Research and Evaluation

 The Wheatbelt GP Network is committed to support primary health research by primary healthcare practitioner.

 The Network’s research profile to date includes:
• Bowel Cancer
o Lim D, Sunderland V B, and Emery J (2008)
Practices of dispensing doctors [paper]. In 2008 State Conference: Primary Health Care MATTERS!. PHCRED-RACGP, Fremantle.
BACKGROUND:Even though dispensing of pharmaceuticals is generally perceived to be the sole provenance of the pharmacist profession, there are some 80 Australian dispensing doctors who are permitted to dispense and supply PBS pharmaceutical benefits where there is no pharmacist available within a reasonable geographical distance.
AIM: To systematically appraise the evidence related to the practices of dispensing doctors.
METHOD: A systematic search of bibliographic databases and reference lists from eligible papers published in English, between 1970 and 2007. At least two of the authors abstracted data from all included papers using a purpose-made data extraction form.
RESULTS: Twenty papers were included in this review. Evidence indicated that dispensing doctors prescribed more pharmaceutical items per encounter and less often generically than their non-dispensing counterparts. There was limited evidence to suggest that dispensing doctors prescribed less judiciously and were associated with poorer dispensing standards. Patient convenience and access to pharmaceuticals were cited as main reasons for doctors dispensing.
DISCUSSION: This review suggested improved prescribing when dispensing was separated from prescribing. However, the findings from this review were influenced by the different health systems and a limited number of adequate studies.
KEY MESSAGES: Dispensing doctors appeared to prescribe more pharmaceuticals and less often as generics than non-dispensing doctors but this did not consistently translate to differences in actual pharmaceutical costs. Dispensing doctors generally perceives patient convenience as the main reason for them to dispense.
o Lim D and Grant R (2005)
Bindoon – Once a dispensing town. Research paper – Central Wheatbelt Division of General Practice, 2.
o Lim D, Gray K, and Roach S (2004)
An investigation into the issues faced by dispensing doctors in rural and remote Western Australia. Research paper – Central Wheatbelt Division of General Practice, 1.
In Australia, dispensing of pharmaceuticals is generally perceived to be the role of the pharmacist professional. Rural and remote doctors in Australia are only permitted to dispense pharmaceuticals to their community should there not be a pharmacy service readily available. These dispensing doctors are required by law to fulfil extensive mandatory standards in place to govern the code of dispensing medicines; these are in additional to those required by statute for general practice. Dispensing doctors are unable to access existing Government and lucrative industry support in place for pharmacists despite their additional dispensing role. Dispensing doctors perceived their dispensing role as bridging their community access to basic healthcare. Many doctors see it as a service and a way of increasing the goodwill of their general practice. Due to large initial capital outlay, dispensing doctors do not generally stock non-prescription pharmaceutical. This unnecessarily restricted their community access to preventative pharmaceuticals. Overseas study has suggested that dispensing doctors prescribed less than non-dispensing doctors. However, no Australian comparative study has been done to date. Dispensing doctors plays a pivotal role in primary Indigenous healthcare in addition to and even before the implementation of Section 100. Government and industry need to recognise the contribution made by dispensing doctors in their community in order to ensure the viability of the profession.

 The Network’s program evaluation profile includes:
• After Hours GP Program and Wheatbelt Nurses Guideline

• Discovering Solutions for Family Abuse - Men’s Domestic Violence Program

• Membership Annual Survey

• Home Medicines Review

o Lim D (2004)
Another unspoken role of rural HMR Facilitator - mentoring through AACP accreditation [poster]. In 3rd Annual MMR Facilitator National Conference. The MMR Program - Where to from here? Pharmacy Guild of Australia, Melbourne.

• National Prescribing Service

o Lim D C and Rowett D S (2006)
Assessment of duration of effect on drug utilisation post academic detailing: a Central Wheatbelt based analysis [paper]. In McLachlan A., Boyd R., Eades S., Ford D, Grogan B., Hagon F., Mackson J., Mant A., Thompson J., Walsh D., Weekes L. (Eds) National Medicines Symposium – Balancing Beliefs, Benefits and Harms. PHARM Committee, Canberra.
Academic detailing has been shown to be useful in improving and modifying prescribing patterns of general practitioners (GPs). The Central Wheatbelt Division of General Practice, Inc. has been in partnership with National Prescribing Service (NPS) Ltd. since 1993 in delivering topic specific academic detailing to GPs in the Central Wheatbelt catchments. Data provided by NPS based on the volume of Pharmaceutical Benefit Schedule (PBS) prescriptions dispensed for ulcer healing drugs shown a parallel trend between the GPs in the Central Wheatbelt catchments and that of the national average (academic detailing on Optimising Use of Proton Pump Inhibitors was delivered between May 2004 and January 2005). Whilst the PBS data on antibiotics dispensed had indicated a higher rate of prescription among the GPs in the Central Wheatbelt catchments than that of national average (NPS antibiotics program was not delivered within the Central Wheatbelt catchments). A recent analysis of PBS data on asthma medications undertaken by the Division has, in addition, shown a pattern of academic decay in GPs’ retention of the messages imparted during the academic detailing. The changes in GPs’ prescription after academic detailing is most apparently within the first quarter with washout period lasting up to 6 months.

• Stakeholders’ Perspectives on Wyalkatchem Surgery

• Sustainability of Wheatbelt Community Resilience Program

o Surawski N, Pedersen A, and Briskman L (2008)
Resisting Refugee Policy: Stress and Coping of Refugee Advocates. Australian Community Psychologist, 20(2).

While there is clear evidence of the negative effects of Australian policy with respect to people seeking asylum on our shores, there is little research regarding the experiences of their advocates. In the present study, two main aims were investigated. First, we examined the stress levels of advocates and their coping strategies. Second, we examined changes in personal relationships and positive experiences as outcomes of the involvemnet with refugees. Eighty four refugee movement advocates completed an on-line questionnaire. Results indicated that they experienced moderate to high levels of stress in their refugee advocacy. While they used emotional support significantly more than other coping strategies, they found emotional support and instrumental support the most effective. Regardless of the high cost involved in such advocacy (eg., financial, emotional and interpersonal), participants noted a number of positive outcomes such as new friendships and personal growth. The findings are discussed in terms of long-term implications in relation to immigration policy and community support.