General Practice
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The Discipline of General Practice is part of the School of Population Health and Clinical Practice
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Browsing General Practice by Author "Abramson, M."
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Item Metadata only Caregivers' use of, and attitudes towards, written asthma action plans in North-West Melbourne(Strategic Medical Publishing, 2005) Barton, C.; Sulaiman, N.; Clarke, D.; Abramson, M.We investigated the attitudes of caregivers towards written asthma action plans (WAAPs). A small number of caregivers participating in a larger randomised controlled trial (RCT) participated in qualitative interviews. 'Ownership and use of WAAPs' and 'Schools and WAAPs' were the main themes to emerge. The new school year is an opportunity to review and update WAAPs.Item Metadata only Cohort Profile: Melbourne Atopy Cohort study (MACS)(Oxford University Press, 2016) Lowe, A.; Lodge, C.; Allen, K.; Abramson, M.; Matheson, M.; Thomas, P.; Barton, C.; Bennett, C.; Erbas, B.; Svanes, C.; Wjst, M.; Real, F.; Perret, J.; Russell, M.; Southey, M.; Hopper, J.; Gurrin, L.; Axelrad, C.; Hill, D.; Dharmage, S.Item Open Access COPDX: an update of guidelines for the management obstructive pulmonary disease with a review of recent evidence(Australasian Med Publ Co Ltd, 2006) Abramson, M.; Crockett, A.; Frith, P.; McDonald, C.• Long-acting β2 agonists are an effective and convenient treatment for chronic obstructive pulmonary disease (COPD), but do not significantly improve lung function. • The long-acting anticholinergic tiotropium, which can be taken once daily, decreases exertional dyspnoea and increases endurance by reducing hyperinflation. • The role in COPD of the combination of a long-acting β2 agonist and a glucocorticoid in a single inhaler remains unclear. • The minimum duration of an effective pulmonary rehabilitation program that includes exercise training is 6 weeks. • Long-term treatment with inhaled glucocorticoids may reduce the rate of decline in lung function, but the effect is small. • Aminophylline should no longer be routinely used in acute exacerbations of COPD. • Non-invasive positive pressure ventilation (NPPV) reduces mortality and hospital stay in patients with acute hypercapnic ventilatory failure; it is also an effective weaning strategy for patients who require intubation. • Further studies are required to clarify the role of NPPV in the long-term management of stable COPD.Item Metadata only Coping as a mediator of psychosocial impediments to optimal management and control of asthma(W B Saunders Co Ltd, 2003) Barton, C.; Clarke, D.; Sulaiman, N.; Abramson, M.Adherence to asthma medication regimens by asthma patients is often poor and contributes to the continued and substantial burden of asthma in the community. There is evidence of increased rates of behavioural problems, anxiety and depression in people with moderate-to-severe asthma and these factors may interfere with adherence and contribute to poor asthma control. An alternative explanation is that the relationship between feelings of anxiety and depression, and adherence to the treatment regimen may be more accurately predicted from the coping styles used, rather than the experience of asthma itself. The objective of this paper was to review evidence for associations between coping strategies used by asthma patients, asthma management and health outcomes. The Medline and PsychInfo databases were searched for articles containing the terms "asthma" and "coping". Patients with asthma tended to use different strategies for coping with stress and illness compared to healthy participants and individuals with other chronic illnesses. Emotion-focussed coping strategies such as denial were commonly used by patients with poor medication adherence, those who attended emergency departments for asthma, were admitted to hospital for asthma, or suffered near-fatal asthma attacks. Interventions to improve coping strategies have been effective in reducing symptoms and psychological distress. The availability of coping resources to patients and/or their caregivers and the coping strategies that are used are likely to mediate the influence of psychosocial factors on the management of asthma. Further studies exploring the ways in which individuals cope with asthma will improve our understanding of the mechanisms linking psychological and social status to asthma morbidity and mortality.Item Metadata only Do small group workshops and locally adapted guidelines improve asthma patients' health outcomes? A cluster randomized controlled trial(Oxford Univ Press, 2010) Sulaiman, N.; Barton, C.; Liaw, S.; Harris, C.; Sawyer, S.; Abramson, M.; Robertson, C.; Dharmage, S.Objective. To improve health outcomes of children and adolescents with asthma using a multifaceted intervention for GPs. Methods. The design of the study was a cluster randomized controlled trial. GPs were randomized at a practice level in general practice clinics in Melbourne, Australia. Participants were children/adolescents aged 2–14 years with asthma and their caregivers identified from the medical records of participating clinics. Questionnaires were completed by 411 at baseline and 341 at follow-up. The intervention arm (n = 18 GPs) participated in a small group asthma education programme and was provided with locally adapted paediatric asthma guidelines. One control arm (n = 18 GPs) received only the adapted paediatric asthma guidelines, while the other control arm (n = 15 GPs) received an unrelated educational intervention. The outcome measures of the study were children/adolescents and caregivers completed questionnaires about asthma management and control, asthma knowledge and quality of life at recruitment and 6 months later. Ownership of a written asthma action plan (WAAP) was the primary outcome. Results. There was no evidence for changes in ownership of WAAPs between the three study arms. Adolescents in the intervention group reported an improvement in quality of life subscale score ‘positive effects’ (mean difference = 2.64, P = 0.01), but there was no evidence for an effect of the intervention on other study outcomes among the three study arms. Conclusions. The intervention was associated with some improvement in quality of life for adolescents. However, overall, the intervention did not translate into increased ownership of WAAPs, control of asthma or improved quality of life.Item Metadata only Experiences of Australian parents caring for children with asthma: it gets easier(Maney Publishing, 2005) Barton, C.; Sulaiman, N.; Clarke, D.; Abramson, M.Objective: To describe the experiences of Australian parents caring for children with asthma. Methods: A combination of random sampling, purposeful sampling and quota sampling was used to select care-givers from general practices in Melbourne's north and north-western suburbs. Data collection involved a single semi-structured in-depth interview with 21 parents caring for a child with asthma. Thematic analysis was aided by QSR NVivo. Results: Children experienced predominantly mild-to-moderate, episodic asthma. Six themes emerged from the interviews: emotions and behaviours, coping strategies, disruption to activities, health and treatment beliefs, problems with asthma management, and relationships with doctors. Parents' experiences and health beliefs impacted on their management of asthma. These may act as barriers to optimal asthma care in some families. The overriding theme to emerge was `it gets easier'. It got easier with time because the children could communicate more effectively, and were better able to take care of themselves, and their asthma became less severe or less of a problem. Discussion: This research has highlighted the need for health professionals to emphasize the chronic nature of asthma, but negotiate strategies with care-givers to optimize the use of asthma medications, with consideration being given to care-givers' fears, frustrations and health beliefs.Item Metadata only Factors associated with ownership and use of written asthma action plans in North-West Melbourne(Strategic Medical Publishing, 2004) Sulaiman, N.; Barton, C.; Abramson, M.; Liaw, S.; Harris, C.; Chondrosa, P.; Dharmage, S.; Clarke, D.Purpose: Written asthma action plans (WAAPs) have become a core component of asthma management in Australia. We investigated ownership, utilisation and factors associated with ownership of asthma action plans by caregivers. Methods: 443/776 (57%) caregivers of children aged 2–14 years with asthma were identified from 32 GP clinics as part of a randomised controlled trial (RCT), and completed self-administered questionnaires. Results: Only 29% of participants owned a WAAP, while 13% possessed verbal instructions, and 56% had no plan. An asthma action plan for children, which was developed by a general practitioner (GP) was more likely to comprise verbal instructions (p = 0.001), while action plans developed by paediatricians were more likely to be written (p < 0.001). Just over one half of caregivers (59%) reported discussing their child’s action plan the last time they visited their doctor for asthma. Factors associated with WAAP ownership included nights waking (p = 0.013), self reported severity (p = 0.001), and days lost from school (p = 0.037). Children who had seen a GP in the last 3 months for asthma, or who had been to the Emergency Department (ED) or hospital were more likely to possess a WAAP (p < 0.001). Caregivers who were less satisfied with their child’s asthma control were more likely to own a WAAP (p = 0.037). Caregivers with any action plan found it useful and 82% reported using their action plan for management of an acute attack. However, caregivers with a WAAP were more likely to adhere to the plan for an acute attack compared to caregivers with verbal instructions (OR = 4.5, p < 0.05). Caregivers with a WAAP were more knowledgeable about asthma (p = 0.002), better able to recognise the difference between preventer and reliever medications (p = 0.01), and better able to recognise an asthma attack (p = 0.006). Conclusions: Ownership of WAAPs in this group was still too low. Importantly, caregivers with written instructions were more knowledgeable about asthma and more likely to report following the action plan during an asthma attack.Item Metadata only Interactions between psychosocial problems and management of asthma: who is at risk of dying?(Marcel Dekker Inc, 2005) Barton, C.; McKenzie, D.; Walters, E.; Abramson, M.; Bailey, M.; Campbell, D.; Coleridge, J.; Couper, F.; Driver, J.; Drummer, O.; Evans, N.; Forbes, A.; Maclean, A.; McNeil, J.; Pinskier, H.; Robertson, C.; Thomson, G.; Willis, J.; Victorian Asthma Mortality Study GroupAdjustment for psychosocial and family problems is common in epidemiological research. Recursive partitioning algorithms, such as CHi Square Automatic Interaction Detection (CHAID), can be used to explore complex interactions between these factors and predictor and outcome variables. We investigated the nature of interactions between asthma management variables and psychosocial problems and how these interactions changed the risk of asthma mortality; 50 cases of asthma death and 201 emergency department controls were recruited. A validated questionnaire was used to collect data. An extended version of CHAID was used to identify statistically significant (p 0.05) interactions controlling for asthma severity. Family problems were associated with increased risk of mortality for patients aged > 31 years (OR = 6.5; 95% CI 2.6-16.1) but not for younger patients. Males were at increased risk overall, but females with family problems (OR = 4.3; 95% CI 1.7-10.7) were at greater risk then males (OR = 3.1; 95% CI 1.2-7.9) with family problems. Alcohol use increased risk of mortality for individuals with verbal instructions (OR = 5.4; 95% CI 1.5-19.5) or without a written action plan (OR = 4.4; 95% CI 1.0-19.4). Individuals with severe asthma and who reported having lung function tests were at increased risk for mortality if family (OR = 8.2; 95% CI 1.6-41.6) or financial problems (OR = 11.5; 95% CI 2.0-65.9) were present. This analysis highlights some important interactions and the magnitude of additional risk for mortality associated with psychosocial or family problems. Psychosocial problems need to be identified and addressed as part of asthma management, because even with best practice, these problems place patients at an increased risk of dying.Item Metadata only What determines knowledge of asthma among young people and their families?(Marcel Dekker Inc, 2002) Barton, C.; Abramson, M.; Aroni, R.; Stewart, K.; Thien, F.; Sawyer, S.In this analysis, we sought to determine factors that predicted the level of asthma knowledge in a sample of adolescents with asthma and their parents. Eighty-five young people aged 10-24 years attending tertiary care asthma clinics and 46 of their parents answered validated respiratory and asthma knowledge questionnaires. Older adolescents were more knowledgeable about asthma than were younger adolescents (r=0.36, p=0.001). Young people with severe asthma (p=0.015) scored higher on the asthma knowledge questionnaire than those with mild/moderate asthma. Asthma knowledge among young people was related to that of their mothers (r=0.47, p=0.014), however, only age and the asthma knowledge of fathers significantly predicted adolescent asthma knowledge. Adolescents develop increasing autonomy for asthma self-management as they mature, but parents remain an important source of information about asthma for young people.