Research and Training.

The Discipline of General Practice is taking part in an after-hours medical care trial which is one of a series of national trials funded by the Commonwealth Department of Health and Aged Care. The national trials will explore different approaches to the provision of after-hours primary medical care by developing and testing different service delivery and funding arrangements. We at the Discipline of General Practice are acting as external evaluators for one such trial, The Central Sydney and Broken Hill After-Hours Primary Medical Care Trial. The sponsors for this trial include the Central Sydney Area Health Service, the Central Sydney and Canterbury Divisions of General Practice, the Far West Area Health Service and the Barrier Division of General Practice.

The Central Sydney/ Broken Hill trial consists of an umbrella telephone triage service, supported by a range of after-hours treatment and care options, including an after-hours GP service located within the Emergency Department at Canterbury Hospital, and the use of taxi vouchers as an alternative to ambulance travel. The Telephone Triage Service is available to residents of both Central Sydney and Broken Hill, and aims to provide a focus for referral and appropriate channelling of patients to the most appropriate care available for their needs and for advice and information to support consumer inquiries. The GP clinic provides access to a GP when such access is not usually available, and will also handle primary care type patients from lower triage categories normally seen in the ED. The Discipline of General Practice will be evaluating the trial in terms of health outcomes, patient and provider satisfaction, and a variety of process measures (such as numbers of patients/ callers, type of condition and so on). Some economic analysis will also be conducted.

For more information please contact Associate Professor Dimity Pond on 02 4924 6078 or Sarah Ball (project officer) on 02 4924 6076 or e-mail sarah.ball@newcastle.edu.au

BHP Health and Employment Project

The BHP Health and Employment Project commenced in October 1999. Initially funded under an RMC New Staff Grant from the University, the project received further funding under the General Practice Evaluation Program (CDHAC) to broaden the scope of the project. The aims of the project are to:

1. examine the physical and psychological effects of the closure of BHP on former employees and their families in quantitatively measurable terms in order to develop an aggregate picture of the health impacts involved
2. determine the extent to which an intervention program for general practitioners (GPs) impacts on GP knowledge, attitude and practice within the context of unemployment and redundancy

In relation to Aim 1, the experiences of former BHP employees and their families will be compared and contrasted to those presently working in a similar industry (OneSteel) within Newcastle. Participants in the study will be surveyed over three 6-monthly follow up periods following the closure to assess change over time.

In relation to Aim 2, training workshops providing GPs with Cognitive Behaviour Therapy skills and information about health effects of unemployment and the local community resources available will be implemented. Consultation audits will document the GP’s assessment and management of their patient’s health. The intervention will be assessed in terms of change in attitudes and practices of GPs.

Associate Professor Dimity Pond leads the research team. Dr Parker Magin, a local GP and member of the Disciplines academic staff and Elizabeth Harris, Deputy Director of the Centre for Health Equity Training Research and Evaluation in South West Sydney are co-investigators. For more information please phone Amber Sutton on 4924 6072 or e-mail at asutton@wallsend.newcastle.edu.au

Influence of Rural Exposure - Student Placement Experiences

Questionnaires received back from students who have completed their GP attachments or country term (as well as other placements) are entered into the computer and analysed. This feedback helps the organisers and administrators to make next years placements work even more efficiently so that the student’s feelings of satisfaction and success on the placements are increased. This is particularly important when a student is placed in a rural area, as this is often the first real exposure some students have had to rural life. It is hoped that this exposure is a positive one and will contribute significantly to the student returning to a rural area to practice. Such information provided by the student in these surveys is also required to submit a report to the RUSC committee who contribute significant funds to student placements. Eventually, all this information will be entered into a Rural Exposure Database. This will be maintained for long term evaluations and will keep track of where students practice when they graduate and if their placement experiences contributed in any significant way to these decisions.

The project specifically focuses on developing curriculum for teaching gender issues in medicine with an emphasis on rural medicine.

A mentor scheme is also being developed to assist young doctors in training and to help raise the profile of women in medicine.

It is hoped that more young doctors, especially females, will be attracted to work in rural areas. In order to achieve this goal, it is widely recognised that the style of medical practice and training will need to evolve to satisfy the needs of doctors in urban and rural communities.

Research capacity in General Practice

This new project is being funded by the DHAC to develop research capacity in general practice and in primary health care.

The project aims to involve more general practitioners and other primary health care workers in developing their own research and to work with primary health care organisations such as divisions of general practice to further develop their research and evaluation capacity.

This project is operating at a number of levels, and includes work being undertaken with 8 Divisions of General Practice, with other academics working in nursing and allied health disciplines and with individual GPs and groups of GPs.

A few examples of the work being undertaken as part of this project are

• Support for the development of a project on colonoscopy by a rural GP
• Provision of evaluation workshops for the staff of some of the divisions of general practice
• Support for the development of a system of clinical governance by a group of Newcastle GPs
• Collaboration with the Faculty of Nursing to develop research into work of practice nurses in general practice
• Support for divisions in developing the evaluation component of projects

The University of Newcastle has been working collaboratively with the Departments of General Practice at the Universities of Sydney and NSW, the University Department of Rural Health at Broken Hill, and the RACGP. Some of the state wide initiatives will include the development of a generic outline for Divisions Evaluation workshops, the Development of a statewide evaluation plan for the project, and a state wide conference during 2002.

The staff employed to work on the PHCRED project include:

Academic staff:

Dr Helen Tolhurst (0.4)— coordinator of project and responsible for North West Slopes, New England, Barwon and Hunter Rural Divisions of General Practice

Dr David Brookman (0.2)- responsible for development of IT initiatives, and responsible for Taree and Nelson Bay areas of Hunter Rural Division, and Port Macquarie and Mid North Coast Divisions of General Practice

Dr Parker Magin (0.2) —responsible for Hunter Urban Division and Central Coast Division of General Practice

Dr Nayan Shah (0.3)- responsible of the development of post graduate education

General staff:

Ms Susan Heaney- Project officer- responsible for a range of administrative aspects of the project.

It is anticipated that the range of activities undertaken, as part of this project will be extended as the project progresses.

This project is a national project, which has been commissioned by the General Practice Partnership Advisory Council, and funded by the DHAC.

The project aims to investigate the experiences of women working in rural practice and ways in which to support women in rural practice in order to better recruit and retain women in rural practice.

As part of the project 120 women have been interviewed nationally and the data is currently being analysed. In addition interviews have been conducted with representatives from a number of organisations which provide support for rural doctors.

The project has found that the women interviewed for the study indicated a need for policies, which recognise

• that the working lives of the majority of female rural GPs are interrupted by the birth and nurturing of young children
  
  
• that the working lives of the majority of female rural GPs are based on a real need to balance their family and general practice responsibilities
  
  
• their preference for working in a professional and social environment which values and supports the contribution which they make to the health care of their communities.
  
  
• Fair and flexible practice structures
  
  
• Clarity and fairness in employment conditions
  
  
• Improved remuneration for some types of work such as long consultations, and provision of mental health services
  
  
• Availability of child care for after hours work and the development of after hours safety provisions

The project is due to be completed in early July 2001.

For further information on the project contact either

Dr Helen Tolhurst Project director

Ms Noela Lippert Project officer

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21 June, 2001
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