scholarly journals Management of a Chronic Skin Disease in Primary Care: An Analysis of Early-Career General Practitioners’ Consultations Involving Psoriasis

2021 ◽  
pp. 2021055
Author(s):  
Sameerah Nawaz ◽  
Amanda Tapley ◽  
Andrew Davey ◽  
Mieke L Van Driel ◽  
Alison Fielding ◽  
...  
Keyword(s):  
General Practitioners ◽  
Early Career ◽  
Learning Goals ◽  
Cross Sectional ◽  
Problem Diagnosis ◽  
Multivariable Regression ◽  
Chronic Skin ◽  
New Diagnosis ◽  
Sectional Analysis ◽  
Prescribing Medication

Background: The management of psoriasis by general practitioners (GPs) is vital, given its prevalence, chronicity, and associated physical and psychosocial co-morbidities. However, there is little information on how GPs (including early-career GPs) manage psoriasis. Objectives: This study assessed the frequency with which Australian specialist GP vocational trainees (‘registrars’) provide psoriasis care and the associations of that clinical experience. Methods: A cross-sectional analysis was done of data from the ReCEnT study, an ongoing multi-site cohort study of Australian GP registrars’ experiences during vocational training. In ReCEnT, 60 consecutive consultations are recorded 3 times (6-monthly) during each registrar's training. The outcome factor for this analysis was a problem/diagnosis being psoriasis, and independent variables were related to registrar, patient, practice and consultation factors. This study analysed 17 rounds of data collection (2010-2017) using univariate and multivariable regression. Results: Data from 1,741 registrars regarding 241,888 consultations and 377,980 problems/diagnoses were analysed. Psoriasis comprised 0.15% (n=550) of all problems/diagnoses (95% CI, 0.13-0.16). Significant patient multivariable associations of a problem/diagnosis being psoriasis included age, gender, being new to a practice or a registrar, and psoriasis being an existing problem rather than a new diagnosis. Significant registrar associations included seeking in-consultation information/assistance, not scheduling a follow-up appointment, prescribing medication, and generating learning goals. Conclusions: Australian registrars have modest training exposure to psoriasis and may find psoriasis management challenging. Furthermore, continuity of care (essential for optimal chronic disease management) was modest. The findings have implications for GPs’ approaches to the management of psoriasis more widely as well for general practice education and training policies.    

scholarly journals Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031527 ◽  
Author(s):  
Clare Heal ◽  
Hilary Gorges ◽  
Mieke L van Driel ◽  
Amanda Tapley ◽  
Josh Davis ◽  
...  
Keyword(s):  
Antibiotic Prescription ◽  
Early Career ◽  
Cross Sectional ◽  
Topical Antibiotics ◽  
Systemic Antibiotic ◽  
Cross Sectional Analysis ◽  
Clinical Encounters ◽  
New Diagnosis ◽  
Sectional Analysis ◽  
Systemic Antibiotics

ObjectiveTo establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).DesignA cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study.SettingReCEnT is an ongoing multisite cohort study of Australian registrars’ in-consultation clinical practice across five Australian states.ParticipantsRegistrars participating in ReCEnT from 2010 to 2017.Outcome measuresManagement of impetigo with systemic antibiotics.Results1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01).ConclusionsAustralian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.

scholarly journals Stature is inversely associated with self-reported diabetes in middle-aged Mexican women

2017 ◽  
Vol 41 ◽  
pp. 1
Author(s):  
Ruy Lopez-Ridaura ◽  
Karl P Puchner ◽  
Eduardo Ortiz-Panozo ◽  
Isabel Vieitez ◽  
Martín Lajous
Keyword(s):  
Menopausal Status ◽  
Urban Environments ◽  
Urban Setting ◽  
Mexican Women ◽  
Inverse Association ◽  
Middle Aged ◽  
Cross Sectional ◽  
Multivariable Regression Model ◽  
Multivariable Regression ◽  
Sectional Analysis

Objective. To investigate whether stature is associated with two highly prevalent cardiom- etabolic disorders—diabetes mellitus (DM) and high blood pressure (HBP) —in middle-aged Mexican women. Methods. We conducted a cross-sectional analysis of a sample of 93 481 middle-aged Mexican female teachers, all participating in the Mexican Teachers Cohort (MTC, or ESMaestras) study. We used a multivariable regression model to investigate the association of stature quintiles with the self-reported outcomes of DM and HBP. Results. After adjusting for birth cohort, ethnicity, family history, birthweight, occupation of household’s head during participant’s childhood, menopausal status, and geographical region of birthplace, stature was inversely associated with DM, with the odds for DM being 9% higher in the lowest stature quintile when compared to the highest stature quintile. Stratification for location of residence resulted in confirmation of the above-mentioned findings only in partici- pants living in urban environments. Conclusions. We found an inverse association of stature with DM but not with HBP. Our data suggest that urban setting might be an important effect modifier of this association, which merits further investigation since it might provide valuable insights into the epidemiological transition occurring in developing countries.

scholarly journals Australian general practice trainees’ exposure to ophthalmic problems and implications for training: a cross-sectional analysis

2016 ◽  
Vol 8 (4) ◽  
pp. 295 ◽  
Author(s):  
Simon Morgan ◽  
Amanda Tapley ◽  
Kim M Henderson ◽  
Neil A Spike ◽  
Lawrie A McArthur ◽  
...  
Keyword(s):  
General Practice ◽  
Information Seeking ◽  
Learning Goals ◽  
Training Methods ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Australian General Practice ◽  
Simple Logistic ◽  
Sectional Analysis

ABSTRACT INTRODUCTION Eye conditions are common presentations in Australian general practice, with the potential for serious sequelae. Pre-vocational ophthalmology training for General Practitioner (GP) trainees is limited. AIM To describe the rate, nature and associations of ophthalmic problems managed by Australian GP trainees, and derive implications for education and training. METHODS Cross-sectional analysis from an ongoing cohort study of GP trainees’ clinical consultations. Trainees recorded demographic, clinical and educational details of consecutive patient consultations. Descriptive analyses report trainee, patient and practice demographics. Proportions of all problems managed in these consultations that were ophthalmology-related were calculated with 95% confidence intervals (CI). Associations were tested using simple logistic regression within the generalised estimating equations (GEE) framework. RESULTS In total, 884 trainees returned data on 184,476 individual problems or diagnoses from 118,541 encounters. There were 2649 ophthalmology-related problems, equating to 1.4% (95% CI: 1.38–1.49) of all problems managed. The most common eye presentations were conjunctivitis (32.5% of total problems), eyelid problems (14.9%), foreign body (5.3%) and dry eye (4.7%). Statistically significant associations were male trainee; male patient and patient aged 14 years or under; the problem being new and the patient being new to both trainee and practice; urban and of higher socioeconomic status practice location; the practice nurse not being involved; planned follow up not arranged; referral made; in-consultation information sought; and learning goals generated. DISCUSSION Trainees have comparable ophthalmology exposure to established GPs. However, associations with referral and information-seeking suggest GP trainees find ophthalmic problems challenging, reinforcing the critical importance of appropriate training.

scholarly journals Prevalence and Associations of General Practice Registrars’ Management of Atopic Dermatitis: A Cross-Sectional Analysis from the Registrar Clinical Encounters in Training Study

2021 ◽  
pp. e2021128
Author(s):  
Anneliese Willems ◽  
Amanda Tapley ◽  
Alison Fielding ◽  
Er Tsing Vivian Tng ◽  
Elizabeth Holliday ◽  
...  
Keyword(s):  
General Practice ◽  
Atopic Dermatitis ◽  
Response Rate ◽  
Learning Goals ◽  
Cross Sectional ◽  
Clinical Encounters ◽  
Chronic Inflammatory Condition ◽  
English Speaking ◽  
Recent Project ◽  
Sectional Analysis

Introduction: Atopic dermatitis (AD) is a chronic inflammatory condition which imposes substantial burden upon patients and their families. As a frequent primary care presentation, general practice (GP) trainees must develop adequate skills in AD diagnosis and management. Objectives: We aimed to explore the prevalence and associations of GP registrars’ management of patients with AD. Methods: This study used data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study of the clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors were independent variables in multivariable logistic regression with outcome factor ‘diagnosis/problem being AD’. Results: From 2010-2019, 2,783 registrars (96% response rate) provided data from 381,180 consultations. AD was encountered in 0.6% of consults. AD was more likely to be seen in patients aged 0-1 years and patients from a non-English speaking background. AD was less likely to be seen in Aboriginal or Torres Strait Islander patients. Learning goals were more likely to be generated for AD and these consultations were associated with registrars seeking information or assistance. AD was strongly associated with a medication being prescribed, of which the most prescribed medications were mild or moderate potency topical corticosteroids.  Conclusions: Our findings suggest that, similar to other dermatological presentations, registrars find AD challenging to manage. There may be some gaps in AD management knowledge and application.

Knowledge of Breastfeeding and Kangaroo Mother Care Practices Among General Practitioners in Rural Western India

2021 ◽  
pp. 037957212110265
Author(s):  
Nisha Fahey ◽  
Nitesh Sadhwani ◽  
Smit Shethwala ◽  
Jeroan Allison ◽  
Apurv Soni ◽  
...  
Keyword(s):  
General Practitioners ◽  
Newborn Care ◽  
Cross Sectional Study ◽  
Kangaroo Mother Care ◽  
Average Score ◽  
Western India ◽  
Cross Sectional ◽  
Multivariable Regression ◽  
Care Practices ◽  
Multivariable Regression Models

Background: Breastfeeding and Kangaroo Mother Care (KMC) are interventions to reduce neonatal mortality and undernutrition. We investigated the knowledge of allopathic and Ayurvedic, Yoga-naturopathy, Siddha, and Homeopathic (AYUSH) general practitioners in rural western India and identified attributes associated with awareness and knowledge on these topics. Methods: This cross-sectional study of general practitioners in the Anand district of Gujarat, India, used an anonymous self-reported survey. Multivariable regression models were used to identify practitioner attributes associated with awareness and knowledge. Results: Among the 158 respondents, a quarter (26.0%) were trained in allopathic medicine and 63.0% had practiced for 5 years or more. The average score of breastfeeding knowledge was 8.0 of 13. Most (79.1%) did not have any awareness of KMC. After adjusting for potential confounders, knowledge of breastfeeding practices among AYUSH practitioners was 4-fold greater than that of allopathic practitioners (incidence rate ratio: 3.9; 95% CI: 3.2-4.6). By contrast, AYUSH practitioners had 80% decreased odds of awareness about KMC compared with allopathic practitioners (odds ratio: 0.2; 95% CI: 0.1-0.3). Discussion: This study demonstrates distinct knowledge gaps among allopathic and AYUSH general practitioners regarding breastfeeding and KMC. There is a need for tailored continuing medical education among general practitioners to enhance their clinical knowledge of newborn care practices to achieve improvements in neonatal health.

Prevalence and associations of prescribing of long-acting reversible contraception by general practitioner registrars: a secondary analysis of ReCEnT data

2020 ◽  
Vol 46 (3) ◽  
pp. 218-225
Author(s):  
Rachel Turner ◽  
Amanda Tapley ◽  
Sally Sweeney ◽  
Andrew Davey ◽  
Elizabeth Holliday ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Secondary Analysis ◽  
Early Career ◽  
Learning Goals ◽  
Cross Sectional ◽  
Clinical Encounters ◽  
Effective Form ◽  
Prescribing Practice ◽  
Health Related ◽  
Long Acting

ObjectiveLong-acting reversible contraception (LARC) is the most effective form of contraception but use in Australia is low. Uptake of LARC prescribing by early-career general practitioners (GPs) has important implications for community reproductive health. We aimed to investigate the prevalence and associations of Australian GP registrars’ LARC prescribing.MethodsA cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) cohort study 2010–2017. GP registrars collected data on 60 consecutive consultations on three occasions during their training. The outcome factor was prescription of LARC (compared with non-LARC). A secondary analysis was performed with problems involving prescription of LARC (compared with other problems). Associations with patient, practice, registrar and consultation independent variables were assessed by univariate and multivariable logistic regression.Results1737 registrars recorded 5382 problems/diagnoses involving women aged 12–55 years in which contraception was prescribed. 1356 (25%) involved LARC. Significant multivariable associations of prescribing LARC included patient age (OR 2.85, 95% CI 3.17 to 3.74, for age 36–45 years compared with age 12–18 years), practice rurality - inner-regional (OR 1.47, 95% CI 1.22 to 1.79) and outer-regional/remote/very remote (OR 1.47 95% CI 1.15 to 1.87) compared with major cities, practices in areas of lower socioeconomic status (SES) (OR 0.93, 95% CI 0.91 to 0.96 for SES by decile), generating learning goals (OR 1.37, 95% CI 1.04 to 1.79), in-consultation assistance-seeking (OR 1.58, 95% CI 1.24 to 2.01), and the registrar having reproductive health-related postgraduate qualifications (OR 1.33, 95% CI 1.01 to 1.76).ConclusionsThe prevalence of LARC prescribing by Australian GP registrars is higher than has been previously estimated in established GPs. Postgraduate qualifications in reproductive health are associated with prescribing LARC. Prescribing practice differs according to rurality and relative socioeconomic disadvantage.

scholarly journals Clinical associations of an updated medication effect score for measuring diabetes treatment intensity

2019 ◽  
pp. 174239531988409 ◽  
Author(s):  
Anastasia-Stefania Alexopoulos ◽  
William S Yancy ◽  
David Edelman ◽  
Cynthia J Coffman ◽  
Amy S Jeffreys ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Controlled Trial ◽  
Clinical Factors ◽  
Cross Sectional ◽  
Patient Level ◽  
Medication Effect ◽  
Multivariable Regression ◽  
Onset Of Diabetes ◽  
Sectional Analysis

Objectives The medication effect score reflects overall intensity of a diabetes regimen by consolidating dosage and potency of agents used. Little is understood regarding how medication intensity relates to clinical factors. We updated the medication effect score to account for newer agents and explored associations between medication effect score and patient-level clinical factors. Methods Cross-sectional analysis of baseline data from a randomized controlled trial involving 263 Veterans with type 2 diabetes and hemoglobin A1c levels ≥8.0% (≥7.5% if under age 50). Medication effect score was calculated for all patients at baseline, alongside additional measures including demographics, comorbid illnesses, hemoglobin A1c, and self-reported psychosocial factors. We used multivariable regression to explore associations between baseline medication effect score and patient-level clinical factors. Results Our sample had a mean age of 60.7 ( SD = 8.2) years, was 89.4% male, and 57.4% non-White. Older age and younger onset of diabetes were associated with a higher medication effect score, as was higher body mass index. Higher medication effect score was significantly associated with medication nonadherence, although not with hemoglobin A1c, self-reported hypoglycemia, diabetes-related distress, or depression. Discussion We observed several expected associations between an updated medication effect score and patient-level clinical factors. These associations support the medication effect score as an appropriate measure of diabetes regimen intensity in clinical and research contexts.

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