I have been in general practice since 1979. I chose general practice because I wanted to be responsible for the long term care of a group of patients. I was a partner in a practice for 21 years and now practise in Hillcrest, an inner north eastern suburb of Adelaide. My interests in the provision of comprehensive personal care, prevention, clinical informatics, quality care and health services led me to undertake a PhD part time from 1998 to 2006. Currently I spend three days per week in my practice and two days as a University Senior Research Fellow in the Discipline of General Practice at the University of Adelaide. I serve on a number of local, State and national committees in my areas of interest.
I applied for a Foundation grant because I wanted to answer a question that arose from my experience in practice. This research study aims to test a strategy to increase vaccination against influenza and invasive pneumococcal disease. Pneumonia complicating influenza or COVID-19 infection is a cause of severe illness and death.
Our target group is people aged 18-64 years with chronic obstructive pulmonary disease, diabetes, heart disease, cancer, liver disease, rheumatoid arthritis, ulcerative colitis or Crohn’s disease or who smoke, of whom only 8% have received pneumococcal vaccine and only 33% receive influenza vaccine.
These patients make an average of eight visits to their general practice every year, providing many opportunities for them to be vaccinated, most of which are not taken. In our study, when under-vaccinated patients in the target group make an appointment to see their GP the Doctors Control Panel (DCP) software will generate SMS reminders automatically for them about these vaccinations. In addition, when those patients arrive for their appointment, the DCP will automatically print the same reminders for them and the GP or practice nurse will receive the reminders on their computer screen during the consultation. This strategy enables and helps these patients who are at risk to be vaccinated with a minimum of additional effort, time or cost.
We will compare changes in the proportion of patients who have been vaccinated. The vaccination status of target group patients in a group of ‘usual care’ control practices will be measured to monitor any changes in vaccinated resulting from other routine population wide efforts to increase vaccination and that might be prompted by the COVID-19 epidemic.
The likely outcome of the study is that we will know whether this strategy increases vaccination rates. The likely benefits of widespread implementation of these reminders are reduced rates of preventable illness and death, and reduced health care costs to the community.
The grant funding from the Foundation is vital in enabling our research study. Other grant funding bodies that are used to receiving applications mainly from other medical specialists, hospitals and laboratory based research institutions sometimes have difficulty in appreciating the possible contribution that research studies conducted in, by or about general practice can make to improving health care and outcomes.
Three often difficult aspects of research studies are funding, ethical approval and recruitment. The RACGP could do more to support research by helping with recruitment. It could tell members in its communications about research studies that are or that soon will be recruiting, and maintain a list of those research studies on its Website.
The Foundation’s grants are a great help to GPs who are starting in research. Applications are assessed by fellow GPs who know the context in which GPs work, and who want to foster research that can generate the evidence for the value that general practice provides.
Dr Oliver Frank