Audio podcast interviews August 2009
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HIV…chronic disease management
Justin Denholm, BMed MBioethics, is a research registrar, Victorian
infectious Diseases Service, Royal Melbourne Hospital. He discusses the
current issues in long term management of patients living with HIV with
Jenni Parsons. Patients with HIV treated with combination antiviral
therapy (cART) now often have rapid and sustained control of HIV
viraemia (often to undetectable levels) and a sustained increase in CD4+
T-cell counts. This has resulted in decreased opportunistic infections
and increased longevity. Management has therefore shifted more to a
chronic disease management model, in which GPs are able to provide an
important role. Management focuses on the effects of HIV and its
treatment on long term health, the psychosocial impact of living with a
chronic disease and the specific issues related to a sexually
transmissible infection. Specific issues include psychosocial support,
mental health, risk behaviour, assessing and managing increased risk of
cardiovascular and metabolic disease, increased risk of malignancy and
vaccination against preventable diseases.
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TB... what's new, what's
not?
Dr Anna Ralph, MBBS, MPH, DTM&H, FRACP, is an infectious diseases
physician and PhD scholar untertaking research in tuberculosis.She
discusses whats new in diagnosis and management of the very old disease
of TB with Dr Jenni Parsons. Despite lower incidence of TB in Australia
compared to other places in the world, TB remains a significant problem
in a number of at risk groups including migrants from sub Saharan
Africa, India, Vietnam, the Phillipines, China and Indonesia; patients
with HIV; and Indigenous Australians. While newer diagnostic tests
(interferon gamma release assays) are available, they have some
limitations and in Australia sputum microscopic examination and cuture
remains the main method of diagnosis in symptomatic individuals.
Developments in pharmacotherapy include a metronidazole related
antibiotic and agents targeting MTB genes. However, the standard first
line treatment remains 6 months of rifampicin, isoniazid plus
pyrazinamide and ethambutol for the first 2 months. In Australia,
patients with TB are managed in specialty treatment units, the GP has an
important roole in avoiding diagnostic delay, infection control,
avoiding drug interactions (particularly with rifampicin), nutrition,
smoking cessation, psychological support and encouraging adherence to
therapy.
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Dementia - community needs versus
primary care services
Dr Fiona Millard, MBChB, FRACGP, MGP is an adjunct senior lecturer in
Aged Care at James Cook University. She discusses research she has
published in August 2009 AFP on what patients with dementia and their
carers required from primary care providers, and the knowledge,
attitudes and beliefs of health providers about dementia. Important
themes from patients and carers include the need for timely
investigation of symptoms, early and accurate diagnosis, explanation and
support in the home. Up to 35% of GPs in the postal survey component
said they preferred not to look after patients with dementia and about
15% of primary health providers indicated they thought early diagnosis
may be harmful.
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Medical Assistants… developing a role
in primary care
Abbe Anderson, MBA, is CEO GPpartners, Lutweyche, Queensland. She
discusses the role and training of Medical Assistants in primary care
with Jenni Parsons. Medical assistants undertake a variety of
administrative, reception and clinical duties in a primary care setting
work under the supervision of doctors, nurses or practice managers. A 12
month TAFE course has been developed to train staff for this role. The
clinical tasks that can be undertaken by medical assistants include
wound dressings; venepuncture; and vision, hearing, height, weight and
blood pressure checks. This role potentially provides flexibility of
staffing in medical practices, with medical assistants undertaking
administrative or clinical duties as required, freeing up nursing time
for chronic disease management and more complex tasks. It also
formalises and provides specific training for a role many medical
receptionists have already partially undertaken in the primary care
setting.
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