In rural settings, GPs play a dominant role in the management of T2DM, with over 2.9 million GP consultations per year related to diabetes in Australia . This increased demand on rural GPs is due to the limited access to specialist services, allied health professionals and other treatment facilities. In rural and remote towns, vast gaps exist between patient management and the targets defined in the guidelines for management of T2DM . Due to this variance, it is vital to examine the specific diabetic complications occurring among patients with T2DM in rural general practice, the current scope of care, management and decision making processes occurring among rural GPs . The management of T2DM is ever evolving and requires up-to-date knowledge particularly in rural areas where very little research and literature exists concerning current GP clinical efficacy .
This study showed that the Dutch version of the PACIC instrument had mixed measurement properties when applied for assessing diabetes care and COPD care in gen- eral practice in a rural setting. The five previously defined domains were confirmed and their internal consistency was good. The correlation with patient evaluations of gen- eral practice was positive, and diabetes patients reported higher presence of structured chronic care than COPD patients as expected. However, substantial numbers of patients did not provide answers to the PACIC questions, although they returned the questionnaires and completed other parts of the questionnaire reasonably well. Also, we found that a number of items might have floor or ceiling effects. A surprising finding was that better scores for chronic care were linked to lower patient reported enable- ment after the latest consultation in general practice. The mean scores on the PACIC domains and total instru- ment were similar to those found in diabetes patients in the USA , but higher than those found in patients with osteoarthritis in Germany . The PACIC scores for diabe- tes patients in The Netherlands may be explained by the
Unlike traditional teaching environments where a variety of clinical teachers contribute to teaching in any given subject, in this program a single general / family practi- tioner was given the onerous duty of providing the vast majority of the teaching. This was performed on a one to one basis in the context of isolated and usually very busy rural practice. Solo rural doctors could find the extra work associated with teaching to be unsustainable. However, unlike a traditional 4–6 week placement, the longitudinal nature of the program can deliver benefits to the practi- tioner's medical practice. Over time, the supervising GP develops a clear understanding of the strengths and weak- nesses of the student and is able to allocate tasks for the student to perform under supervision that while facilitat- ing learning are also service tasks. This can temper the workload of the supervisor, similar to the balance between service and teaching commonly seen in the post registration medical education environment.
Nevertheless, the results of our study showed that the SPEED tool has an excellent internal consistency in our setting with person reliability estimates ranging from 0.87 to 0.93, which are results similar to the value (0.9) reported by the original authors . More importantly, this study provides multiple sources of validity evidence for the SPEED tool, from exploratory factor analysis and from the many-facet Rasch model. Principal component analysis is not a formal structural model per se, and it does not contain error terms, so it is useful to index the variables but it cannot be used to gather validity evi- dence. Given that the participants in the study are regis- trars in a rural generalist-training program with a distributed model, the results showed that the SPEED is a tool for assessing the educational climate in a rural medical postgraduate GP training context with a high degree of validity and reliability.
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The Australian population is ageing, living longer and accessing a limited health care budget. Public hospitals are accommodating increasingly older patients with complex medical conditions. General practitioners can provide, to community-dwelling older clients, appropriate plans of care and interventions to prevent a range of negative health outcomes including hospitalization. General practitioners need appropriate tools to rapidly and accurately identify patients who can benefit from early identification and intervention. There many tools to identify or assess frailty in older people but no gold standard for use in primary care. The EFS is validated, requires no specialist geriatric training, simple to use and potentially more useful to GPs for identifying at risk older patients than the health assessments currently available. With this knowledge, the authors are piloting the introduction of the EFS in an Australian rural general practice.
Deakin University ’ s Rural Community Clinical School (RCCS) offers a 12 month comprehensive rural LIC program to 20 students in their penulti- mate year of Deakin ’ s ’ 4 year graduate entry medical degree . Following 2 years of pre-clinical training at a large regional campus, RCCS students are placed in groups of 2 – 4 students across nine rural sites (geographical classification ASGC RA 2–4)  in South West Victoria, where they are attached to a rural General Practice and its associated health ser- vice. In this primary care environment, students par- ticipate in all the core year three disciplines of medicine, surgery, musculoskeletal medicine, mental health, women ’ s and children ’ s health in a simultan- eous, integrated way [8, 11]. The General Practices in which RCCS students are placed also host a num- ber of vocational GP trainees for periods of 6–12 months.
A strength of this research is the high response rate and sample of allied health students from a broad range of disciplines contributing to the existing limited literature exploring allied health student placement experiences. The mixed methodology offers both a broad and in-depth insight into students ’ responses, allowing an exploration of their rural placement experiences and the in ﬂ uences of these experiences on their placement satisfaction and rural practice intentions. There are also some acknowl- edged limitations to this study. A stronger study design would be to compare change in rural practice intention with students who did not undertake a rural placement. The students who consented to participate in the study may be more likely to be favorable of rural practice. Students ’ intentions to practice rurally prior to and follow- ing placement were completed at the end of the placement relying on their perceptions of their intention prior to commencing the placement. Students ’ intentions and con- sideration for rural practice does not mean that they will enter the rural allied health workforce. However, the strength of the longitudinal nature of this allied health student follow-up study is enabling the researchers to track the students 1-, 3-, and 5-years post-graduation to determine their workforce outcomes.
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The sample size was calculated based on the prevalence of obesity in an earlier study done in Chennai among the general population, which was found to be 28.5%. 15 Based on this prevalence, using the formula 4PQ/L 2 , with 95% confidence limits and 13.5% relative precision, the sample size was calculated to be 542. Allowing 10% for refusals and attritions, the final sample size was calculated as 596, which were rounded off to 600. Systematic random sampling method was used to identify the sample population. The list of people in the village aged >20 years was obtained from the field staff of the RHTC. There were a total of 24498 adults in the area living in approximately 7329 households during the study period. The households were arranged in sequential order and sampling frame was prepared. The sampling interval was calculated by dividing the total number of households (7329) by the required sample size (600). The sampling interval obtained was 12. The first number was selected at random by lottery method as 4. From this number, every 12 th household was visited for data collection. All eligible adult residents from each house were taken for the study to get the required sample size of 600. If a house was found locked or eligible subject not available, the next house was visited.
new AF diagnoses, and to add extra leads for AF diagnostic workup. In some cases of paroxysmal AF, the 12-lead ECG may show sinus rhythm while the iECG showed AF. This will be obvious from a comparison of the p-waves on the lead I iECG and lead I of the 12-lead ECG, as well as the regularity of the rhythm. Following a 12-lead ECG, for patients with confirmed AF, GPs will be encouraged to use the EDS to Figure 3 entering an iECG result in TopBar AF app (test patient shown). AF, atrial fibrillation; GP, general practitioner.
articles as some reported more than one technique. There are differences between the journals. The BMJ shows a greater range and breadth of articles than Family Practice. More sophisticated techniques are reported more often in the BMJ than either of the other two journals. In the BMJ, the two most common statistical methods used were logistic regression (n = 14, 17.7%) and the Chi-squared test (n = 13, 16.5%). The two least common were the Mantel-Haenszel statistic (n = 1, 1.3%) and Cronbach's alpha (n = 1, 1.3%). Relatively new innovations such as random effects models were seen in both the BMJ and the BJGP. The least sophisticated statistical methods appeared in Family Practice. Methods based on likelihood ratios were seldom found in either the BMJ or BJGP and not at all in Family Practice. Nonparametric tests were often unspecified but where they were included Mann-Whitney U test, Spearman's correlation coefficient and the Wil- coxon matched-pairs signed ranks test. Multiple compari- sons included Bonferonni techniques and Scheffe's contrasts. Survival analysis included Kaplan-Meier curves and Cox regression.
that assumes GP work can be done by clinicians with far less training than a GP receives, our view is that these concerns can be addressed and we should welcome these newcomers warmly. We should support their development and supervision, in a way that ensures they can take some of the pressure off our working days, so that we can spend more time with patients who really need our levels of skill and expertise. This would also give us time to engage with the strategic development of our practices and services to communities, leading the delivery of primary care of the future. The College has consistently emphasised that the expansion of the wider practice team should complement, rather than replace, the expert skills of the GP and the drive to increase the GP workforce and that in order for successful integration to take place, appropriate arrangements for supervision, indemnity and regulation are required (RCGP 2018).
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General practitioners (GPs) are doctors that work in primary care. They treat common medical conditions and refer patients to hospital and other services for ur- gent and specialist treatment. In some parts of the UK there is a significant shortfall in the number of General Practitioners (GPs), and the age profiles of GPs are such that there is significant concern over the supply of ap- propriately trained GPs to fill future vacancies. Despite initiatives to increase the numbers of GP training oppor- tunities available, applications to GP training nationally continue to fall. Some parts of the UK particularly in the north of England, significantly struggle to recruit suffi- cient numbers of GP trainees . This chronic shortage of GPs has had a number of consequences for general practice, specifically the enhanced profile of the General Practice Nurse (GPN) . Central to this study, the GPN role has evolved and developed to address some of these workforce issues. In particular, chronic disease management and surveillance now comes under the aegis of the GPN .
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 G. Viegi, P. Paoletti, L. Carrozzi, M. Vellutini, E. Divig- giano, C. Di Pede, G. Pistelli, G. Giutini and M. D. Le- bowitzt, “Prevalence Rates of Respiratory Symptoms in Italian General Population Samples Exposed to Different Levels of Air Pollution,” Environmental Health Perspec- tives, Vol. 94, 1991, pp. 95-99. doi:10.2307/3431299  G. Viegi, M. Pedreschi, S. Baldacci, L. Chiaffi, F. Pistelli,
prescribing and the extent of therapeutic exchange between colleagues. McCarthy et al. (1992) found a significant positive correlation between the number of partners and number of different preparations prescribed, although they concluded that the larger drug repertoires used by larger practices were likely to increase the risk of side effects and interactions. Evidence that peer contact can influence attitudes to prescribing through group discussions of prescribing case studies was reported by Taylor (1979). This type of exchange may occur more frequently in partnerships however Soumerai and Avom (1987) found that size of practice was not a predictor of physician prescribing change as a result of an educational initiative. From the perspective of economic rather than educational initiatives, Bosanquet and Leese (1988) concluded that the size of partnerships was one factor associated with an ability to respond to economic incentives, with larger partnerships being more able in this respect than smaller ones.
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It is well established that maintenance on antipsychotic drugs will significantly reduce the relapse rate of schizophrenia (Davis et al. 1980) even if they do not substantially influence the natural life history of the disease (McGlashan, 1988) . Most general practitioners on account of their long term contact with patients with schizophrenia, are likely to be involved in the management of their maintenance medication. Long term maintenance with oral antipsychotic drugs is as effective as depot preparations in preventing relapse (Schooler et al, 1980) and thus intramuscular depot medication should only be considered if compliance is poor. Regular injections also provide the opportunity for monitoring of patients, whether this is carried out in hospital, primary care or the community. There is no unequivocal moment at which drug maintenance can be stopped; rather a sensible choice involving patients' views must be made. Unfortunately, relapse may occur even after many years and hence both patients and their carers should be instructed to keep a careful watch for warning signs of the illness.
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Data were collected from September 2003 to November 2004 and consisted of focus group interviews and quali- tative questionnaire responses. Four focus group inter- views with a total of 18 GP participants were conducted, and thematic saturation was achieved. Participants were purposively sampled through 3 urban divisions of general practice (geographically based organizational units in Australian general practice) to recruit male and female GPs, established doctors and those relatively new to general practice, and GPs practising within dif- ferent socioeconomic patient catchments. The focus groups were conducted by J.A. and P.M. and employed a modified grounded-theory approach, with discussions being informant-led as much as possible and themes being added or deleted as data collection progressed. We chose a grounded-theory approach to enable us to view “events, action, norms, values, etc. from the per- spective of the people who [were] being studied.” 15 In
location and work pattern. The configuration of health services affects access for citizens, and tradeoffs of geo- graphical factors against other measures of accessibility such as waiting times, costs and socio-economic factors are inevitable . Studies from the United States show that rural residents often incur long travel times to access health care [2,3] and may choose therefore to use local generalist services rather than travel to see a specialist . In Scotland, local health services in rural and remote areas have evolved in response to varied geography and to demographic, historical and societal events and trends. There is currently much debate about the most appropri- ate configuration of services, specifically the range of serv- ices to be offered and the skills required by healthcare workers to provide care at any particular level. For exam- ple, should family doctors (general practitioners) carry our minor surgical procedures if specialists are unavaila- ble locally, and if so, how should they be trained? Previ- ous studies of rural health in Scotland indicate that the pattern of services provided at remote and rural general practices differs from urban based practice, with higher consultation rates, differing nature of consultations, and a wider range of generalist services provided by individual practitioners . Rural practices often serve small popula- tions scattered over wider areas or more difficult terrain than their urban counterparts.
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This study explored the motivations and teaching prac- tices of rural GP supervisors of GP registrars. The use of semi-structured interviews, the maintenance of anonymity and the involvement of researchers from outside the gen- eral practice vocational training field (JF, VT, POM) has contributed to the veracity of the supervisors’ responses and their interpretation. As the study reports on GP su- pervisors working within one Regional Training Provider which has a rural footprint, the findings may not be trans- ferrable, particularly to urban supervisors. We have not in- vestigated the reasons why GPs choose not to become supervisors. In respect to supervisor teaching styles and activities, there was no observation of practice to confirm what supervisors report doing.
Fifty- ive percent of respondents initially worked in the country, whilst at the time of the survey 28% were employed there. Signi icantly more males commenced work in rural practice than did females, however, at the time of the survey there was no signi icant difference between the sexes. Eighty-one per cent of males and 84% of females who worked in rural practice at the time of the survey, began their career there (Table 4).
With the increasing feminisation of the medical work- force, currently sitting around 55% of medical students in Australia , the statistically significant negative association between female GPs and female specialists and take-up of rural practice, compared to their male peers, is a concern for future rural medical workforce supply . This does not appear to be related to differ- ences in rural background because it is seen that females compared to males have very similar crude asso- ciations between rural background and rural practice. However, females from both rural and urban back- grounds who practise as GPs or specialists are much less likely than males to practise in rural areas. Clearly there is scope to increase the rural workforce supply by increasing the take-up of rural practice by females to rates similar to those of males. However, this is unlikely unless expressed concerns of female doctors about diffi- culty in working part-time, on-call demands and more generally achieving a work-life balance are addressed [35,36].