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Biomedical subjects

Chris Del Mar

Publications and source records attributed to Chris Del Mar.

10 recordsLinked to original sources
PubMed2003

Computerisation in Australian general practice.

AIM: To assess the current levels of computer use in Australian general practice, and identify clinical and administrative tasks for which computers are most commonly used by general practitioners. METHODS: A telephone survey of a nationally representative sample of Australian GPs in active practice (n = 1202). RESULTS: The national response rate was 55.5%, with New South Wales, Tasmania and the Australian Capitol Territory recording lower than national rates, and Queensland, Western Australia and the Northern Territory recording higher rates. Australian general practices were highly computerised (86%). General practitioners practising in capital cities were less likely to be computerised than their rural colleagues (p < .001). There were no significant differences in general computerisation among practices in the Australian states and territories (p > .05). Three task sets for which computers were used were identified: general administrative functions, patient oriented administrative functions and clinical functions. Computers were more likely to be used for administrative than clinical tasks. Use for administrative tasks increased with the size of the practice (p < .001) and with years of computer use (p < .001). DISCUSSION: The results suggest that within two years 95% of Australian general practices will be computerised. While use of computers for clinical functions is less common than for administrative purposes, electronic script writing packages are widely employed. However, other theoretically valuable functions for improving clinical outcomes for patients, such as patient educational material and decision support systems, are the least commonly used.

Australia↗
PubMed2002

Dissemination of an efficacious antenatal smoking cessation program in public hospitals in Australia: a randomized controlled trial.

This study investigated the impact of a behaviorally based intervention designed to increase the number of hospitals that routinely provide effective smoking cessation programs for pregnant women. In Queensland, Australia, 70 publicly funded hospitals were matched on numbers of births and maternal socioeconomic status and randomly allocated to an awareness-only intervention group or a behaviorally based intervention group. Success was defined as the routine offer of an evidence-based smoking cessation program to at least 80% of the pregnant clients who smoke. At 1 month, 65% of the behaviorally based intervention hospitals agreed to provide materials about smoking cessation programs for their antenatal patients, compared with 3% of the awareness-only hospitals. After 1 year, 43% of the intervention hospitals still provided the material, compared with 9% of the awareness-only hospitals. These findings show that a brief intervention to hospitals can encourage antenatal staff to provide smoking cessation materials to pregnant women.

Awareness↗
PubMed2002

A child with earache. Are antibiotics the best treatment?

BACKGROUND: Conventional management of acute otitis media, deduced from pathophysiology, embodies scant regard to analgesia, but concentrates on the microbiological cure by the use of antibiotics. OBJECTIVE: A commonly encountered case of uncomplicated acute otitis media in a child of three is presented. An evidence based approach to management is offered. RESULTS: The search for empirical evidence of patient relevant benefits and harms challenges the conventional approach. A Cochrane review of the literature on the use of antibiotics for acute otitis media shows that the benefits of antibiotic use (reduced pain in those children who go on to suffer pain beyond 24 hours) are offset by adverse events from the antibiotics themselves (gastrointestinal symptoms and rashes). There is insufficient information to be sure about rare complications of not using antibiotics as well using them, but it seems that in either case, catastrophe is very rare. DISCUSSION: Thinking in terms of a balance of harms and benefits would result in a decreased proportion of children prescribed antibiotics for acute otitis media.

Anti-Bacterial Agents↗
PubMed2002

Does primary medical practitioner involvement with a specialist team improve patient outcomes? A systematic review.

Patients with chronic or complex medical or psychiatric conditions are treated by many practioners, including general practitioners (GPs). Formal liaison between primary and specialist is often assumed to offer benefits to patients. The aim of this study was to assess the efficacy of formal liaison of GPs with specialist service providers on patient health outcomes, by conducting a systematic review of the published literature in MEDLINE, EMBASE, PsychINFO, CINAHL and Cochrane Library databases using the following search terms: 'family physician': synonyms of 'patient care planning', 'patient discharge' and 'patient care team'; and synonyms of 'randomised controlled trials'. Seven studies were identified, involving 963 subjects and 899 controls. Most health outcomes were unchanged, although some physical and functional health outcomes were improved by formal liaison between GPs and specialist services, particularly among chronic mental illness patients. Some health outcomes worsened during the intervention. Patient retention rates within treatment programmes improved with GP involvement, as did patient satisfaction. Doctor (GP and specialist) behaviour changed with reports of more rational use of resources and diagnostic tests, improved clinical skills, more frequent use of appropriate treatment strategies, and more frequent clinical behaviours designed to detect disease complications. Cost effectiveness could not be determined. In conclusion, formal liaison between GPs and specialist services leaves most physical health outcomes unchanged, but improves functional outcomes in chronically mentally ill patients. It may confer modest long-term health benefits through improvements in patient concordance with treatment programmes and more effective clinical practice.

Cooperative Behavior↗