Patients' attitudes and intentions towards taking medical advice for type 2 diabetes mellitus: a theory of planned behaviour analysis.

PURPOSE: A key component of effective diabetes care is understanding patients' perceptions about diabetes management. Patients' attitudes and intentions towards taking medical advice may predict the outcomes for effective diabetes care. This study aims to measure participants' attitudes, beliefs and intentions towards following medical advice to manage their diabetes using the Theory of Planned Behaviour (TPB). The domains of the TPB are correlated with clinical measures of diabetes to determine if these attitudes and intentions are predictive of better diabetes control. METHODS: A pilot study was conducted. A 34-item survey was designed using the Theory of Planned Behaviour (TPB) framework and administered via mail by four general practice clinics. Included participants (N = 104; response rate 29.5%) had a diagnosis of type 2 diabetes and were taking medication for glycaemic control. Scores for each domain of the TPB survey were correlated with participants' clinical indicators for diabetes: HbA1c, blood pressure, lipid profile, cholesterol, and kidney health (eGFR and albumin: creatinine ratio) and BMI. RESULTS: Participants surveyed generally reported positive attitudes and intention to follow medical advice. Medical advice was perceived to be beneficial and useful by the majority. However, in general, there was no correlation between positive intentions and improved clinical indicators of disease. Clinical indicators did not improve with duration of illness. The burden of illness is likely a mitigating factor for positive intention as participants perceive medical advice as difficult and inconvenient to follow. CONCLUSIONS: Patients' individual capacity to implement medical advice should be addressed in shared-decision making models to potentially improve patient outcomes towards therapeutic targets.

Epidemiology of soccer-related head injury in children 5-14 years in Victoria, Australia.

AIM: Our aim was to use epidemiological data to determine the incidence of soccer-related head injuries in children aged 5-14 years who presented at emergency departments (EDs) or were admitted in hospitals in Victoria, Australia. METHODS: ED presentation and hospital admission de-identified aggregate data were from the Victorian Injury Surveillance Unit. Soccer participation data were compared with the soccer-related head injury data to determine the incidence of this injury among these children. RESULTS: The incidence of ED presentations was 0.17% of children participating in soccer during the study period (financial years 2011-2012 to 2015-2016). The 10-14-years age group presented with more head injuries than the 5-9-years age group. For the admissions data, soccer had a significantly lower (P = 0.0379) incidence of head injury when compared with 'sport as a whole'. CONCLUSIONS: The low incidence of soccer-related head injuries presenting to an ED or admission to hospital is consistent with international findings.

How does the duration of consults vary for upper respiratory tract infections in general practice where an antibiotic has been prescribed?

BACKGROUND: There is limited data on the duration of consults resulting in the prescription of antibiotics for upper respiratory tract infections (URTIs) in general practice. OBJECTIVE: To explore how demographic factors influence consult duration where antibiotics have been prescribed for URTI in Australian general practice. METHODS: 2985 URTI-specific presentations were identified from a national study of patients who were prescribed an antibiotic after presenting to general practice between June and September 2017. Consult duration was analysed to assess for any variation in visit length based on demographic factors. RESULTS: The overall median consult duration was 11.42 minutes [interquartile range (IQR) 7.95]. Longer consult duration was associated with areas of highest socio-economic advantage where patients living in postcodes of Index of Relative Socio-economic Advantage and Disadvantage (IRSAD) Quintile 5 (highest 20% on the IRSAD) had significantly longer consults [median 13.12 (IQR 8.01)] than all other quintiles (P < 0.001). Females [11.75 (IQR 8.13)] had significantly longer consults than males [10.87 (IQR 7.57); P < 0.001]. Clinics based in State C and State F had significantly shorter consults when compared with all other included states and territories (P < 0.001) and shorter consult duration was associated with visits on Sundays [median 8.18 (IQR 5.04)]. CONCLUSION: There is evidence for the association of demographic and temporal factors with the duration of consultations for URTIs where an antibiotic has been prescribed. These factors warrant further research.

Symptom profile of patients receiving antibiotics for upper respiratory tract infections in general practice: an observational study using smartphone technology.

BACKGROUND: Upper respiratory tract infections (URTIs) are a common presentation in general practice and are linked to high rates of inappropriate antibiotic prescription. There is limited information about the trajectory of patients with this condition who have been prescribed antibiotics. OBJECTIVE: To document the symptom profile of patients receiving antibiotics for URTIs in Australian general practice using smartphone technology and online surveys. METHODS: In total, 8218 patients received antibiotics after attending one of the 32 general practice clinics in Australia from June to October 2017: 4089 were identified as URTI presentations and were the cohort studied. Patients completed the Wisconsin Upper Respiratory Symptom Survey (WURSS-24) 3 and 7 days after visiting their general practitioner (GP). RESULTS: Six hundred fourteen URTI-specific patients responded to at least one symptom survey (RR 15%). The majority of patients reported moderate to mild symptoms at 72 hours [median global symptom severity score 37 (IQR 19, 59)] post-GP visit which reduced to very mild symptoms or not sick by day 7 [11 (IQR 4, 27)]. Patients receiving antibiotics for URTI reported the same level of symptom severity as patients in previous studies receiving no treatment. CONCLUSIONS: The recovery of most patients within days of receiving antibiotics for URTI mimics the trajectory of patients with viral URTIs without treatment. Antibiotics did not appear to hasten recovery. Monitoring of patients in this context using smart phone technology is feasible but limited by modest response rates.

A process for developing standards to promote quality in general practice.

BACKGROUND: Since 1991, the Royal Australian College of General Practitioners' (RACGP) Standards for General Practices (the Standards) have provided a framework for quality care, risk management and best practice in the operation of Australian general practices. The Standards are also linked to incentives for general practice remuneration. These Standards were revised in 2017. OBJECTIVE: The objective of this study is to describe the process undertaken to develop the fifth edition Standards published in 2017 to inform future standards development both nationally and internationally. METHOD: A modified Delphi process was deployed to develop the fifth edition Standards. Development was directed by the RACGP and led by an expert panel of GPs and representatives of stakeholder groups who were assisted and facilitated by a team from RACGP. Each draft was released for stakeholder feedback and tested twice before the final version was submitted for approval by the RACGP board. RESULTS: Four rounds of consultation and two rounds of piloting were carried out over 32 months. The Standards were redrafted after each round. One hundred and fifty-two individuals and 225 stakeholder groups participated in the development of the Standards. Twenty-three new indicators were recommended and grouped into three sections in a new modular structure that was different from the previous edition. CONCLUSION: The Standards represent the consensus view of national stakeholders on the indicators of quality and safety in Australian general practice and primary care.

How are junior doctors managing patients with self-limiting illnesses at their first presentation? A video vignette study.

PURPOSE: To conduct a video vignette survey of medical students and doctors investigating test ordering for patients presenting with self-limiting or minor illness. METHODS: Participants were shown six video vignettes of common self-limiting illnesses and invited to devise investigation and management plans for the patients' current presentation. The number of tests ordered was compared with those recommended by an expert panel. A Theory of Planned Behaviour Questionnaire explored participants' beliefs and attitudes about ordering tests in the context of self-limiting illness. RESULTS: Participants (n=61) were recruited from across Australia. All participants ordered at least one test that was not recommended by the experts in most cases. Presentations that focused mainly on symptoms (eg, in cases with bowel habit disturbance and fatigue) resulted in more tests being ordered. A test not recommended by experts was ordered on 54.9% of occasions. With regard to attitudes to test ordering, junior doctors were strongly influenced by social norms. The number of questionable tests ordered in this survey of 366 consultations has a projected cost of $17 000. CONCLUSIONS: This study suggests that there is some evidence of questionable test ordering by these participants with significant implications for costs to the health system. Further research is needed to explore the extent and reasons for test ordering by junior doctors across a range of clinical settings.