Dr Carla Bernardo

Title: Do patients with pre-diabetes managed with Metformin achieve better glycaemic control? A national study using general practice data

Start date: 1 September 2021

End date: 1 September 2023

Funding scheme: FND001174: RACGP Foundation - Diabetes Australia Research Grant

Description: By using a large general practice database containing de-identified medical records of more than two million patients attending over 650 general practices and more than 2,700 general practitioners across Australia (MedicineInsight), we propose to investigate if patients with pre-diabetes managed with Metformin achieve better blood sugar control than those not using Metformin. The study will also explore other relevant outcomes for diabetes prevention, including changing from pre-diabetes to diabetes within 3-5 years, cholesterol levels and blood pressure among these patients. The sample size in MedicineInsight is considered large enough, and with data available for many patients since 2011, it provides the perfect opportunity to explore the proposed research questions. A GP registrar with previous experience in research will coordinate the study. Moreover, if successful, this proposal will support her training as an academic registrar in 2022 and potential position as a PhD candidate at the University of Adelaide. Data extraction will be performed using standardised methods, while data analysis and findings interpretation will be supported by an experienced group of clinicians and epidemiologists. Statistical analysis will consider traditional regression models used in observational studies (cohorts) and an innovative approach (potential outcome or counterfactual model) that simulates randomised controlled trials, which is considered the gold standard to explore causal relationships in research. Therefore, the study will allow us to answer whether managing patients with Metformin is an effective strategy to prevent diabetes, which may help reduce the risk of further complications. Finally, this proposal aims to build capacity in general practice research by involving two GP registrars as part of the research team and developing an online activity targeting Australian GPs.

Funder name: RACGP Foundation

Funder reference: DIA2021-06

Application date: 1 May 2021

Award date: 25 August 2021

Application Status: RFA Complete

Investigators: . S, Pham L, Jahan H, Zheng M, Gonzalez-Chica D, De Oliveira Bernardo C, Stocks N

Progress Status: Established - Financial

Total Awarded Amount: AUD 57,261

Current?: true

Primary Fund Scheme Amount: AUD 57,261

Administered By:

Funding Category (Source of Funds for Primary Fund Scheme): Other

Title: Increasing immunisation in general practice against invasive pneumococcal disease and influenza in people under 65 years old who are higher risk of and from these infections because of certain chronic conditions and/or the treatments for those conditions

Start date: 3 February 2020

End date: 1 November 2022

Funding scheme: ORG121001: HCF / RACGP Foundation Research Grant

Description: People with chronic obstructive pulmonary disease, diabetes, heart disease, cancer, rheumatoid arthritis, ulcerative colitis or Crohn’s disease are at higher risk of serious illness or death from pneumonia and influenza.   Many people under 65 years with these conditions are not offered recommended vaccines against these infections.



In our study, unimmunised people in this group attending their general practice will receive advice to ask their GP or practice nurse about these immunisations.  The advice will be generated automatically by a special purpose version of software that is already in the market and that we have used in previous research studies.  The software searches the patient’s electronic clinical record seeking any history of any of the target conditions and any history of immunisation against pneumococcal infection or influenza.  If the patient has any of the target conditions and is not fully immunised, a sheet with information and advice prints automatically, for the receptionist to hand to the patent to read while waiting.  In addition, during the consultation the GP or practice nurse that the patient is seeing will receive the same reminders on screen.

 

We will compare the proportion of each practice’s patients who had been immunised at baseline with the proportion who have been immunised by the end of the trial.  We will also examine whether and if so how immunisation rates vary according to characteristics of patients, GPs, consultations and general practices.



The likely outcomes are that we will know whether informing and advising patients automatically about recommended immunisations at a time when they can act on that advice immediately increases immunisation rates, and we will have a better understanding of factors associated with immunisation.  The likely benefits of widespread implementation of these kinds of reminders are reduced rates of preventable illness and death, and reduced health care costs to the community.

Funder name: RACGP Foundation

Funder reference: HCF18

Application date: 3 May 2019

Award date: 31 July 2019

Application Status: RFA Complete

Investigators: Frank O, Gonzalez-Chica D, De Oliveira Bernardo C, Stocks N

Progress Status: Established - Financial

Total Awarded Amount: AUD 56,859

Current?: true

Primary Fund Scheme Amount: AUD 56,859

Administered By:

Funding Category (Source of Funds for Primary Fund Scheme): Other

Title: Road traffic accident-related consultations and management of physical and psychological trauma in Australian general practice, 2011-2018

Start Date: 1 August 2019

End Date: 1 February 2022

Description: Road traffic accidents are the eighth cause of death worldwide, claiming more than 1.35 million lives annually. Not only the deaths, but also the injuries resulting for these crashes remain a serious problem. Emergency care and rehabilitation, including monitoring by the general practitioner, are essential to limit the physical and psychological impact of injuries. In Australia, despite there are sources of data on road traffic injuries based on insurance claims and hospital data, there is lack of information in general practice. Therefore, this study aims to identify the frequency and temporal trend of consultations related to road traffic crashes in Australian general practices as well as the management of physical (chronic pain) and psychological (anxiety, depression, insomnia) conditions related to these accidents, including the prescriptions of opioids, anxiolytics or other psychotropic drugs.

Data will be extracted from the MedicineInsight program, a large national general practice dataset with de-identified medical records from more than 3 million patients of all ages, states and Australian regions. All patients who had at least one consultation with a general practitioner (GP) related to a road traffic accident between January 2011 and December 2018 within a MedicineInsight practice will be included. Those patients will have their prescription history investigated to identify prescriptions of opioids, anxiolytics and other psychotropic drugs after the accident.

Results from this part of the study will provide information to the development of focus groups with GPs, in order to understand their perspectives and reservations on the management of conditions resulting from road accidents. Based on GPs feedback, educational material will be created and electronically available for GPs across Australia as a way to provide information to improve patient outcomes and minimize recovery time and physical and psychological sequelae from road traffic accidents.

Funding Scheme: FND000789: MAIC/RACGP Foundation Research Grant

Funding Category (Source of Funds): Other

Funder Name (Organisation): RACGP Foundation

Funder Reference: MAIC01

Investigators: Black-Tiong S, De Oliveira Bernardo C, Gonzalez-Chica D, Hoon E, Frank O

Application Date: 6 May 2019

Award Date: 31 July 2019

Administered By:

Total Awarded Amount: AUD 99,189

Application Status: RFA Complete

Progress Status: Established - Financial

Title: Coverage of influenza, pneumococcal, and herpes zoster immunisation amongst patients with immune-mediated inflammatory conditions and use of reminders to improve vaccination rates in Australian general practice

Start date: 1 February 2019

End date: 31 December 2022

Funding scheme: FND000653: Pfizer-Independent Grants Program for Learning and Change

Description: Overall goal

To investigate the current vaccination coverage for influenza, pneumococcus, and herpes zoster amongst patients affected by immune-mediated inflammatory disease (IMID) and increase vaccination rates using targeted printed patient immunisation reminders, electronic health practitioner immunisation reminders, and educational activities in Australian general practice.

Target population

Patients affected by IMID (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or inflammatory bowel disease) attending Australian general practice. Across Australia, these conditions affect approximately 2% of the population (~500.000 individuals).  Educational activities will be targeting general practitioners (GPs) and other primary healthcare providers working in these practices.

Methods

Current vaccination coverage (Stage 1): deidentified data on influenza, pneumococcus and herpes zoster vaccinations for patients with IMID will be extracted, with practice consent, from all participating practices using the Doctors Control Panel (DCP) for 2013-2018. DCP is a well-established software package that retrieves medical information from electronic medical records and identifies preventive health care activities that are due.

Time series trial (Stage 2): DCP will also be used to generate targeted printed patient immunisation reminders (read in the waiting room) and electronic GP immunisation reminders (GP computer) in a representative sample of Australian general practices. The outcome measures at the end of the intervention (24 months) are 1) recorded administration of influenza, pneumococcal, and herpes zoster vaccines to patients with IMID, and 2) documented contraindications to, or refusal of, those vaccines over two years.

Assessment

Compared to the baseline (Stage 1), we expect an improvement of at least 20% in vaccination coverage after the intervention (Stage 2).

Funder name: Pfizer Inc

Funder reference: Pfizer International

Application date: 27 July 2018

Award date: 22 January 2019

Application Status: RFA Complete

Investigators: Stocks N, Young A, Gonzalez-Chica D, Frank O, De Oliveira Bernardo C, Hill C, Andrews J, Hoon E

Progress Status: Established - Financial

Total Awarded Amount: AUD 200,000

Current?: true

Primary Fund Scheme Amount: AUD 200,000

Administered By:

Funding Category (Source of Funds for Primary Fund Scheme): Other