Patient engagement and coaching for health: the PEACH study- a cluster randomised controlled trial using the telephone to coach people with type 2 diabetes to engage with their GPs to improve diabetes care: a study protocol.

Background
The PEACH study is based on an innovative 'telephone coaching' program that has been used effectively in a post cardiac event trial. This intervention will be tested in a General Practice setting in a pragmatic trial using existing Practice Nurses (PN) as coaches for people with type 2 diabetes (T2D). Actual clinical care often fails to achieve standards, that are based on evidence that self-management interventions (educational and psychological) and intensive pharmacotherapy improve diabetes control. Telephone coaching in our study focuses on both. This paper describes our study protocol, which aims to test whether goal focused telephone coaching in T2D can improve diabetes control and reduce the treatment gap between guideline based standards and actual clinical practice.
Methods/design
In a cluster randomised controlled trial, general practices employing Practice Nurses (PNs) are randomly allocated to an intervention or control group. We aim to recruit 546 patients with poorly controlled T2D (HbA1c >7.5%) from 42 General Practices that employ PNs in Melbourne, Australia. PNs from General Practices allocated to the intervention group will be trained in diabetes telephone coaching focusing on biochemical targets addressing both patient self-management and engaging patients to work with their General Practitioners (GPs) to intensify pharmacological treatment according to the study clinical protocol. Patients of intervention group practices will receive 8 telephone coaching sessions and one face-to-face coaching session from existing PNs over 18 months plus usual care and outcomes will be compared to the control group, who will only receive only usual care from their GPs. The primary outcome is HbA1c levels and secondary outcomes include cardiovascular disease risk factors, behavioral risk factors and process of care measures.
Discussion
Understanding how to achieve comprehensive treatment of T2D in a General Practice setting is the focus of the PEACH study. This study explores the potential role for PNs to help reduce the treatment and outcomes gap in people with T2D by using telephone coaching. The intervention, if found to be effective, has potential to be sustained and embedded within real world General Practice.

Guidelines for the management of postmenopausal osteoporosis for GPs

BACKGROUND : Since the last series of guidelines on the management of osteoporosis from Osteoporosis Australia was published in Australian Family Physician (October 2002), there have been further advances in our understanding of the treatment involved in both the prevention of bone loss and the management of established osteoporosis.

OBJECTIVE : This article provides updated guidelines for the management of postmenopausal osteoporosis to assist general practitioners identify those women at risk, and reviews current treatment strategies.

DISCUSSION : Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonatesr raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone therapy has mixed risks and benefits that requires individual patient counselling.

Climate change and human health: what can GPs do?

In recent months articles in the most respected peer reviewed medical journals in Australia, the USA and Britain have called for urgent action to reduce climate change.1–4 The chief scientist of the United Kingdom has described climate change as ‘the most severe problem that we are facing today – more serious even than the threat of terrorism’.5 Yet, many of you will wonder if this is really such an urgent issue, and – even if it is – what on earth has it got to do with general practice?

Foraging behaviour and habitat utilisation of Australasian gannets determined using GPS loggers

Australasian gannets (Morus serrator) breed in the cool temperate waters of south-eastern Australia and also at several localities around New Zealand, where they are a major marine predator feeding on commercially-exploited pelagic fish. This study investigated the foraging behaviour and habitat utilization of gannets at Pope’s Eye Marine Reserve during the 2005-2005 breeding period using GPS-depth-loggers. GPS data were recorded for a total of 45 foraging trips from 20 individuals. Gannets were found to forage at average maximum distances of 52.7 km (± 29.6 km) from the colony, with total foraging path lengths of 177.1 km (± 93.4 km) and foraging trip durations of 16.5 h (± 9.9 h). During foraging trips gannets spent on average 31.5% (± 11.4) of the time flying at an average flight speed of 47.3 km h-1 (± 2.9 km h-1). Gannets made an average of 39.8 (± 35.2) dives per trip and 3.8 (± 5.6) dives per daylight hour. Dives had an average depth of 3.5 m (± 1.1 m) and a mean maximum depth of 7.0 m (± 3.0 m), lasting for a mean dive duration of 5.3 sec (± 1.3 sec). Gannets foraged predominantly in shallow coastal waters and there was some evidence for foraging site fidelity. Considerable individual variation in foraging strategies was also observed. The results highlight the potential of GPS technology to reveal the fine-scale foraging behaviour of marine predators, thereby improving our understanding the interaction between marine predator populations, commercially exploited fish stocks and the marine environment.

Case studies of change : addressing family support needs of rural GPs

The National Rural Faculty of The Royal Australian College of General Practitioners received commonwealth funding between 2000–2002 to develop a rural medical family support project. There were three elements to this project:

* a counselling and communication skills or ‘mentoring’ workshop for rural GP spouses in each state
* the development of a resource kit of existing rural medical family support strategies, and
* the piloting of a range of strategies designed to address family support needs in collaboration with rural GPs, registrars and their families.

This article focusses on the last of these three elements.

Do GPs use electronic mental health resources? A qualitative study

BACKGROUND
The Better Outcomes in Mental Health Care (BOMHC) initiative encourages general practitioners to use electronic mental health resources (EMHRs) during consultation with patients requiring psychological assistance. However, there is little data on GPs’ acceptance and use of EMHRs.

METHOD
Semistructured interviews were conducted with 27 GPs to determine their attitude toward EMHRs, and their use during consultation with patients.

RESULTS
Few GPs reported frequently using EMHRs in consultation. Identified barriers to use included lack of familiarity with information technology, and insufficient knowledge of available resources. Identified advantages of electronic resources included high patient acceptance, time efficiency, and improved quality of information.

DISCUSSION
General practitioners recognise several advantages of utilising electronic resources for managing patients with mental illness. However, GPs are not sufficiently familiar with electronic resources to use them effectively. This could be overcome by education.

Accuracy of ARGOS locations of pinnipeds at-sea estimated using Fastloc GPS

Background: ARGOS satellite telemetry is one of the most widely used methods to track the movements of free-ranging marine and terrestrial animals and is fundamental to studies of foraging ecology, migratory behavior and habitat-use. ARGOS location estimates do not include complete error estimations, and for many marine organisms, the most commonly acquired locations (Location Class 0, A, B, or Z) are provided with no declared error estimate.
Methodology/Principal Findings: We compared the accuracy of ARGOS locations to those obtained using Fastloc GPS from the same electronic tags on five species of pinnipeds: 9 California sea lions (Zalophus californianus), 4 Galapagos sea lions (Zalophus wollebaeki), 6 Cape fur seals (Arctocephalus pusillus pusillus), 3 Australian fur seals (A. p. doriferus) and 5 northern elephant seals (Mirounga angustirostris). These species encompass a range of marine habitats (highly pelagic vs coastal), diving behaviors (mean dive durations 2–21 min) and range of latitudes (equator to temperate). A total of 7,318 ARGOS positions and 27,046 GPS positions were collected. Of these, 1,105 ARGOS positions were obtained within five minutes of a GPS position and were used for comparison. The 68^th percentile ARGOS location errors as measured in this study were LC-3
0.49 km, LC-2 1.01 km, LC-1 1.20 km, LC-0 4.18 km, LC-A 6.19 km, LC-B 10.28 km.
Conclusions/Significance: The ARGOS errors measured here are greater than those provided by ARGOS, but within the range of other studies. The error was non-normally distributed with each LC highly right-skewed. Locations of species that make short duration dives and spend extended periods on the surface (sea lions and fur seals) had less error than species like elephant seals that spend more time underwater and have shorter surface intervals. Supplemental data (S1) are provided allowing the creation of density distributions that can be used in a variety of filtering algorithms to improve the quality of ARGOS tracking data.

Combination antidepressants : use by GPs and psychiatrists

Background : Current treatment of depression fails to achieve remission in 50% of patients. Combinations of two antidepressants are used by some Australian psychiatrists.

Objective : This article investigates the pros and cons of combination antidepressant therapy and provides suggestions for when to consider their use, which combinations to choose, and how to introduce combination antidepressant therapies.

Discussion : Combining two antidepressants is a controversial strategy, with supporters and critics arguing its efficacy and safety from opposing perspectives. The use of combination antidepressant therapies may facilitate remission from depression. However, there is limited evidence supporting these treatments, and safety concerns are often cited. There is some support for combination therapies in selected cases from international bodies. After considering risks and benefits on a case-by-case basis, careful use of selected combination antidepressant therapy may be one of a range of effective treatments for some individuals suffering from depression.

The place of information and communication technology-mediated consultations in primary care : GPs' perspectives

Background: New information and communication technologies such as email and text messaging have been shown to be useful in some aspects of primary care service delivery. Little is known about Scottish GPs’ attitudes towards the adoption of these technologies as routine consultation tools.

Objectives: To explore GPs’ perceptions of the potential place of new non-face-to-face consultation technologies in the routine delivery of primary care; to explore GPs’ perceived barriers to the introduction of these technologies and to identify the processes by which GPs feel that new consultation technologies could be incorporated into routine primary care.

Methods: Qualitative interview study: 20 in-depth semi-structured interviews carried out with maximum variation sample of GPs across Scotland.

Results: Whilst the face-to-face consultation was seen as central to much of the clinical and diagnostic work of primary care, many GPs were conditionally willing to consider using new technologies in the future, particularly to carry out administrative or less complex tasks and therefore maximize practice efficiency and patient convenience. Key considerations were access to appropriate training, IT support and medico-legal guidance.

Conclusions: GPs are conditionally willing to use new consultation media if clinically appropriate and if medico-legal and technical support is available.