Australian Family Physician January/February 2007 - Quality framework
Vol 36, (1/2) 1-96
The theme for the January/February issue of AFP
is
quality framework. This month's articles include a quality framework for
Australian general practice, professionalism, patient focus, competence,
financing, BEACH reliability and validity, mandatory fortification with
folic acid, early health assessment of refugees, and evaluation of renal
function.
Quality and general practice
Shiong Tan
The relationship between scholarship and action, evidence and practice is one that resonates well with
general practice. In 1986, Avedis Donabedian declared: 'In all my work, I have tried to embody the passionate
conviction that the world of ideas and the world of action are not separate, as some would have us think, but inseparable parts of each other. Ideas are the truly potent forces that shape our tangible world'.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
A quality framework for Australian general practice
Barbara J Booth, Teri Snowdon
Quality improvement in health care is a
priority. After more than a decade of strategic change in Australian
general practice, The Royal Australian College of General Practitioners
has developed a conceptual framework for quality improvement.
Capacity and the quality framework
Teri Snowdon, Jill Benson, Judy Proudfoot
How many times have we repeatedly told ourselves: 'I must ask about immunisation', 'I must make sure all my diabetes patients are recorded', 'I must enter the blood pressure (BP) in the right spot in my software'? Knowing what to do is often not the problem for general practitioners; doing all that we know we should do in a time and cost effective way, is the challenge. General
practice covers the broadest range of needs in the health care system. People need prompt, safe care for acute and emergency situations; well organised care for ongoing complex conditions; empathic and supportive care for special needs; and everything in between.
Professionalism and the quality framework
Joanna Flynn, Barbara Booth, Rachel Portelli
As the visible manifestation of a profession's culture and values, medical professionalism is under increased pressure to play its part in quality improvement.
Patient focus and the quality framework
Barbara J Booth, Tony McBride
The Royal Australian College of General Practitioners Quality Framework for Australian General Practice provides a mechanism for planning and assessing quality improvement initiatives in an Australian context that takes account of the perspective of patients in the health care system.
Competence and the quality framework
Kaye Atkinson, Claire Jackson, Morton Rawlin
The quality framework developed by The Royal Australian College of General Practitioners is described by Booth in this issue of Australian Family Physician. This article applies the framework to the ‘competence’ domain.
Knowledge and information and the quality framework
Ron Tomlins
The quality framework developed by The Royal Australian College of General Practitioners is described by Booth in this issue of Australian Family Physician. This article applies the framework to the ‘knowledge and information’ domain.
Financing and the quality framework
Ian Thomas Watts, Beres Wenck
Using a quality framework can assist in the design of payment arrangements to ensure that the optimal effects of health funding are achieved.
The quality of data on general practice - A discussion of BEACH reliability and validity
Helena Britt, Graeme Miller, Clare Bayram
The quality of data used to measure quality is as important as quality of care itself. Any organisation undertaking studies within general practice should ensure the methods they adopt meet these ‘best practice’ standards, to ensure and demonstrate the reliability, representativeness and quality of their data. The BEACH (Bettering the Evaluation and Care of Health) program is a continuous national study of general practice activity in Australia that began in April 1998.
Early health assessment of refugees
Jill Benson, Mitchell M Smith
This is the first in a series of articles looking at refugee health in Australian general practice. Each year approximately 13 000 refugees settle in Australia, mostly from countries with minimal public and personal health resources. They may present in a very different manner to the rest of the population and are at risk of unfamiliar and complex illnesses.
Evaluation of renal function - CARI guidelines
David W Johnson
The Caring for Australasians with Renal Impairment (CARI) guidelines initiative is an Australian and New Zealand project that aims to provide high quality, evidence based clinical practice guidelines for the management of all stages of kidney disease. This article summarises CARI guidelines on the Evaluation of renal function and is the first in a series of articles on aspects of assessment and management of patients with chronic kidney disease.
Monitoring kidney function in diabetes- Frequently asked questions
Patrick J Phillips, George Phillipov
If microalbuminuria is the earliest indicator of diabetic nephropathy why measure plasma creatinine?
High risk squamous cell carcinoma
Anthony Dixon
Case study: Mrs MA, 70 years of age, has a history of scalp psoriasis dating over 10 years. She explained that the rash was slowly progressing and had failed to respond to an array of topical treatments offered.
Pertussis in Australia today - A disease of adolescents and adults that can kill infants
Sanjaya Senanayake
Adolescents and adults are the main reservoir of pertussis infection in Australia today. Diagnosis in these age groups can be difficult because of atypical clinical presentations and limitations of laboratory investigations.
Counselling in graphics - Visual aids for distressed patients and their doctors
Anne Sved-Williams, Helen Roxburgh
Distressed patients present to their general practitioners with a range of information which may overwhelm both patient and doctor. This article provides visual aids which give structure to counselling sessions, providing a grounding for both patient and doctor. Case studies are presented that demosntrate the use of these aids in counselling sessions.
Why doctors should care about animal cruelty
Miranda Sherley
Animal cruelty is a significant problem for society, and there are good reasons why doctors should be particularly concerned by it. Increasing evidence for links between animal cruelty and child or spousal abuse is an area of growing concern internationally and of real importance to health professionals.
Clinical challenge
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue. Answers to this clinical challenge will be published next month, and are available immediately following successful completion online.
Risk management: what is it?
Sara Bird
Case histories are based on actual medical negligence claims or medicolegal referrals, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved.
Mandatory fortification with folic acid - What would Hippocrates say?
Mark Lawrence, Lynn Riddell
In October 2006, the Australian and New Zealand Food Regulation Ministerial Council asked for a review of the proposed food standard permitting mandatory fortification of bread with folic acid. This article contributes to the policy debate associated with the standard's review by discussing the potential benefits and risks to the target population and the wider Australian population with emphasis on recent (2006) literature.
Producing newsletters - Criteria for success
Sarah Louise Eckermann, Ellen McIntyre, Anne Magarey
Newsletters, while informal when compared to peer reviewed journals and organisational reports, are a popular communication tool used to provide and share information, for and about people with a common interest or need. Newsletters are an effective way to build networks and improve communication. As the editors of several newsletters in primary health care, the authors have developed criteria that aim to increase the success of a newsletter.
Information scanning for GPs
Anne Magarey, Ellen McIntyre
Information scanning is a very useful skill for general practitioners to have, whether the aim is to keep up-to-date for clinical reasons or to undertake research. It is both easy to learn and adaptable to your information needs. In this article we use a specific example to describe information scanning as GPs may use it, and then discuss the topic more broadly. We also provide some clues on keeping the information useful and manageable.
Quality improvement activities associated with organisational capacity in general practice
Cheryl Amoroso, Judy Proudfoot, Tanya Bubner, Edward Swan, Paola Espinel, Christopher Barton, Justin Beilby, Mark Harris
Clinical audit is recognised worldwide as a useful tool for quality improvement.
Do multidisciplinary care plans result in better care for patients with type 2 diabetes?
Nicholas A Zwar, Oshana Hermiz, Elizabeth J Comino, Timothy Shortus, Joan Burns, Mark Harris
Since the introduction of the Enhanced Primary Care package, care plans have become part of Australian general practice. Previous research has focused on barriers to the uptake of care plans. This study examined the effect of multidisciplinary care plans on provision and outcome of care for patients with type 2 diabetes.
Ezetimibe added to statin therapy (EASY study) - An evaluation by Australian general practitioners
Leon A Simons, Julie Symons
This study estimated changes in low density lipoprotein cholesterol (LDL-C) levels and proportion of patients attaining goal LDL-C <2.5 mmol/L when ezetimibe was added to existing statin monotherapy under Pharmaceutical Benefits Scheme (PBS) guidelines in a general practice setting.
Sex, pain and cranberries - Ideas from the 2006 Registrar Research Workshop
Brett D Montgomery, Erin McMeniman, Sara Kate Cameron, Tristram Duncan, Stuart Prosser, Ray Moore
The Registrar Research Workshop has been a feature of Australian general practice training since 1994. Twentyfive general practice registrars attend the annual 3 day event, which aims to develop registrars' understanding of the research process.
Health behaviours in survivors of childhood cancer
Marina Reeves, Elizabeth Eakin, Sheleigh Lawler, Wendy Demark-Wahnefried
Results from a Queensland study of childhood cancer survivors show that the majority are not meeting the national guidelines for fruit and vegetable intake or physical activity requirements and a significant proportion are overweight or obese. These survivors expressed strong interest in health promotion aimed at improving diet and physical activity.
