of CVAR worldwide, the aim of this study was to explore the views of general practitioners (GPs) and patients on prerequisites for successfully implementing CVAR assessment in general practice. Multiple data involving GPs and patients were collected using focus groups (FGs) in three divisions of General Practice in Sydney between 2005 and 2006. Both GPs' and patients' opinions were analysed using thematic analysis. Twenty-two GPs participated in three GP FGs and 26 patients in three patient FGs. Many GPs thought that an initial cardiovascular risk screening could start from 40 years old while some patients thought it should start even younger. Targeting patients with known risk factors was supported by most GPs although some also stressed the importance of reaching those of unknown risk. For new patients or patients presenting for other problems, another visit for CVAR risk assessment and discussion was preferred by most GPs. A strong GP-patient relationship, common ground on priorities between GPs and their patients, patient awareness of cardiovascular risk and motivation were seen as important by both GPs and patients to the implementation of CVAR assessment. Addressing the appropriate selection of patients and time for implementing CVAR assessment requires a consideration of multiple factors. GPs see it as a process that may need to be staged over more than one consultation and requiring appropriate strategies.Journal of Evaluation in Clinical Practice 04/2010; 16(3):580-4. · 1.23 Impact Factor
