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Safety and acceptability of practice-nurse-managed care of depression in patients with diabetes or heart disease in the Australian TrueBlue study

2013-05-29T17:30:19Z

Title: Safety and acceptability of practice-nurse-managed care of depression in patients with diabetes or heart disease in the Australian TrueBlue study Authors: Schlicht, Kate; Morgan, Mark Andrew; Fuller, Jeffrey; Coates, Michael; Dunbar, James Anthony Abstract: Objectives To determine the safety and acceptability of the TrueBlue model of nurse-managed care in the primary healthcare setting. Design A mixed methods study involving clinical record audit, focus groups and nurse interviews as a companion study investigating the processes used in the TrueBlue randomised trial. Setting Australian general practices involved in the TrueBlue trial. Participants Five practice nurses and five general practitioners (GPs) who had experienced nurse-managed care planning following the TrueBlue model of collaborative care. Intervention The practice nurse acted as case manager, providing screening and protocol-management of depression and diabetes, coronary heart disease or both. Primary outcome measures Proportion of patients provided with stepped care when needed, identification and response to suicide risk and acceptability of the model to practice nurses and GPs. Results Almost half the patients received stepped care when indicated. All patients who indicated suicidal ideations were identified and action taken. Practice nurses and GPs acknowledged the advantages of the TrueBlue care-plan template and protocol-driven care, and the importance of peer support for the nurse in their enhanced role. Conclusions Practice nurses were able to identify, assess and manage mental-health risk in patients with diabetes or heart disease.

The association of levels of physical activity with metabolic syndrome in rural Australian adults

2013-05-13T02:09:09Z

Title: The association of levels of physical activity with metabolic syndrome in rural Australian adults Authors: Vaughan, Clare Maree; Schoo, Adrian Martinus M; Janus, Edward Denis; Philpot, Benjamin Joel; Davis-Lameloise, Nathalie; Lo, Sing Kai; Laatikainen, Tiina K M; Vartiainen, Erkki; Dunbar, James Anthony Abstract: Physical activity (PA) reduces risk factors related to metabolic syndrome. Rurality influences the way people incorporate physical activity into daily life. The aim of this study is to determine the association of PA level with metabolic syndrome in a rural Australian population. The influence of adiposity on these associations is also investigated. Three cross-sectional population health surveys were conducted in south-east Australia during 2004–2006 using a random population sample (n = 1563, participation rate 49%) aged 25–74 years. PA was assessed via a self-administered questionnaire, and components of the metabolic syndrome via anthropometric measurements taken by specially trained nurses and laboratory tests. Approximately one-fifth of participants were inactive in leisure-time and over one-third had metabolic syndrome (men 39%, women 33%; p = 0.022). There was an inverse association between level of PA and metabolic syndrome (p < 0.001). Men who were inactive in leisure-time were more than twice as likely and women more than three times as likely to have metabolic syndrome compared with those having high PA. Body mass index (BMI) is a mediating factor in the association between level of PA and metabolic syndrome. Some PA is better than none if adults, particularly women, are to reduce their risk of metabolic syndrome and associated vascular diseases. Specialised interventions that take rurality into consideration are recommended for adults who are inactive.

Preventing Type 2 Diabetes: The Role of the GP

2013-05-13T02:04:14Z

Title: Preventing Type 2 Diabetes: The Role of the GP Authors: Dunbar, James Anthony; Reddy, Prasuna; Audehm, Ralph Abstract: It is now over five years since clinical trials in China, Finland, India and the USA have shown that type 2 diabetes may be, at least in theory, preventable through lifestyle change. Two implementation trials regarding the prevention of diabetes, the first conducted in Finland and the second, the Greater Green Triangle Diabetes Implementation Trial in Victorian and South Australian General Practices, have now shown what can be done in clinical practice.

Scaling up Type 2 Diabetes Prevention Programs: National and State Interventions in Australia

2013-05-13T02:04:02Z

Title: Scaling up Type 2 Diabetes Prevention Programs: National and State Interventions in Australia Authors: Dunbar, James Anthony; Colagiuri, Stephen; Reddy, Prasuna; Vita, Philip; Timoshanko, Amy; Audehm, Ralph; Milat, Andrew Abstract: Australia has one of the world's largest systematic, government-funded diabetes prevention programs. This chapter describes a federally-funded national program, a state-funded program in Victoria and an implementation trial in New South Wales. A coincidence of events, influential individuals and policy directions has led to these initiatives.