Collaborative care : the role of practice nurses

Background
Comorbid depression can occur with diabetes and heart disease. This article reports on a feasibility study focusing on additional roles for practice nurses in detecting and monitoring depression with other chronic diseases.
Method
A convenience sample of six practices in southeast Australia was identified. Practice nurses received training via a workshop, which included training in the use of the Patient Health Questionnaire, to detect depression.
Results
The 332 patients who participated in the project each received a comprehensive health summary to assist with self management. Depression was identified in 34% of patients in this convenience sample. After 18 months implementation, practice nurses were strongly in favour of continuing the model of care. General
practitioners gave highly favourable ratings for effectiveness and willingness to continue this model of care.
Discussion
Practice nurses can include depression monitoring alongside systematic care of diabetes and heart disease. A randomised trial is currently underway to compare the clinical outcomes of this model with usual care.

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.

Vertebroplasty : letter to the editor

In separate letters the authors debate whether the promotion of vertebroplasty in routine care is both premature and potentially dangerous as there are no completed RCTs.

Rural smokers : a prevention opportunity

Background: Smoking is the largest single cause of preventable death and disease in Australia. This study describes smoking prevalence and the characteristics of rural smokers to guide general practitioners in targeting particular groups.

Methods: Cross sectional surveys in the Greater Green Triangle region of southeast Australia using a random population sample (n=1563, participation rate 48.7%) aged 25–74 years. Smoking information was assessed by a self administered questionnaire.

Results: Complete smoking data were available for 1494 participants. Overall age adjusted current smoking prevalence was 14.9% (95% CI: 13.1–16.7). In both genders, current smoking prevalence decreased with age. Those aged 25–44 years were more likely to want to stop smoking and to have attempted cessation, but less likely to have received cessation advice than older smokers.

Discussion: This study provides baseline smoking data for rural health monitoring and identifies intervention opportunities. General practice is suited to implement interventions for smoking prevention and cessation at every patient encounter, particularly in younger individuals.

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.

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.

What are the special needs of chronically ill young people?

Although significant advances have been made in the treatment of serious disease, there remains much scope for assisting young people in adjusting to life with a chronic medical condition. Commonly, chronically ill young people experience lower emotional well being than their healthy peers. Conventional approaches to promoting emotional well being have involved referring young people and their families to an appropriate public mental health service or psychologist/psychiatrist in private practice. However, there is increasing interest in the use of peer support programs. Support groups such as the ChIPS program aim to promote positive adjustment to chronic illness by bring together young people facing similar circumstances. It is maintained that by increasing connections between chronically ill young people, emotional well being can be enhanced.

Vitamin D and the musculoskeletal health of older adults

The scientific literature related to vitamin D and bone health in older adults is extensive.

This article aims to summarise key practice points regarding vitamin D and bone health in older adults, relevant to general practitioners, and to provide an overview of the background literature to enable GPs to appreciate the extent of the supporting evidence.

Vitamin D supplementation can prevent falls, particularly in the vitamin D deficient elderly. However, adequate vitamin D levels and dietary calcium intake are needed for effective primary fracture prevention with greatest benefits occurring in the elderly with vitamin D deficiency and/or low dietary calcium intakes. For secondary fracture prevention, ie. preventing further fractures in the elderly who have already sustained a fragility fracture, specific anti-osteoporosis treatment is necessary. However, to maximise the benefits of these medications, vitamin D deficiency should be corrected and adequate dietary calcium consumed.

Facilitating best practice : transferring the lessons of the Clinical Support Systems program

The Clinical Support Systems Program (CSSP) includes the management of clinical practice using clinical and consumer pathways, outcome and performance indicators, clinical measurement and review in a continuous improvement cycle using the best available extant evidence. The Royal Australasian College of Physicians is testing the CSSP model through four consortia around Australia. There are 17 project sites in three States. The funded projects address major clinical problems including congestive heart failure and acute coronary syndromes, acute stroke management, and colorectal cancer care. There is some early evidence of the CSSP influencing change in areas beyond the bounds of the project settings and the College has developed a plan to promote wider adoption of best practice. This approach recognises the College’s role in providing Fellows with the practical tools of quality improvement, the means to collect data and compare their practice to other clinicians, while traversing the appropriate educational framework.