Aust Fam Physician
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Integrated care has the potential to deliver efficiencies and improvements in patient experiences and health outcomes. Efforts towards integrated care, especially at the primary and community health levels, have increasingly been under focus, both nationally and internationally. In Australia, regional integration is a priority, and integration of care is a task for meso-level organisations such as Primary Health Networks (PHNs). ⋯ Six elements that consistently emerged during the development of a series of rapid reviews on integrated primary healthcare in Australia are presented in this paper. The elements identified are context, governance and leadership, infrastructure, financing, engagement, and communication. They offer a starting point for reflection in the planning and practices of organisations in their drive for continuous improvements in integrated care.
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Chronic pain is a large and growing public health concern in Australia. Chronic pain is generally associated with physical, psychological, social and cultural risk factors. ⋯ Knowledge of psychopharmacology is important in the management of chronic pain. The majority of patients with chronic pain have comorbid psychiatric conditions ranging from mild anxiety, depression and adjustment problems, to severe delusional and psychotic disorders. Depression and anxiety are known to enhance the perception of pain. Not all antidepressants have independent analgesic properties. There is now a convincing body of controlled data, as well as extensive longstanding clinical experience, supporting tricyclic antidepressants (TCAs) as analgesics independently of their antidepressant actions.
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With increasing computerisation in general practice, national primary care networks are mooted as sources of data for health services and population health research and planning. Existing data collection programs - MedicinesInsight, Improvement Foundation, Bettering the Evaluation and Care of Health (BEACH) - vary in purpose, governance, methodologies and tools. General practitioners (GPs) have significant roles as collectors, managers and users of electronic health record (EHR) data. They need to understand the challenges to their clinical and managerial roles and responsibilities. ⋯ Representatives from existing programs, Medicare Locals, Local Health Districts and research networks held workshops on the scope, challenges and approaches to the quality and use of EHR data. Challenges included data quality, interoperability, fragmented governance, proprietary software, transparency, sustainability, competing ethical and privacy perspectives, and cognitive load on patients and clinicians. Proposed solutions included effective change management; transparent governance and management of intellectual property, data quality, security, ethical access, and privacy; common data models, metadata and tools; and patient/community engagement. Collaboration and common approaches to tools, platforms and governance are needed. Processes and structures must be transparent and acceptable to GPs.
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General practitioners (GPs) are commonly asked about popular diets. The Palaeolithic diet is both highly popular and controversial. ⋯ The Palaeolithic diet remains controversial because of exaggerated claims for it by wellness bloggers and celebrity chefs, and the contentious evolutionary discordance hypothesis on which it is based. However, a number of underpowered trials have suggested there may be some benefit to the Palaeolithic diet, especially in weight loss and the correction of metabolic dysfunction. Further research is warranted to test these early findings. GPs should caution patients who are on the Palaeolithic diet about adequate calcium intake, especially those at higher risk of osteoporosis.
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When one speaks of global health, there are few issues that actually have a health impact globally rather than in just one or more regions of the world or in a specific population. When truly thinking globally, among the most important global health issues affecting large segments of the world's populations is the persistence of vaccine-preventable diseases. ⋯ Although there may be outbreaks of vaccine-preventable diseases within or across nations, effective immunisation strategies cannot be conducted in a one-off manner. No matter how effective a single immunisation campaign may be, each year there is a new global cohort of children who need protection to prevent disease, as well as new opportunities to vaccinate adults against a wide array of avoidable illnesses. The developing world should no longer experience 450,000 preventable deaths each year from rotavirus, nor 145,000 from measles. By the same token, there should no longer be 2000 preventable deaths each year from influenza in Australia. It is time to use our global health efforts to address the most pressing risks, both at home and abroad.