General medicine

Objective: To evaluate the costs and health outcomes associated with primary care use by Indigenous people with diabetes in remote communities in the Northern Territory. Design, setting and participants: A population-based retrospective cohort study from 1 January 2002 to 31 December 2011 among Indigenous NT residents ≥ 15 years of age with diabetes who attended one of five hospitals or 54 remote clinics in the NT. Main outcome measures: Hospitalisations, potentially avoidable hospitalisations (PAH), mortality and years of life lost (YLL). Variables included disease stage (new, established or complicated cases) and primary care use (low, medium or high). Results: 14 184 patients were eligible for inclusion in the study. Compared with the low primary care use group, the medium-use group (patients who used primary care 2–11 times annually) had lower rates of hospitalisation, lower PAH, lower death rates and fewer YLL. Among complicated cases, this group showed a significantly lower mean annual hospitalisation rate (1.2 v 6.7 per person [P < 0.001]) and PAH rate (0.72 v 3.64 per person [P < 0.001]). Death rate and YLL were also significantly lower (1.25 v 3.77 per 100 population [P < 0.001] and 0.29 v 1.14 per person-year [P < 0.001], respectively). The cost of preventing one hospitalisation for diabetes was $248 for those in the medium-use group and $739 for those in the high-use group. This compares to $2915, the average cost of one hospitalisation. Conclusion: Improving access to primary care in remote communities for the management of diabetes results in net health benefits to patients and cost savings to government.

Susan L Thomas DrPH · Yuejen Zhao BM, MBiostat, PhD · Steven L Guthridge MB BS, MTH, FAFPHM · John Wakerman MB BS, MTH, FAFPHM

More patients are receiving treatment from a doctor or nurse within an appropriate time for the urgency category

Elizabeth Ingram

GPs are best placed to begin discussions about end-of-life care, and being well prepared is important

Liz Marles

Hand hygiene in public hospitals has improved, but remains suboptimal, especially before touching patients

Gwendolyn L Gilbert MD, FRACP, FRCPA

MSF reflects on the emergency medical response in the wake of a disaster

Daniel Martinez Garcia MD · Alexandra L Brown BA

The guidelines are not intended for bariatric surgeons and their teams

John McCallum

Reassessing the benefits, harms and risk levels of statin therapy

Ian R Hamilton-Craig PhD, FRACP, FCSANZ

Comparing data between centres and nationally is complex but necessary

Debra J Rickwood · Nic R Telford · Alexandra G Parker · Chris J Tanti · Patrick D McGorry

Although good for patient safety, introducing a short-stay unit did not increase overall bed capacity

Patrick T Russell MD, FRACP · Paul Hakendorf BSc, MPH · Campbell H Thompson MD, DPhil, FRACP

Clinical guidelines are ideally suited to electronic publication and updating

Richard I Lindley · Richard G Larkins · Erin Lalor

Over 40% of GPs would like to reduce their working hours, but only about a quarter of these have managed to do so

Richard Norman PhD · Jane P Hall BA, PhD

The advent of thrombolytic treatment has focused global research and public awareness on ischaemic events rather than other stroke subtypes

Linda J Nichols · Lindsay Smith · Penny L Allen

The key to accessible and comprehensive aged care is to base general practices in aged care facilities

Ian Maddocks

Why can television broadcast dubious scientific material without disclosing the experts’ conflicts of interest?

Daniel D L Bernal · Luke R E Bereznicki · Gregory M Peterson

Avoiding adverse outcomes through accurate and timely communication

Erica Y Tong BPharm(Hons), MClinPharm · Melanie Kowalski BPharm · Gary S Yip MB BS, FRACP · Michael J Dooley BPharm, GradDipHospPharm, PhD

For women getting breast implants in Australia or overseas, preoperative screening should be routine

Kathy L Flitcroft BBSc, MA, PhD · Andrew J Spillane MD, FRACS · Rebecca L Read MB BS, DPhil, FRACS

Simple strategies can be used to improve filter monitoring and removal

Nicholas I Brown · Reade Deleacy · Chloe Szikla · Ashu Jhamb

An improved capacity to retrieve relevant evidence helps support policy and practice

Jennifer J Tieman · Ruth M Sladek · Ellen McIntyre

We need a better understanding of the effects of policy levers on general practice before adjusting Medicare further

Michael J Taylor

If GPs offered chlamydia testing to all young adults, rates of diagnosis and treatment would be much higher

Anna H Yeung BSc(Hons), MPH · Meredith Temple-Smith BSc, MPH, DHSc · Christopher K Fairley MB BS, PhD · Alaina M Vaisey BSc, MPH · Rebecca Guy PhD · Matthew G Law MA, MSc, PhD · Nicola Low MD, FFPH, MSc · Amie L Bingham BA(Hons), BSc, MPH · Jane Gunn MB BS, PhD · John Kaldor PhD · Basil Donovan MD, FAFPHM, FAChSHM · Jane S Hocking MPH, MHSc(PHP), PhD

A mystery solved after 15 years of pain and swelling

Suran L Fernando · Jamma Li

To the Editor: I agree with Baum on the objective evidence of the good health of Australians and that there still is room for improvement in our primary health care system, but I think it is simplistic of her to characterise “fee-for-service general practice” as providing “episodic care”.1 The Royal Australian College of General Practitioners description of “person centred, continuing, comprehensive and coordinated wholeperson health ...

Mark R Nelson

In reply: Australian general practice generally provides good primary medical care. However, while Nelson says a significant amount of activity is disease prevention, the Bettering the Evaluation and Care of Health study indicates that, in terms of problems at general practitioner–patient encounters, prevention constitutes less than 9.1% of activity and, in terms of reasons for encounters, it constitutes less than 15.9%.1 The general practice model works ...

Fran E Baum

there is something comforting about sitting here with my hand on Robert’s breast he says, here, steady yourself against me here, he says, after a pause, he is thinking how best to fit me, he says it must have been bad but you’re here, you’re with us the surroundings burst with surgical fittings it all looks very Weimar, very neue Sach i expect fishnets, a crossed leg, a trail of ...

Lucy Dougan PhD