 DISCIPLINE OF GENERAL
PRACTICE
University of Tasmania
Mark Nelson, Jan Gartlan
Mark - Chair, Jan - PhD candidate
Ph: 03 6226 4739
E: janette.gartlan@utas.edu.au
ASPREE Trial Launched in Tasmania
The Discipline of General Practice at the University of Tasmania has recently launched the ASPirin in Reducing Events in the Elderly trial (ASPREE). ASPREE is a randomized double-blind placebo controlled trial which will be conducted within general practice. It is designed to detect a 15% difference in major adverse cardiovascular events between placebo and 100mg aspirin daily in subjects aged 70 years and above. ASPREE will be run in every Australian state, through six universities with a target of 20,500 subjects. The trial is supported by the National Heart Foundation, the National Stroke Foundation, Alzheimer's Australia, and the Australian Divisions of General Practice. It has received financial and in kind support from the National Health and Medical Research Foundation, the National Heart Foundation, and Bayer AG.
Tasmanian GPs were invited to become co-investigators for the trial to aid in recruitment of participants and to build their research capacity. As such the study is acting as an entry point for GPs to become involved in research, helping to build links between GPs and the University of Tasmania and raising the profile of GP research within Tasmania. Approximately 40 GPs attended three dinners held around the state to launch the trial and most were recruited as Co-investigators. To date, over 100 GPs have expressed interest in becoming Co-investigators. The ASPREE Steering Committee aim to recruit a total number of 200 Tasmanian GPs.
ASPREE is overtly linked with the RCBI program in the Discipline of General Practice at the University of Tasmania. Former RDP fellow Jan Gartlan is using the ASPREE study as a source of data for her PhD and 2006 RDP Fellow Lin Bowers-Ingram is employed on the study part time as a research nurse. They are both gaining experience in working on a large scale clinical trial and contributing to the PHCRED phase 2 goals of building an expanded pool of primary health care researchers and conducting primary health care research relevant to practice and policy.
GREATER HEALTH
 Greater Green Triangle University Department of Rural Health
Flinders and Deakin Universities
Rachel Boak
PHCRED Coordinator
Ph: 03 5553 3502
E: Rachel.boak@greaterhealth.org
Building Capacity with Partnerships: Greater Green Triangle UDRH Research Projects linking with General Practices
During 2005 the PHCRED program the Green Triangle University Department of Rural Health (GGT UDRH) offered two bursaries to General Practices as teams rather than to individuals. Each bursary was valued at $20 000, similar to a research fellow grant. One GP in each practice was the designated primary research person. Involving the whole practice in a large research program provided the bursary holders with experience of 'real research'.
General Practice Bursaries were implemented as part of the following PHCRED program strategies:
Provide opportunities for early-mid career researchers to gain experience through participation in the research projects of senior researchers.
Both General Practices applied to undertake work in the area of chronic disease management. Both wished to investigate how to best orientate practice work systems to meet identified needs. Their proposed research objectives were incorporated as part of beyondblue - national depression initiative funded research project, designed by senior researchers, which shared some of the same research objectives.
Undertake dialogues with policy advisors, practitioners and other key stakeholders at local and national levels to inform, and maximise the relevance of, local programs.
The General Practice bursaries served a dual purpose; first, by supporting the GPs and their Practices to undertake research, and secondly, by involvement in the larger scale research project allowed the GPs to provide input as key local stakeholders, helping to maximise the relevance of the beyondblue funded project.
Create research career pathways for early-mid career researchers using specific strategies including mentoring.
The PHCRED Coordinator provided mentoring. The PHCRED Program Manager supervised both the GPs and also the overall large scale research project. Now, a year later, both GPs, and one in particular, continue to build their research capacity. Research has also become a regular part of their work and a regular function of their practices. One practice has reported that they are particularly pleased with the positive impact on patients and the greater involvement of practice nurses.
RURAL HEALTH RESEARCH UNIT, SCHOOL OF MEDICINE
JAMES COOK UNIVERSITY
Robyn Preston
PHCRED Coordinator
Ph: 07 4796 3383
E: robyn.preston@jcu.edu.au
On-line Introductory Research Modules
The PHCRED program at JCU is piloting a new way of delivery research capacity building programs through the internet. Our on-line Research Modules are an introduction level resource for novice researchers. Equally they can be a refresher course for those who have been away from research practice for a time. They were written with Australian urban and rural primary health care practitioners in mind so the content uses examples which we hope you can identify with in your practice. Each module includes practical exercises and guides and links to further reading and resources. They have been extensively reviewed by experts in each field and are designed to be easily accessed through dial-up email systems. Regular postings to the notice board will keep users up to date with developments in each field.
The modules have been available on JCU website, through the Blackboard Learning System TM since 11 September 2006. Access is available to all PHC practitioners who register via email.
 Modules now available include:
- Qualitative Research for Health Professionals (a suite of six modules)
- Writing for Publication
- Primary Health Care Evaluation
- Evaluation using the Log-Frame Method
Other members of the PHCRED QLD Collaboration plan to develop research and evaluation modules in 2007. Keep up to date on these developments through our website http://www.uq.edu.au/phcredqld/
To access the JCU modules
E: phcred@jcu.edu.au with your name, organisation and email address.
General Practice Education and Training Registrar Research Workshop
Ms Robyn Preston, PHCRED Coordinator and Dr Clare Heal, former PHCRED Fellow, enjoyed facilitating and presenting this year's workshop held from 25-27 May in Brisbane. In between presentations about research, small groups (five registrars with facilitators) planned a mock research proposal around a question that had arisen out of their practice. On the final day each group presented their proposal and was assessed by their peers.
DISCIPLINE OF GENERAL PRACTICE
The University of Queensland
Denise Schultz
PHCRED Qld Coordinator
Ph: 07 3346 4905
E: d.schultz@uq.edu.au
Queensland Networks - recruit, participate and publish
General Practitioners are invited to join in two successful research networks operating in Queensland investigating clinically important primary health care research questions.
Dr Geoff Spurling from Inala is now recruiting patients with recurrent impetigo to trial effective treatments. GPs treating this skin condition will be able to recruit patients and participate in the development of treatment options for trial in the general practice setting.
This year, network sponsor, the Primary Health Care Research, Evaluation and Development (PHCRED) has conducted two important primary care trials. One investigating wound management and the other examining how GPs are currently treating common shoulder pain.
From Townsville, Dr Clare Heal's work on wet and dry wound management was published in the British Medical Journal in May. Her work with 16 other GPs from Mackay was awarded the prestigious Excellence in Research award from AAAGP in July. The research trial was conducted with a bursary from PHCRED.
Dr Scott Masters from Caloundra is currently analysing data from his recent trial to reveal how shoulder pain is diagnosed and treated by GPs in Queensland. He has data from 100 patients recruited through this GP driven research network. Dr Masters is currently a Research Fellow with Griffith University.
The aim of the GP research networks is to ask, investigate and provide answers to research questions that GPs face everyday. The network is co-ordinated by PHCRED and allows GPs to participate in research from their own practice. PHCRED also offers a variety of short courses, research fellowships and ongoing support for GPs interested in pursuing a research career. Involvement in the networks also attracts QA and CPD points accredited by RACGP and ACRRM.
GPs interested in recruiting patients, conducting research or participating in priority research setting process should contact Denise Schultz at PHCRED Queensland
Ph: 07 3346 4905
or visit PHCRED Queensland website
Web: http://www.uq.edu.au/phcredqld
PHCRED Queensland is a joint initiative of Bond University, Griffith University, James Cook University, Mount Isa Centre for Rural and Remote Health and the University of Queensland. It is funded by the Australian Government Department of Health and Ageing.
Discipline of General Practice
The University of Newcastle
Prof Dimity Pond
Director
Ph: 02 4968 6730
E: dimity.pond@newcastle.edu.au
PHCRED Staff at the University of Newcastle have been assisting Prof Dimity Pond and her team with an NHMRC funded grant investigating the detection and management of dementia in general practice.
The purpose of this project is to examine how GPs detect and manage people with dementia living in the general community. Over the next two decades, as the Australian population ages, numbers with dementia are expected to double by 2020. There is evidence of a need for improvement in GPs' ability to diagnose and manage dementia, as studies show that GPs fail to identify over 50% of dementia cases, depending on their severity. The study focuses on a new questionnaire, the General Practitioner Assessment of Cognition (GPCOG), that GPs can use to detect dementia in its early stages.
Many older people attend their general practitioner regularly. The GPCOG's use and further testing in a random sample of GP patients should further demonstrate its usefulness in a GP setting, where brevity in assessment is of great importance in improving uptake. In addition, the study aims to determine whether a screening (nil complaints of memory problems) or case finding (patients complain of memory problems to their GP, and/or if the GP already identifies the patient as suffering from probable dementia) approach to dementia results in better outcomes and a more acceptable process for carers. We also will be evaluating the outcomes of training based on the 'Care of Patients with the Dementia in General Practice Guidelines'.
The benefits of earlier diagnosis include recognition and management of reversible causes, and allowing patients time to plan for the future (eg prepare wills, appoint powers of attorney, prepare advance directives) while they are still competent to do so. Co-morbidities such as depression may be identified. Appropriate support services can be mobilised and referral to a specialist organised if the diagnosis is unclear or further work up is needed. Peer support and education for patients and families may also be provided earlier if diagnosis is made earlier, particularly through referral to Alzheimer's Australia.
 University Department of Rural Health (UDRH) Northern New South Wales
University of Newcastle
Trish Thornberry
Lecturer in Nursing, University of New England (UNE) (PhD candidate UNE)
PHCRED Research Fellow
Ph: 02 6767 7227
E: pthornbe@une.edu.au
Trish Thornberry, Program Coordinator, Bachelor of Nursing Studies at the University of New England and also a PhD candidate in the Faculty of Social Sciences, is the recipient of a PHCRED Research Fellowship with the UDRH Northern NSW in Tamworth.
The New South Wales public health system is currently undergoing the most significant reforms since the 1980's. The aim of this PhD research project is to evaluate the subjective and emotional impact of the mergers and the subsequent changes, if any, to the quality and safety aspects of care within rural New South Wales' public health agencies. This study is being conducted across Hunter New England, Greater Western and Greater Southern Area Health Services with a sample of primary health care clinicians, managers, nurses, administrative assistants and professionals who have left NSW Health since the mergers in 2005.
The research is being conducted in two phases. Phase 1 involved 20 semi-structured telephone interviews with a purposive sample of participants from the three area health services to identify key areas of impact resulting from the reforms. Phase 2 will involve an on-line questionnaire comprising closed and open questions developed from the main themes that emerged in Phase 1.
Final analysis of the data from both phases will be completed during the next six months with preliminary results disseminated through appropriate journal articles and at various conferences in 2007. The second phase of this research is being supported by a PHCRED research fellowship through the UDRH's PHCRED program.
Individuals working for NSW Health and those who have left NSW Health since the 2005 mergers can complete the confidential questionnaire available on-line at http://tlc.une.edu.au/rahs/
Northern Rivers University Department of Rural Health
University of Sydney
Hudson Birden
Senior Lecturer, Public Health
Ph: 02 6620 7603
E: hudsonb@med.usyd.edu.au
The Northern Rivers University Department of Rural Health (NRUDRH) are beginning our series of workshops on applied research practice in October. Our target audience consists of employees of the North Coast Area Health Service and GPs. The workshops are designed to take participants through an educational process on conducting health research, starting by identifying a research question and undertaking a literature review, then proceeding through the full process of developing appropriate methodology, data collection instruments, proposal writing, project management, data collection and management, analysis and writing.
Participants are encouraged to bring a research idea to the program and work through the development and implementation of that project over the course of the workshops. Workshops will be intensive, with small numbers to maximise support for each participant. They will be video conferenced between Lismore and Coffs harbour, with presenters rotating so that each site takes turns being the primary site for a workshop. We are also developing a similar program for staff working in Aboriginal health that will commence this year.
From 31 July, Megan Passey is Coordinator of the NRUDRH PHC RED program. She brings a wealth of experience in International Health, program evaluation, and medical research.
DEPARTMENT OF GENERAL PRACTICE
University of Western Australia
Simone Karner & Tracy Reibel
Research Officer & Statewide Coordinator
UWA PHC RED
Ph: 08 9449 5131
E: tracy.reibel@uwa.edu.au
The Chronic Disease Management project is a partnership between the University of Western Australia PHCRED unit and the Fremantle Regional GP Network. It involves evaluation of a Healthy at Home (H@H) program that aims to educate and empower patients with Diabetes, Chronic Obstructive Pulmonary Disease (COPD) or Heart Failure to stay in control of their condition and maintain independence at home. As it assesses a health reform initiative being undertaken by the State Government, findings of the project are forwarded to the Health Department.
Phase 1 - February - April 2006
Prior to the H@H program commencing, Fremantle Regional GP Network initiated a study of a sample of General Practitioners and Practice Nurses. GPs and Practice Nurses (PNs) participated in focus groups to determine pre-program thoughts, attitudes and concerns relating to components associated with the H@H Program. These will be reassessed in Phase 2.
Key Findings of Phase 1 were:
Perceived benefits:
- Possible reductions in GP workloads
- Increase understanding and knowledge of local allied health providers
- Better patient care and health outcomes as the program would allow them access to a broad range of services available to assist with the management of their condition
- Could act as a motivator for patients to make positive changes concerning their lifestyle
- Greater GP satisfaction as the program would allow them to feel that they are doing the most for their patient.
Perceived concerns:
- Concern that the delivery of the program would rely foremost on GPs and PNs thus significantly increasing their workloads
- Concerns regarding the possible diminishment of the GP role as a result of the PN role within the program
- The 24 hour component of the program was viewed as superfluous and a possible duplication of existing services
- Concerns regarding patient participation due to transport issues and the geographic location of CDM teams
- The potential for a decline in quality of patient care was a concern for some participants as a result of GPs having to take on new patients or patients for whom they have no previous history.
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