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Specificity of early-career general practitioners’problem formulations in patients presenting with dizziness:a cross-sectional analysis

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Family Medicine and Community Health 2021年第4期9卷 10-19,I0001,I0002页

作者： Jocelyn Ledger Amanda Tapley Christopher Levi Andrew Davey Mieke van Driel Elizabeth G Holliday Jean Ball alison fielding Neil Spike Kristen FitzGerald Parker Magin The University of Newcastle School of Medicine and Public Health CallaghanNew South WalesAustralia NSW&ACT Research and Evaluation Unit GP SynergyRegional Training OrganisationNewcastleNew South WalesAustralia The Sydney Partnership for Health EducationResearch and Enterprise(SPHERE)SydneyNew South WalesAustralia Department of Neurology John Hunter HospitalNewcastleNew South WalesAustralia Primary Care Clinical Unit The University of Queensland Faculty of MedicineBrisbaneQueenslandAustralia Clinical Research Design and Statistical Support Unit(CReDITSS) The University of Newcastle Hunter Medical Research InstituteNew LambtonNew South WalesAustralia Eastern Victoria General Practice Training Regional Training OrganisationHawthornVictoriaAustralia Department of General Practice and Primary Health Care The University of MelbourneMelbourneVictoriaAustralia General Practice Training Tasmania Regional Training OrganisationHobartTasmaniaAustralia University of Tasmania School of Medicine HobartTasmaniaAustralia

Objectives Dizziness is a common and challenging clinical presentation in general *** to determine specific aetiologies can lead to significant morbidity and *** aimed to establish frequency and associations of general practitioner(GP)trainees’(registrars’)specific vertigo provisional diagnoses and their non-specific symptomatic problem *** A cross-sectional analysis of Registrar Clinical Encounters in Training(ReCEnT)cohort study data between 2010 and *** is an ongoing,prospective cohort study of registrars in general practice training in *** collection occurs once every 6 months midtraining term(for three terms)and entails recording details of 60 consecutive clinical consultations on hardcopy case report *** outcome factor was whether dizziness-related or vertigo-related presentations resulted in a specific vertigo provisional diagnosis versus a non-specific symptomatic problem *** with patient,practice,registrar and consultation independent variables were assessed by univariate and multivariable logistic *** Australian general practice training *** training is regionalised and delivered by regional training providers(RTPs)(2010-2015)and regional training organisations(RTOs)(2016-2018)across Australia(from five states and one territory).Participants All general practice registrars enrolled with participating RTPs or RTOs undertaking GP training *** 2333 registrars(96%response rate)recorded 1734 new problems related to dizziness or *** these,546(31.5%)involved a specific vertigo diagnosis and 1188(68.5%)a non-specific symptom *** associated with a non-specific symptom diagnosis on multivariable analysis were lower socioeconomic status of the practice location(OR 0.94 for each decile of disadvantage,95%CIs 0.90 to 0.98)and longer consultation duration(OR 1.02,95%CIs 1.00 to 1.04).A specific vertigo diagnosis was associated wit

关键词： diagnosis formulation sectional

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Absolute cardiovascular risk assessment by Australian early-career general practitioners: a cross-sectional study

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Family Medicine and Community Health 2023年第3期11卷 45-61页

作者： Toby Morgan Anna Ralston Andrew Davey Elizabeth G Holliday Mark Nelson alison fielding Mieke van Driel Amanda Tapley Dominica Moad Jean Ball Jennifer Presser Neil Spike Parker Magin School of Population Health University of New South Wales Faculty of MedicineKensingtonNew South WalesAustralia NSW&ACT Research and Evaluation Unit GP Synergy Ltd-NewcastleMayfield WestNew South WalesAustralia School of Medicine and Public Health The University of NewcastleCallaghanNew South WalesAustralia University of Tasmania Menzies Institute for Medical Research HobartTasmaniaAustralia University of Tasmania School of Medicine HobartTasmaniaAustralia General Practice Clinical Unit The University of Queensland Faculty of MedicineBrisbaneQueenslandAustralia Clinical Research Design and Statistical Support Unit(CReDITSS) The University of Newcastle Hunter Medical Research InstituteNew LambtonNew South WalesAustralia Department of General Practice and Primary Health Care The University of MelbourneCarltonVictoriaAustralia Monash University Faculty of Medicine Nursing and Health Sciences ClaytonVictoriaAustralia

Objective To determine the prevalence and associations of general practice registrars’performing absolute cardio-vascular risk(ACVR)assessment(ACVRa).Design A cross-sectional study employing data(2017–2018)from the Registrar Clinical Encounters in Training project,an ongoing inception cohort study of Australian GP *** outcome measure was whether an ACVRa was *** employed univariable and multivariable *** was conducted for all patient problems/diagnoses,then for an‘at-risk’population(specific problems/diagnoses for which ACVRa is indicated).Setting Three GP regional training organisations(RTOs)across three Australian *** GP registrars training within participating *** 1003 registrars(response rate 96.8%)recorded details of 69105 problems either with Aboriginal and/or Torres Strait patients aged 35 years and older or with non-Indigenous patients aged 45 years and *** these problems/diagnoses,1721(2.5%(95%CI 2.4%to 2.6%))involved an *** ACVRa was‘plausibly indicated’in 10384 problems/*** these,1228(11.8%(95%CI 11.2%to 12.4%))involved ***‘all problems/diagnoses’,on multivariable analysis female gender was associated with reduced odds of ACVRa(OR 0.61(95%CI 0.54 to 0.68)).There was some evidence for Aboriginal and/or Torres Strait Islander people being more likely to receive ACVRa(OR 1.40(95%CI 0.94 to 2.08),p=0.10).There were associations with variables related to continuity of care,with reduced odds of ACVRa:if the patient was new to the registrar(OR 0.65(95%CI 0.57 to 0.75)),new to the practice(OR 0.24(95%CI 0.15 to 0.38))or the problem was new(OR 0.68(95%CI 0.59 to 0.78));and increased odds if personal follow-up was organised(OR 1.43(95%CI 1.24 to 1.66)).For‘ACVRa indicated’problems/diagnoses,findings were similar to those for‘all problems/diagnoses’.Association with Aboriginal and/or Torres Strait Islander status,however,was significant at p<0.05(OR 1.60(95%CI 1.04 to 2.46))a

关键词： sectional continuity Island

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