Royal New Zealand College of General Practitioners

The Australian Journal of General Practice (AJGP) aims to provide relevant, evidence-based, clearly articulated information to Australian general practitioners (GPs) to assist them in providing the highest quality patient care

Intrauterine contraceptive device (IUCD) insertion is a reversible and effective way to reduce unplanned pregnancy. Doctors play a key role in IUCD usage. This study aimed to assess knowledge, views, practice and self-efficacy regarding copper IUCD usage among public primary care doctors in Sarawak. A cross-sectional study was conducted in all public primary care clinics in Sarawak. A selfadministered online survey form was distributed to doctors in the eligible clinics. A total of 312 doctors participated in the survey. Most of them (81.4%) worked in a clinic where IUCDs were available. The median knowledge score among the medical officers was 15 (maximum score: 20). The knowledge score was correlated with the length of primary care experience and was higher among the doctors who had prior IUCD training and ever had inserted IUCDs. The doctors were concerned about the side effects of IUCDs, especially perforation and pelvic inflammatory diseases, and were negatively influenced by the additional counselling time required when recommending IUCDs. They recognised IUCD usage as a long-term and reversible contraception method. Most (69.2%) doctors had inserted IUCDs before, but only 45.9% had inserted five or more IUCDs. The self-efficacy of the doctors regarding IUCD insertion was moderate (63% of the total score). The knowledge and self-efficacy of the public primary care doctors in Sarawak were moderate. Although IUCDs were widely available, the number of IUCD insertions was relatively small. Further research is warranted to quantify IUCD usage and identify its barriers among nurses and patients.

Background: Trainees of specialist medical colleges commonly experience sub-optimal achievement on final summative examinations. Objective: To explore experiences of trainees sitting the Royal Australian and New Zealand College of Ophthalmologists Advanced Clinical Examination (RACE), and their supervising Fellows, to identify reasons for failure. Methods: Mixed methods study involving trainee post-RACE feedback surveys 2013-2021 (written n=317, clinical n=418), and semi-structured interviews with trainees (n=19) who sat RACE 2017-2021, and supervising ophthalmologists (n=10). Results: Four meta-themes were identified: 1) Examination difficulty: “Oh, I read that paper, it’s … so hard”, related to the perception that some examinations were disproportionally challenging; 2) Ambiguous questions: “I don’t know what you guys are asking me”, encompassed concerns about understanding the content and volume of information required; 3) Not fit for purpose: “The majority of competent general ophthalmologists, they would not pass”, captured perceptions that some examinations reflected subspecialty rather than generalist knowledge; and 4) Time pressure: “It is so time pressured”. Conclusion: Enhanced mechanisms are required to improve examination reliability, so as not to unfairly compromise the achievement of specific cohorts of trainees. Valid and defensible score adjustment processes are needed to account for variability in examination design and difficulty across semesters.

Melasma, a condition characterised by hyperpigmented patches on the face, is one of the common skin conditions in women seeking treatment from primary care practitioners (PCPs). Several treatment modalities are available for PCPs as well as dermatologists. Each treatment option has its pros and cons, including accessibility and cost. This article aims to explore and address the treatment options that PCPs can offer for melasma. This article outlines how to offer treatment from the PCP's perspective conveniently and cost-effectively. Combined topical treatment seems to be the first-line form that PCPs can offer and manage in the general practice setting. Of the various treatments available, the triple combination of topical hydroquinone with retinoid and corticosteroid is widely described in the literature.

While evidence can help inform best practice, it needs to be placed in context.There may be no evidence available or applicable for a specific patient with his or her own set of conditions, capabilities, beliefs, expectations and social circumstances.There are areas of uncertainty, ethics and aspects of care for which there is no one right answer.General practice is an art as well as a science.Quality of care also lies with the nature of the clinical relationship, with communication and with truly informed decision-making.The BACK TO BACK section stimulates debate, with professionals presenting their opposing views regarding a clinical, ethical or political issue.

Introduction: Tumor necrosis factor α-inhibitors (TNF-α-inhibitors) are biological disease-modifying anti-rheumatic drugs (bDMARD’s) that are used in the treatment of different immune mediated inflammatory diseases (IMIDs) (eg. rheumatoid arthritis, psoriasis, Crohn’s disease…). TNF-inhibitors are generally well tolerated and safe, but some major challenges remain in the management of TNF-inhibitors. First of all, only specific specialists (rheumatologist, dermatologist, ophthalmologist, gastro-enterologist) can prescribe these drugs. This implicates that GP’s often are not aware that patients use these drugs. Secondly, patients on TNF-therapy are more susceptible to opportunistic infections (eg influenza of bacterial infection). Recognizing symptoms to refer to the GP is essential and vaccination is highly recommended. Lastly, drug adherence is too low, which impacts the disease activity and clinical outcome. Policy Context And Objective: In 2018, the Royal Association of Pharmacists in Antwerpen (KAVA) and Domus Medica have developed a quality improving program (QIP) in the context of Medical-Pharmaceutical Concertation (MPC). MPC is an initiative from the NIDHI in Belgium to promote the rational prescribing and dispensing of medication and the safe use of medication in general. The NIHDI provides financial incentives to general practitioners (GP) and community pharmacists (CP) to organize local MPC-projects, based on a QIP. A local MPC-project starts with a ‘kick-off meeting’, to make agreements of the rational use of medication. Most of the time, different cases are discussed in small interprofessional groups. After this meeting, the agreements are subsequently implemented into practice and can be evaluated with quality indicators. This specific QIP focusses on four challenges: (1) to improve the influenza vaccination coverage in this group of patients, (2) to stimulate the communication between GP and CP, (3) to educate GP, CP and patients about the alarm symptoms of infections and (4) to improve patient adherence. Target Population: MPC targets the general practitioner and community pharmacist with mutual patients on TNF-therapy. Highlights: The Royal Association of Pharmacists in Antwerpen (KAVA) and the GP organization Domus Medica strongly believe in this initiative. Currently 13 local MPC-projects have been organized in which 68 CP and 118 GP participated. The three most important conclusions of these MPC-projects are; •GPs want to know which patients are on TNF-therapy, the CP can play an active role in the identification of these patients in the GP practice; •The influenza vaccination coverage is unknown in the pharmacy and GP practice. This will be checked after the MPC. Advocating and sensitization campaigns are useful and will he implemented and evaluated afterwards; •Referring to GP in case of alarm symptoms is necessary and should be done sooner. Conclusion: MPC is an initiative from the NIDHI in Belgium to promote the rational prescribing and dispensing of medication and the safe use of medication in general. KAVA and Domus Medica have developed a quality improving program, specifically targeted on TNF-inhibitors. Currently, 13 local MPC-projects have been organized. Further research is necessary to analyze the impact of the MPC-project.

The Wellington Lifelines Group (WeLG) is comprised of the lifeline utilities serving the Wellington region of New Zealand. They share a collective understanding that Wellington’s infrastructure is vulnerable to natural hazards, which was gained from previous studies based on a variety of modelling and expert opinion approaches. These initial studies provided a foundation for deeper analysis to be undertaken around the vulnerability of the region’s infrastructure to earthquakes. The focus was on the likely damage states, interdependencies, and direct and wider economic consequences of a potential major earthquake in the region. The in-depth study used computer modelling and focused stakeholder engagement to quantify the improved resilience and economic benefit of the construction of a package of infrastructure upgrades. The study informs consideration of the mitigations that could be applied to address the core issues—short-term (emergency planning works), medium term (policy change at central government level), and long-term (the potential construction of new, resilient, infrastructure). This paper outlines this WeLG project, including the objectives, process, and intended outcomes.