%0 Journal Article
%~ PubMed
%A Johnson, David W
%A Jones, Graham R D
%A Mathew, Timothy H
%A Ludlow, Marie J
%A Doogue, Matthew P
%A Jose, Matthew D
%A Langham, Robyn G
%A Lawton, Paul D
%A McTaggart, Steven J
%A Peake, Michael J
%A Polkinghorne, Kevan
%A Usherwood, Tim
%A , Australasian Creatinine Consensus Working Group
%T Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: new developments and revised recommendations.
%B The Medical Journal of Australia
%D 2012
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd.
%V 197
%N 4
%P 224-225
%@ 1326-5377
%X The publication of the Australasian Creatinine Consensus Working Group''s position statements in 2005 and 2007 resulted in automatic reporting of estimated glomerular filtration rate (eGFR) with requests for serum creatinine concentration in adults, facilitated the unification of units of measurement for creatinine and eGFR, and promoted the standardisation of assays. New advancements and continuing debate led the Australasian Creatinine Consensus Working Group to reconvene in 2010. The working group recommends that the method of calculating eGFR should be changed to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, and that all laboratories should report eGFR values as a precise figure to at least 90 mL/min/1.73 m(2). Age-related decision points for eGFR in adults are not recommended, as although an eGFR < 60 mL/min/1.73 m(2) is very common in older people, it is nevertheless predictive of significantly increased risks of adverse clinical outcomes, and should not be considered a normal part of ageing.If using eGFR for drug dosing, body size should be considered, in addition to referring to the approved product information. For drugs with a narrow therapeutic index, therapeutic drug monitoring or a valid marker of drug effect should be used to individualise dosing. The CKD-EPI formula has been validated as a tool to estimate GFR in some populations of non-European ancestry living in Western countries. Pending publication of validation studies, the working group also recommends that Australasian laboratories continue to automatically report eGFR in Aboriginal and Torres Strait Islander peoples. The working group concluded that routine calculation of eGFR is not recommended in children and youth, or in pregnant women. Serum creatinine concentration (preferably using an enzymatic assay for paediatric patients) should remain as the standard test for kidney function in these populations.
%Z FOR Codes: 110312


%0 Journal Article
%~ PubMed
%A Johnson, David W
%A Jones, Graham R D
%A Mathew, Timothy H
%A Ludlow, Marie J
%A Chadban, Stephen J
%A Usherwood, Tim
%A Polkinghorne, Kevan
%A Colagiuri, Stephen
%A Jerums, George
%A Macisaac, Richard
%A Martin, Helen
%A , Australasian Proteinuria Consensus Working Group
%T Chronic kidney disease and measurement of albuminuria or proteinuria: a position statement.
%B Medical Journal of Australia
%D 2012
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd.
%V 197
%N 4
%P 224-225
%@ 1326-5377
%X Optimal detection and subsequent risk stratification of people with chronic kidney disease (CKD) requires simultaneous consideration of both kidney function (glomerular filtration rate [GFR]) and kidney damage (as indicated by albuminuria or proteinuria). Measurement of urinary albuminuria and proteinuria is hindered by a lack of standardisation regarding requesting, sample collection, reporting and interpretation of tests. A multidisciplinary working group was convened with the goal of developing and promoting recommendations that achieve consensus on these issues. The working group recommended that the preferred method for assessment of albuminuria in both diabetic and non-diabetic patients is urinary albumin-to-creatinine ratio (UACR) measurement in a first-void spot urine specimen. Where a first-void specimen is not possible or practical, a random spot urine specimen for UACR is acceptable. The working group recommended that adults with one or more risk factors for CKD should be assessed using UACR and estimated GFR every 1-2 years, depending on their risk-factor profile. Recommended testing algorithms and sex-specific cut-points for microalbuminuria and macroalbuminuria are provided. The working group recommended that all pathology laboratories in Australia should implement the relevant recommendations as a vital component of an integrated national approach to detection of CKD.
%Z FOR Codes: 110312


%0 Book Section
%A Usherwood, Timothy
%T Chronic kidney disease prevention and management
%B National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people
%D 2012
%C Australia
%I The Royal Australian College of General Practition
%V 
%N 
%P 222-228
%@ 9780869063415
%E RACGP, The
%X 
%Z FOR Codes: 111701


%0 Journal Article
%~ PubMed
%A Kang, Melissa
%A Rochford, Arlie
%A Skinner, Rachel
%A Mindel, Adrian
%A Webb, Marianne
%A Peat, Jenny
%A Usherwood, Tim
%T Facilitating chlamydia testing among young people: a randomised controlled trial in cyberspace.
%B Sexually Transmitted Infections
%D 2012
%C United Kingdom
%I BMJ Group
%V 88
%N 8
%P 568-573
%@ 1368-4973
%X ObjectivesChlamydia notifications have been rising in Australia for over a decade and are highest in young people. This study aimed to evaluate the impact of an internet-based intervention on chlamydia testing among young people 16-25 years.MethodsIn this randomised controlled trial, recruitment, data collection, study interventions and follow-up occurred entirely in cyberspace, facilitated by a website. Eligible participants were aged 16-25 years and resided in Australia. The intervention group received personalised emails inviting interaction about chlamydia testing, while the control group received regular impersonal emails. Primary outcome was self-reported chlamydia testing at 6-month follow-up; secondary outcomes were condom use and changes in knowledge and attitudes.Results704 young people completed baseline information, 40 were excluded and five withdrew prior to follow-up. The follow-up rate was 47.3% overall. In the intervention group, 40.6% (95% CI 30.7% to 51.1%) reported having had a chlamydia test at follow-up compared with 31.0% (95% CI 24.8% to 37.2%) in the control group (p=0.07). A per-protocol analysis found that those who engaged in email interaction were more likely to report chlamydia test uptake compared with those in the control group (52.5%, 95% CI 39.3 to 65.4% cf 31.0%, 95% CI 24.8% to 37.2%, p=0.002). There were no differences in secondary outcomes between groups.ConclusionsThis is the first randomised controlled trial undertaken in cyberspace to promote chlamydia testing. E-technology may be useful in promoting chlamydia testing and healthcare seeking behaviour in young people.
%Z FOR Codes: 111717


%0 Journal Article
%~ PubMed
%A Foster, Juliet M
%A Smith, Lorraine
%A Bosnic-Anticevich, Sinthia Z
%A Usherwood, Timothy
%A Sawyer, Susan M
%A Rand, Cynthia S
%A Reddel, Helen K
%T Identifying patient-specific beliefs and behaviours for conversations about adherence in asthma
%B Internal Medicine Journal
%D 2012
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 42
%N 6
%P e136-e144
%@ 1445-5994
%X Background: Asthma guidelines advise addressing adherence at every visit but no simple tools exist to assist clinicians in identifying key adherence-related beliefs or behaviours for individual patients. Aims: To identify potentially modifiable beliefs and behaviours which predict electronically-recorded adherence with controller therapy. Methods: Patients aged ???14 yrs with doctor-diagnosed asthma who were prescribed inhaled corticosteroid/long-acting ??(2) -agonist (ICS/LABA) completed questionnaires on medication beliefs/behaviours, side-effects, Morisky adherence behaviour score, and Asthma Control Test (ACT), and recorded spirometry. Adherence with ICS/LABA was measured electronically over 8 weeks. Predictors of adherence were identified by univariate and multivariate analyses. Results: 99/100 patients completed the study (57 female; FEV(1) mean ?? SD 83 ?? 23% predicted; ACT 19.9 ?? 3.8). Mean electronically-recorded adherence (n = 85) was 75% ?? 25, and mean self-reported adherence was 85% ?? 26%. Factor analysis of questionnaire items significantly associated with poor adherence identified seven themes: perceived necessity; safety concerns; acceptance of asthma chronicity/medication effectiveness; advice from friends/family; motivation/routine; ease of use; and satisfaction with asthma management. Morisky score was moderately associated with actual adherence (r = -0.45, p < 0.0001). In regression analysis, 10 items independently predicted adherence (adjusted R(2) = 0.67; p < 0.001). Opinions of friends/family about the patient''s medication use were strongly associated with poor adherence. Global concerns about ICS/LABA therapy were more predictive of poor adherence than were specific side-effects; the one-third of patients who reported experiencing side-effects from their steroid inhaler had lower adherence than others (mean 62% vs. 81%; p = 0.015). Conclusions: This study identified several specific beliefs and behaviours which clinicians could use for initiating patient-centred conversations about medication adherence in asthma.
%Z FOR Codes: 110399


%0 Journal Article
%A Jowsey, Tanisha
%A Yen, Laurann
%A Ward, Nathaniel
%A McNab, Justin
%A Aspin, Stanley Clive
%A Usherwood, Timothy
%T It hinges on the door: time, spaces and identity in Australian Aboriginal Health Services
%B Health Sociology Review
%D 2012
%C a
%I eContent Management Pty Ltd
%V 21
%N 2
%P 196 - 207
%@ 1839-3551
%X 
%Z FOR Codes: 111701


%0 Journal Article
%~ PubMed
%A Usherwood, Tim P
%T Private specialist practice: the forgotten sector in health care reform.
%B The Medical Journal of Australia
%D 2012
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd.
%V 196
%N 4
%P 235-236
%@ 1326-5377
%X A window of opportunity for change.
%Z FOR Codes: 111709


%0 Journal Article
%~ PubMed
%A Foster, Juliet M
%A Smith, Lorraine
%A Usherwood, Tim
%A Sawyer, Susan M
%A Rand, Cynthia S
%A Reddel, Helen K
%T The Reliability and Patient Acceptability of the SmartTrack Device: A New Electronic Monitor and Reminder Device for Metered Dose Inhalers.
%B The Journal of Asthma
%D 2012
%C United States
%I Informa Healthcare
%V 49
%N 6
%P 657-662
%@ 1532-4303
%X Objective: The SmartTrack (ST) is a new adherence monitoring device for pressurized metered-dose inhalers (pMDI), with remote upload and ringtone reminder capabilities. Our aim was to assess its reliability and patient acceptability. Methods: Baseline Quality Control (QC): Actuation log accuracy and device functionality tests were undertaken. Simulated Patient Use: Salmeterol/fluticasone inhalers with STs were actuated two times twice daily for 48 h. Accuracy of reminders, data logging, and uploads was tested. Patient Field Testing: Devices were quality tested before dispensing. Asthma patients each field-tested one ST for 7 days and recorded actuations in a diary. Uploaded data were compared to pMDI dose counter and patient diaries. Patient-reported ease of use for the ST was recorded. Results: Baseline QC: 9/10 devices had 100% accuracy; one had an electrical circuit failure. Simulated Patient Use: Accuracy was 99% (2/342 actuations duplicated). Patient Field Testing: One device failed pre-dispensing testing (electrical circuit failure). Eight devices were field-tested by asthma patients (mean age 45, 5 females). Mean actuation log accuracy was 97%. Reminders were 100% accurate. All devices successfully uploaded data. Average patient-rated difficulty of use was 6/100 (1 = extremely easy, 100 = extremely difficult). Conclusions: The ST has acceptable reliability and utility comparable to other electronic monitoring devices. Its remote data upload capability, reminder functions for missed doses, and graphical display of medication use for patient- and physician-feedback are useful additional features.
%Z FOR Codes: 1108


%0 Journal Article
%~ PubMed
%A Peiris, David
%A Usherwood, Tim
%A Panaretto, Katie
%A Harris, Mark
%A Hunt, Jenny
%A Patel, Bindu
%A Zwar, Nicholas
%A Redfern, Julie
%A Macmahon, Stephen
%A Colagiuri, Stephen
%A Hayman, Noel
%A Patel, Anushka
%T The Treatment of cardiovascular Risk in Primary care using Electronic Decision supOrt (TORPEDO) study-intervention development and protocol for a cluster randomised, controlled trial of an electronic decision support and quality improvement intervention in Australian primary healthcare.
%B BMJ Open
%D 2012
%C United Kingdom
%I BMJ Group
%V 2
%N 6
%P e002177
%@ 2044-6055
%X 
%Z FOR Codes: 111799


%0 Journal Article
%~ PubMed
%A Roydhouse, Jessica A
%A Shah, Smita
%A Toelle, Brett G
%A Sawyer, Susan M
%A Mellis, Craig M
%A Usherwood, Tim P
%A Edwards, Peter
%A Jenkins, Christine R
%T A snapshot of general practitioner attitudes, levels of confidence and self-reported paediatric asthma management practice.
%B Australian Journal of Primary Health
%D 2011
%C Australia
%I C S I R O Publishing
%V 17
%N 3
%P 288-293
%@ 1448-7527
%X The prevalence of asthma in Australia is high. Previous findings have suggested that asthma management, particularly in primary care, remains suboptimal and recent government initiatives to improve asthma management and encourage the use of written asthma action plans (WAAPs) in general practice have been implemented. We aimed to assess the attitudes, confidence and self-reported paediatric asthma management practices of a convenience sample of Australian general practitioners (GPs). A baseline questionnaire was administered to GPs as part of a randomised controlled trial. General practitioners (GPs) were recruited from two areas of greater metropolitan Sydney, NSW between 2006 and 2008. Invitations were sent to an estimated 1200 potentially eligible GPs. Of 150 (12.5%) GPs that enrolled, 122 (10.2%) completed the baseline questionnaire. Though 89% were aware of the Australian National Asthma Guidelines, less than 40% were familiar with guideline recommendations. While 85.2% had positive attitudes towards WAAPs, only 45.1% reported providing them frequently. For children with frequent symptoms, 90% agreed they should prescribe daily, inhaled corticosteroids (ICS), and 83% reported currently prescribing ICS to such patients. These findings indicate gaps between GP attitudes and behaviours and highlights opportunities for interventions to improve paediatric asthma management.
%Z FOR Codes: 111717


%0 Journal Article
%~ PubMed
%A Yen, Laurann
%A Gillespie, James
%A Rn, Yun-Hee Jeon
%A Kljakovic, Marjan
%A Anne Brien, Jo
%A Jan, Stephen
%A Lehnbom, Elin
%A Pearce-Brown, Carmen
%A Usherwood, Tim
%T Health professionals, patients and chronic illness policy: a qualitative study.
%B Health expectations : an international journal of public participation in health care and health policy
%D 2011
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 14
%N 1
%P 10-20
%@ 1369-7625
%X This study investigates health professionals'' reactions to patients'' perceptions of health issues - a little-researched topic vital to the reform of the care of chronic illness.
%Z FOR Codes: 111709


%0 Journal Article
%A Davidson, Patricia M
%A DiGiacomo, Michelle
%A Thompson, Sandra C
%A Abbott, Penelope
%A Davidson, Joyce
%A Moore, Louise
%A Daly, John
%A McGrath, Sarah J
%A Taylor, Kate P
%A Usherwood, Timothy
%T Health workforce issues and how these impact on Indigenous Australians
%B Journal of Australian Indigenous Issues
%D 2011
%C Australia
%I Journal of Australian Indigenous Issues
%V 14
%N 4
%P 69-84
%@ 1440-5202
%X 
%Z FOR Codes: 111701


%0 Journal Article
%~ PubMed
%A Shah, Smita
%A Sawyer, Susan M
%A Toelle, Brett G
%A Mellis, Craig M
%A Peat, Jennifer K
%A Lagleva, Marivic
%A Usherwood, Timothy P
%A Jenkins, Christine R
%T Improving paediatric asthma outcomes in primary health care: a randomised controlled trial.
%B Medical Journal of Australia
%D 2011
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd.
%V 195
%N 7
%P 405-409
%@ 0025-729X
%X To evaluate the effectiveness of the Practitioner Asthma Communication and Education (PACE) Australia program, an innovative communication and paediatric asthma management program for general practitioners.
%Z FOR Codes: 111717 110399


%0 Journal Article
%~ PubMed
%A Peiris, David
%A Usherwood, Tim
%A Weeramanthri, Tarun
%A Cass, Alan
%A Patel, Anushka
%T New tools for an old trade: a socio-technical appraisal of how electronic decision support is used by primary care practitioners.
%B Sociology of health & illness
%D 2011
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 33
%N 7
%P 1002-18
%@ 1467-9566
%X This article explores Australian general practitioners'' (GPs) views on a novel electronic decision support (EDS) tool being developed for cardiovascular disease management. We use Timmermans and Berg''s technology-in-practice approach to examine how technologies influence and are influenced by the social networks in which they are placed. In all, 21 general practitioners who piloted the tool were interviewed. The tool occupied an ill-defined middle ground in a dialectical relationship between GPs'' routine care and factors promoting best practice. Drawing on Lipsky''s concept of ''street-level bureaucrats'', the tool''s ability to process workloads expeditiously was of greatest appeal to GPs. This feature of the tool gave it the potential to alter the structure, process and content of healthcare encounters. The credibility of EDS tools appears to be mediated by fluid notions of best practice, based on an expert scrutiny of the evidence, synthesis via authoritative guidelines and dissemination through trusted and often informal networks. Balanced against this is the importance of ''soft'' forms of knowledge such as intuition and timing in everyday decision-making. This resonates with Aristotle''s theory of phronesis (practical wisdom) and may render EDS tools inconsequential if they merely process biomedical data. While EDS tools show promise in improving health practitioner performance, the socio-technical dimensions of their implementation warrant careful consideration.
%Z FOR Codes: 110201 111717


%0 Journal Article
%~ PubMed
%A Jan, Stephen
%A Usherwood, Tim
%A Brien, Jo Anne
%A Peiris, David
%A Rose, John
%A Hayman, Noel
%A Howard, Kirsten
%A Redfern, Julie
%A Laba, Tracey
%A Cass, Alan
%A Patel, Anushka
%T What determines adherence to treatment in cardiovascular disease prevention? Protocol for a mixed methods preference study.
%B BMJ Open
%D 2011
%C United Kingdom
%I B M J Group
%V 1
%N 2
%P e000372
%@ 2044-6055
%X Background Significant gaps exist between guidelines-recommended therapies for cardiovascular disease prevention and current practice. Fixed-dose combination pills (''polypills'') potentially improve adherence to therapy. This study is a preference study undertaken in conjunction with a clinical trial of a polypill and seeks to examine the underlying reasons for variations in treatment adherence to recommended therapy.  Methods/design A preference study comprising: (1) Discrete Choice Experiment for patients; and (2) qualitative study of patients and providers. Both components will be conducted on participants in the trial. A joint model combining the observed adherence in the clinical trial (revealed preference) and the Discrete Choice Experiment data (stated preference) will be estimated. Estimates will be made of the marginal effect (importance) of each attribute on overall choice, the extent to which respondents are prepared to trade-off one attribute for another and predicted values of the level of adherence given a fixed set of attributes, and contextual and socio-demographic characteristics. For the qualitative study, a thematic analysis will be used as a means of exploring in depth the preferences and ultimately provide important narratives on the experiences and perspectives of individuals with regard to adherence behaviour.  Ethics and dissemination Primary ethics approval was received from Sydney South West Area Health Service Human Research Ethics Committee (Royal Prince Alfred Hospital zone). In addition to usual scientific forums, the findings will be reported back to the communities involved in the studies through site-specific reports and oral presentations.
%Z FOR Codes: 110201 111717 111716


%0 Journal Article
%A Jeon, Yun-Hee
%A Jowsey, Tanisha
%A Yen, Laurann
%A Glasgow, Nicholas
%A Essue, Beverley
%A Kljakovic, Marjan
%A Pearce-Brown, Carmen L.
%A Mirzaei, Masoud
%A Usherwood, Timothy
%A Jan, Stephen
%A Kraus, Stefan G.
%A Aspin, Stanley Clive
%T Achieving a balanced life in the face of chronic illness
%B Australian Journal of Primary Health
%D 2010
%C Australia
%I CSIRO Publishing
%V 16
%N 1
%P 66-74
%@ 1448-7527
%X 
%Z FOR Codes: 111706 111099


%0 Journal Article
%~ PubMed
%A Shah, Smita
%A Toelle, Brett G
%A Sawyer, Susan M
%A Roydhouse, Jessica K
%A Edwards, Peter
%A Usherwood, Tim
%A Jenkins, Christine R
%T Feasibility study of a communication and education asthma intervention for general practitioners in Australia.
%B Aust Journal of Primary Health
%D 2010
%C Australia
%I CSIRO Publishing
%V 16
%N 1
%P 75-80
%@ 1448-7527
%X The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor-patient communication. The impact ofthe modified PACE Australia program on the processes and outcomes ofGP care ofchildren with asthma is now being measured in a randomised controlled trial.
%Z FOR Codes: 111403 111717 110203


%0 Journal Article
%~ PubMed
%A Essue, Beverley M
%A Jowsey, Tanisha
%A Jeon, Yun-Hee
%A Mirzaei, Masoud
%A Pearce-Brown, Carmen L
%A Aspin, Clive
%A Usherwood, Tim P
%T Informal care and the self-management partnership: implications for Australian health policy and practice.
%B Australian Health Review
%D 2010
%C Australia
%I CSIRO Publishing
%V 34
%N 4
%P 414-422
%@ 0156-5788
%X Community Child Health Nursing Services provide support for new mothers; however, the focus has often been on individual consultations, complemented by a series of group sessions soon after birth. We describe a new model of community care for first-time mothers that centres on group sessions throughout the whole contact period. The model was developed by practicing child health nurses for a large health service district in south-east Queensland, which offers a comprehensive community child health service. Issues identified by clinicians working within existing services, feedback from clients and the need for more resource-efficient methods of service provision underpinned the development of the model. The pilot program was implemented in two community child health centres in Brisbane. An early individual consultation to engage the family with the service was added in response to feedback from clinicians and clients. The modified model has since been implemented service-wide as the ''First Steps Program''. The introduction of this model has ensured that the service has been able to retain a comprehensive service for first-time parents from a universal population, while responding to the challenges of population growth and the increasing number of complex clients placing demands on resources.
%Z FOR Codes: 111717


%0 Journal Article
%~ PubMed
%A Kang, Melissa
%A Skinner, Rachel
%A Usherwood, Tim
%T Interventions for young people in Australia to reduce HIV and sexually transmissible infections: a systematic review.
%B Sexual Health
%D 2010
%C Australia
%I CSIRO Publishing
%V 7
%N 2
%P 107-128
%@ 1448-5028
%X Background: Like young people in other developed countries, sexually active young Australians can have an increased risk of acquiring sexually transmissible infections (STIs). This paper reviews intervention programs that aim to reduce the incidence and transmission of HIV and STIs among young people in Australia. Methods: Articles were identified from seven databases. Intervention studies conducted in Australia that included young people aged 12-25 years were reviewed. A two-dimensional matrix consisting of ''setting'' and ''intervention type'' was developed to categorise each study. Results: Forty-two studies met the inclusion criteria, and the majority were uncontrolled intervention studies. Of these, 23/42 studies measured participation in chlamydia +/- other STI testing and found that the highest participation rates took place in non-clinical and non-general practice health care settings. Four studies facilitated access to testing indirectly, through the internet or other media. Ten studies involved the provision of education and measured its impact on factors such as knowledge, attitudes and/or behaviour. Three studies involved novel immunisation strategies for either hepatitis B or human papillomavirus vaccines. Two studies evaluated the impact of enhanced STI surveillance programs on prevalence rates. Conclusions: Proactive STI testing in non-clinical and some health settings appears feasible and achieves higher testing rates than in general practice; however, more evaluation of testing strategies in general practice settings is required. New technologies such as the internet and SMS are useful adjuncts for influencing behaviours such as condom use and STI testing. Media campaigns that promote STI testing can have a positive impact on testing rates.
%Z FOR Codes: 111716


%0 Journal Article
%~ PubMed
%A Bhala, N
%A Usherwood, T
%A George, J
%T Nichtalkoholische Fettlebererkrankung [Non-alcoholic fatty liver]
%B Praxis
%D 2010
%C Switzerland
%I Verlag Hans Huber AG
%V 99
%N 3
%P 187-189
%@ 1661-8157
%X 
%Z FOR Codes: 110307


%0 Journal Article
%~ PubMed
%A Sullivan, Frank M
%A Lockhart, Pauline M
%A Usherwood, Timothy P
%T Potential implications of genomic medicine in general practice.
%B Medical Journal of Australia
%D 2010
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd.
%V 193
%N 2
%P 120-123
%@ 0025-729X
%X Genomic research can link specific molecular genetic information with specific diseases. Implications of genomic medicine in general practice include developments in screening and diagnosis, predicting disease prognosis, and optimising preventive and therapeutic care. As users or co-producers of genomic information, or as collaborators in genomic research, general practitioners can help realise the potential of advances in genomic research.
%Z FOR Codes: 60408


%0 Journal Article
%~ PubMed
%A Liu, Hueiming
%A Patel, Anushka
%A Brown, Alex
%A Eades, Sandra
%A Hayman, Noel
%A Jan, Stephen
%A Ring, Ian
%A Stewart, Greg
%A Tonkin, Andrew
%A Weeramanthri, Tarun
%A Wade, Vicki
%A Rodgers, Anthony
%A Usherwood, Tim
%A Neal, Bruce
%A Peiris, David
%A Burke, Hugh
%A Reid, Christopher
%A Cass, Alan
%A , the Kanyini Vascular Collaboration and Kanyini GAP Study Team
%T Rationale and design of the Kanyini guidelines adherence with the polypill (Kanyini-GAP) study: a randomised controlled trial of a polypill-based strategy amongst Indigenous and non Indigenous people at high cardiovascular risk.
%B BMC Public Health
%D 2010
%C United Kingdom
%I BioMed Central Ltd.
%V 10
%N 1
%P 458
%@ 1471-2458
%X ABSTRACT: BACKGROUND: The Kanyini Guidelines Adherence with the Polypill (Kanyini-GAP) Study aims to examine whether a polypill-based strategy (using a single capsule containing aspirin, a statin and two blood pressure-lowering agents) amongst Indigenous and non-Indigenous people at high risk of experiencing a cardiovascular event will improve adherence to guideline-indicated therapies, and lower blood pressure and cholesterol levels. METHODS/DESIGN: The study is an open, randomised, controlled, multi-centre trial involving 1000 participants at high risk of cardiovascular events recruited from mainstream general practices and Aboriginal Medical Services, followed for an average of 18 months. The participants will be randomised to one of two versions of the polypill, the version chosen by the treating health professional according to clinical features of the patient, or to usual care. The primary study outcomes will be changes, from baseline measures, in serum cholesterol and systolic blood pressure and self-reported current use of aspirin, a statin and at least two blood pressure lowering agents. Secondary study outcomes include cardiovascular events, renal outcomes, self-reported barriers to indicated therapy, prescription of indicated therapy, occurrence of serious adverse events and changes in quality-of-life. The trial will be supplemented by formal economic and process evaluations. DISCUSSION: The Kanyini-GAP trial will provide new evidence as to whether or not a polypill-based strategy improves adherence to effective cardiovascular medications amongst individuals in whom these treatments are indicated. TRIAL REGISTRATION: This trial is registered with the Australian New Zealand Clinical Trial Registry ACTRN126080005833347.
%Z FOR Codes: 110201 110399 111701


%0 Journal Article
%~ PubMed
%A Schneider, Julie M
%A Gopinath, Bamini
%A McMahon, Catherine M
%A Britt, Helena C
%A Harrison, Christopher M
%A Usherwood, Tim
%A Leeder, Stephen R
%A Mitchell, Paul
%T Role of general practitioners in managing age-related hearing loss.
%B The Medical Journal of Australia
%D 2010
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd
%V 192
%N 1
%P 20-23
%@ 0025-729X
%X OBJECTIVE: To assess the extent to which general practitioners in Australia are engaged in identifying age-related hearing loss and facilitating its management. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional analysis of data collected between 1998 and 2000 from the Blue Mountains Hearing Study (BMHS), a representative population-based cohort of people aged >or= 50 years in two postcode areas west of Sydney. Also analysed were data collected between 2003 and 2008 from random samples of Australian GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) study, a national continuous cross-sectional survey of GP activity. MAIN OUTCOME MEASURES: Rate of facilitating management and identification of hearing loss in older patients; content of GP-patient encounters with hearing-impaired people; characteristics of participants seeking help from their GP. RESULTS: Of older people in the BMHS with measured (objective) bilateral hearing loss, about a third reported seeking help from their GP. BEACH survey data showed that only about 3 per 1,000 GP consultations with patients aged >or= 50 years involved management of age-related hearing loss. For every 100 age-related hearing problems managed, GPs undertook 12 procedural treatments, provided 20 referrals to specialists, and made 29 referrals to allied health professionals. CONCLUSION: In their routine consultations with patients, GPs have opportunities to identify hearing loss and appropriately refer patients to specialists or allied health professionals. Although GPs are responding to patient presentations for hearing loss, referring around 50% of cases, there appear to be relatively few cases in which hearing loss is identified opportunistically. Levels of identification and management of hearing loss by GPs in Australia are relatively low.
%Z FOR Codes: 111716 111706


%0 Journal Article
%~ PubMed
%A Mathew, Timothy H
%A Corso, Olivia
%A Ludlow, Marie
%A Boyle, Adam
%A Cass, Alan
%A Chadban, Steven J
%A Joyner, Beres
%A Shephard, Mark
%A Usherwood, Tim
%T Screening for chronic kidney disease in Australia: a pilot study in the community and workplace.
%B Kidney International. Supplement
%D 2010
%C United States
%I Wiley-Blackwell Publishing, Inc.
%V 77
%N S 116
%P S9-S16
%@ 0098-6577
%X The pilot program Kidney Evaluation for You (KEY) was conducted in Australia to screen for chronic kidney disease (CKD). Targeting people at high risk (those with diabetes, hypertension, a first-degree relative with kidney failure, or age >50 years), KEY aimed to establish community-based screening protocols, assess efficacy in promoting changes in risk-factor management, and explore participant CKD awareness. KEY offered free cardiovascular and kidney checks using point-of-care testing for on-site pathology measurements (estimated glomerular filtration rate, hemoglobin A1c, cholesterol, hemoglobin, albuminuria), lifestyle assessment, and exit interviews. Participants were telephoned at 3 months to ascertain whether KEY advice had been followed. Community and health professional support was strong; 99% of participants rated involvement as beneficial. Of 402 high-risk individuals recruited, findings were suggestive of CKD in 20.4%. Of these, 69% had hypertension, 30% diabetes, and 40% elevated total cholesterol. All participants with CKD stage 3b or higher were aged >61 years. Overall, 58% of participants were referred to their primary care providers for further action; of these, 82% saw their doctors in the next 3 months and 94% discussed KEY results. Follow-up telephone contact was successful for 82% of participants. A change in management occurred for 67%. Thus, the KEY approach to early detection of CKD and selected referral of participants was largely successful.
%Z FOR Codes: 110312


%0 Journal Article
%~ PubMed
%A Peiris, David P
%A Joshi, Rohina
%A Webster, Ruth J
%A Groenestein, Patrick
%A Usherwood, Tim P
%A Heeley, Emma
%A Turnbull, Fiona M
%A Lipman, Alexandra
%A Patel, Anushka A
%T An electronic clinical decision support tool to assist primary care providers in cardiovascular disease risk management: development and mixed methods evaluation.
%B Journal of Medical Internet Research
%D 2009
%C Canada, United State
%I Journal of Medical Internet Research
%V 11
%N 4
%P e51
%@ 1438-8871
%X BACKGROUND: Challenges remain in translating the well-established evidence for management of cardiovascular disease (CVD) risk into clinical practice. Although electronic clinical decision support (CDS) systems are known to improve practitioner performance, their development in Australian primary health care settings is limited. OBJECTIVES: Study aims were to (1) develop a valid CDS tool that assists Australian general practitioners (GPs) in global CVD risk management, and (2) preliminarily evaluate its acceptability to GPs as a point-of-care resource for both general and underserved populations. METHODS: CVD risk estimation (based on Framingham algorithms) and risk-based management advice (using recommendations from six Australian guidelines) were programmed into a software package. Tool validation: Data from 137 patients attending a physician''s clinic were analyzed to compare the tool''s risk scores with those obtained from an independently programmed algorithm in a separate statistics package. The tool''s management advice was compared with a physician''s recommendations based on a manual review of the guidelines. Field test: The tool was then tested with 21 GPs from eight general practices and three Aboriginal Medical Services. Customized CDS-based recommendations were generated for 200 routinely attending patients (33% Aboriginal) using information extracted from the health record by a research assistant. GPs reviewed these recommendations during each consultation. Changes in CVD risk factor measurement and management were recorded. In-depth interviews with GPs were conducted. RESULTS: Validation testing: The tool''s risk assessment algorithm correlated very highly with the independently programmed version in the separate statistics package (intraclass correlation coefficient 0.999). For management advice, there were only two cases of disagreement between the tool and the physician. Field test: GPs found 77% (153/200) of patient outputs easy to understand and agreed with screening and prescribing recommendations in 72% and 64% of outputs, respectively; 26% of patients had their CVD risk factor history updated; 73% had at least one CVD risk factor measured or tests ordered. For people assessed at high CVD risk (n = 82), 10% and 9%, respectively, had lipid-lowering and BP-lowering medications commenced or dose adjustments made, while 7% newly commenced anti-platelet medications. Three key qualitative findings emerged: (1) GPs found the tool enabled a systematic approach to care; (2) the tool greatly influenced CVD risk communication; (3) successful implementation into routine care would require integration with practice software, minimal data entry, regular revision with updated guidelines, and a self-auditing feature. There were no substantive differences in study findings for Aboriginal Medical Services GPs, and the tool was generally considered appropriate for use with Aboriginal patients. CONCLUSION: A fully-integrated, self-populating, and potentially Internet-based CDS tool could contribute to improved global CVD risk management in Australian primary health care. The findings from this study will inform a large-scale trial intervention.
%Z FOR Codes: 80605 110201


%0 Journal Article
%~ PubMed
%A Jowsey, Tanisha
%A Jeon, Yun-Hee
%A Dugdale, Paul
%A Glasgow, Nicholas J
%A Kljakovic, Marjan
%A Usherwood, Tim
%T Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study.
%B Australia and New Zealand Health Policy
%D 2009
%C United Kingdom, Unit
%I BioMed Central Ltd.
%V 6
%N 
%P 22
%@ 1743-8462
%X ABSTRACT: BACKGROUND: In response to the escalating burden of chronic illness in Australia, recent health policies have emphasised the promotion of patient self-management and better preventive care. A notable omission from these policies is the acknowledgment that patients with chronic illness tend to have co-morbid conditions. Our objectives were: to identify the common challenges co-morbidity poses to patients and carers in their experiences of self-management; to detail the views and perceptions of health professionals about these challenges; and to discuss policy options to improve health care for people with co-morbid chronic illness. The method included semi-structured interviews and focus groups with 129 purposively sampled participants. Participants were people with Type 2 diabetes, chronic obstructive pulmonary disease and/or chronic heart failure as well as carers and health care professionals. Content analysis of the interview data was conducted using NVivo7 software. RESULTS: Patients and their carers found co-morbidity influenced their capacity to manage chronic illness in three ways. First, co-morbidity created barriers to patients acting on risk factors; second, it complicated the process of recognising the early symptoms of deterioration of each condition, and third, it complicated their capacity to manage medication. CONCLUSION: Findings highlight challenges that patients with multiple chronic conditions face in relation to preventive care and self-management. Future clinical policy initiatives need to move away from single illness orientation toward strategies that meet the needs of people with co-morbid conditions and strengthen their capacity to self-manage. These patients will benefit directly from specialised education and services that cater to the needs of people with clusters of co-morbidities.
%Z FOR Codes: 111799


%0 Journal Article
%~ PubMed
%A Bhala, Neeraj
%A Usherwood, Tim
%A George, Jacob
%T Non-alcoholic fatty liver disease.
%B BMJ (Clinical research ed.)
%D 2009
%C United Kingdom
%I BMJ Publishing Group
%V 339
%N 
%P b2474
%@ 1468-5833
%X 
%Z FOR Codes: 110307


%0 Journal Article
%~ PubMed
%A James, Jenny
%A Cameron, Sonya
%A Usherwood, Tim
%T The practice of confidentiality in an Aboriginal medical service--what do GPs need to know?
%B Australian family physician
%D 2009
%C Australia
%I Royal Australian College of General Practitioners
%V 38
%N 10
%P 837-42
%@ 0300-8495
%X BACKGROUND: The medical ethic of confidentiality is usually taught from a western ethical perspective based on the Hippocratic oath. This study at an urban Aboriginal medical service aimed to explore how confidentiality is understood in a community controlled Aboriginal health service, with a view to informing the training of general practitioners. METHOD: Twenty-three people, comprising staff, patients and general practice registrars, were interviewed about confidentiality between July 2007 and February 2008. RESULTS: Six themes were identified: overlapping contexts of confidentiality, key sensitivities, sharing of patient information, importance of consent, multiple roles, and consequences of maintaining or breaching confidentiality. DISCUSSION: Perspectives on confidentiality in this community included issues of social justice, the importance of public demonstrations of confidentiality, and the challenge of protecting all relationships when staff have multiple roles. Incorporation of community perspectives into the teaching of confidentiality may help doctors to understand the responsibilities of practising confidentiality in certain communities.
%Z FOR Codes: 111701


%0 Journal Article
%~ PubMed
%A McDonnell, Louise
%A Usherwood, Tim
%T International medical graduates - Challenges faced in the Australian training program.
%B Australian Family Physician
%D 2008
%C Australia
%I Royal Australian College of General Practitioners
%V 37
%N 6
%P 481-484
%@ 0300-8495
%X BACKGROUND: Few studies have examined the challenges faced by international medical graduate (IMG) registrars and their supervisors in the Australian General Practice Training Program. This study explored registrar and supervisor perspectives on these challenges. METHODS: Five IMG registrars and 10 experienced supervisors were interviewed between August 2006 and March 2007. RESULTS: Six themes were identified: language and communication, cultural issues, understanding the Australian health care system, clinical knowledge and its application, consulting styles and registrar support. DISCUSSION: Addressing the issues identified in this study can provide an easier transition for IMG registrars and help them reach their full potential.
%Z FOR Codes: 111717


%0 Journal Article
%~ PubMed
%A Deshmukh, Vandana M
%A Toelle, Brett G
%A Usherwood, Tim
%A O'Grady, Brian
%A Jenkins, Christine R
%T The association of comorbid anxiety and depression with asthma-related quality of life and symptom perception in adults.
%B Respirology (Carlton, Vic.)
%D 2008
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 13
%N 5
%P 695-702
%@ 1323-7799
%X There are limited data on the association and interaction between anxiety and depression comorbidity and asthma-related quality of life (AQOL) and symptom perception. This study evaluated these associations in patients subsequent to an emergency department (ED) visit for asthma.
%Z FOR Codes: 110203


%0 Journal Article
%~ PubMed
%A Sintchenko, Vitali
%A Usherwood, Tim
%A Coiera, Enrico
%T Are clinicians' information needs and decision support affected by different models of care? Experimental study.
%B Studies in health technology and informatics
%D 2007
%C Netherlands
%I IOS Press
%V 129
%N Pt 2
%P 895-899
%@ 0926-9630
%X This study explores task- and healthcare model-specific differences in clinicians'' information needs which can affect the uptake of decision support. Results of a web experiment involving 104 general practitioners are presented. Respondents indicated that guidelines were the most important source of information with almost equal weighting for acute, chronic and preventive care. A patient''s quality of life was identified as the most important determinant of decision-making in all three models of care. Risk assessment tools and information about outcomes were more valuable (P<0.05) for chronic and preventive care than for acute cases. The participants accessed electronic risk assessment tools in 54%, 45% and 81% of acute, chronic and preventive care scenarios, respectively. Participants estimated that the electronic decision support would have a significantly higher impact in preventive care than in chronic or acute care settings (P=0.01). The differences in the information needs of clinicians related to different care models have to be considered in the design of clinical decision support systems. Systems that target preventive model decisions may have higher adoption and impact.
%Z FOR Codes: 111711 110309


%0 Journal Article
%~ PubMed
%A Cannon, Bianca
%A Usherwood, Timothy P
%T General practice consultations - how well do doctors predict patient satisfaction?
%B Australian family physician
%D 2007
%C Australia
%I Royal Australian College of General Practition
%V 36
%N 3
%P 185-186, 192
%@ 0300-8495
%X BACKGROUND: While patient satisfaction with the general practice consultation has been extensively researched, there have been relatively few studies of doctors'' perception of patient satisfaction. This study sought to measure how accurately doctors are able to predict patient satisfaction with consultations in general practice. METHODS: Adult patients consulting about new episodes of illness in general practice completed a consultation satisfaction questionnaire. The scores from the questionnaire were compared with doctors'' predictions of patient satisfaction. RESULTS: Nine general practitioners completed the study and returned a total of 167 pairs of questionnaires. On average, the patients gave their doctors higher scores on the general satisfaction and professional care scales than on the depth of relationship and perceived time scales of the questionnaire. On every scale, patients reported higher levels of satisfaction than their doctors predicted they would. There was poor correlation between patient and doctor scores for the perceived time scale, but moderate correlation for the other three scales. DISCUSSION: Our findings suggest that a doctor''s sense that a patient was not satisfied following a consultation may be valid, but that doctors may underestimate their patients'' satisfaction.
%Z FOR Codes: 111717


%0 Journal Article
%~ PubMed
%A Shah, S
%A Usherwood, T
%A Toelle, B
%A Jenkins, C
%A Sawyer, S
%T ABS78: A pilot study of Physician Asthma Care Education program in Australia.
%B Primary Care Respiratory Journal
%D 2006
%C United Kingdom
%I Strategic Medical Publishing
%V 0
%N 
%P 0
%@ 1471-4418
%X 
%Z FOR Codes:


%0 Journal Article
%~ PubMed
%A Deshmukh, Vandana M
%A Toelle, Brett G
%A Usherwood, Tim
%A O'grady, Brian
%A Jenkins, Christine R
%T Anxiety, panic and adult asthma: A cognitive-behavioral perspective.
%B Respiratory medicine
%D 2006
%C United Kingdom
%I WB Saunders Co. Ltd.
%V 101
%N 
%P 194-202
%@ 0954-6111
%X A review of previous research suggests increased probability of the prevalence of anxiety disorders, and particularly panic disorder and panic attacks in patients with asthma, as compared to a normal population. Research also indicates significant levels of co-morbidity between asthma and anxiety as measured on dimensional scales of anxiety and panic. Clinical anxiety and panic manifestations affect symptom perception and asthma management through the effects of anxiety symptoms such as hyperventilation, and indirectly through self-management behavior and physician response. However, there is limited data on the impact of anxiety co-morbidity on asthma quality of life. Some studies indicate that individuals with co-morbid asthma and anxiety or panic report worse asthma quality of life both in general and in relation to their symptomatology, being limited in their daily activities, in response to environmental stimuli and in regard to feelings of emotional distress. Cognitive-behavioral therapy (CBT) is an effective and empirically supported treatment of choice for anxiety disorders and panic attacks. However, standard CBT protocols for anxiety and panic may need to be specifically targeted at improving asthma outcomes. Also, asthma research literature is lacking in randomized controlled trials applying CBT to patients with co-morbid asthma and clinical anxiety manifestations. Trials evaluating CBT interventions in individuals with clinical anxiety manifestations and asthma may provide evidence of these interventions as an effective adjunct to improve asthma management and control.
%Z FOR Codes: 111799


%0 Journal Article
%~ PubMed
%A Knight, Andrew
%A Usherwood, Tim
%A Adams, Jon
%T Increasing EBM learning in training GPs - a qualitative study of supervisors.
%B Australian family physician
%D 2006
%C Australia
%I Royal Australian College of General Practitioners
%V 35
%N 4
%P 268-9
%@ 0300-8495
%X 
%Z FOR Codes: 111717


%0 Journal Article
%A Kang, Melissa
%A Bernard, Diana
%A Usherwood, Timothy
%A Quine, Susan
%A Alperstein, Garth
%A Kerr-Roubicek, Helen
%A Elliot, Abigail
%A Bennett, David
%T Primary health care for young people: are there models of service delivery that improve access and quality?
%B Youth Studies Australia
%D 2006
%C Australia
%I Australian Clearinghouse for Youth Studies
%V 25
%N 
%P 49-59
%@ 1038-2569
%X 
%Z FOR Codes:


%0 Journal Article
%~ PubMed
%A Kang, Melissa
%A Bernard, Diana
%A Usherwood, Tim
%A Quine, Susan
%A Alperstein, Garth
%A Kerr-Roubicek, Helen
%A Elliott, Abigail
%A Bennett, David
%T Towards better practice in primary health care settings for young people.
%B Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals
%D 2006
%C Australia
%I Australian Health Promotion Association
%V 17
%N 2
%P 139-144
%@ 1036-1073
%X ISSUE ADDRESSED: To identify and describe elements of accessibility and other dimensions of quality of primary health care for Australian young people. METHODS: Five sampling frames identified relevant services and programs across New South Wales (NSW) which were then selected using purposive, convenience or snowball sampling. In-depth interviews were conducted with senior staff members, tape-recorded, transcribed, entered into the qualitative software package NUD*IST and coded under seven theme headings. RESULTS: Interviews with 77 services across five sectors in NSW identified seven principles of better practice in youth health. These were: accessibility, evidence-based practice, youth participation, collaboration, professional development, sustainability and evaluation. Accessibility was the principle most frequently addressed and evaluation was the least frequently addressed. Many seemingly effective programs and services had been minimally evaluated for impact or outcome related to young people''s access or health. CONCLUSIONS: Principles of better practice in promoting or delivering adolescent health care have strong face validity across a range of sectors and service types in a heterogeneous primary health care system. These principles are applied to varying degrees in a vast array of health and health promotion programs. Despite this, there is a clear need for impact and outcome evaluation among the majority of programs.
%Z FOR Codes: 111717