David Baker – East Sydney Doctors

GPs and syphilis

David BakerEast Sydney Doctors

David Baker – East Sydney Doctors

Aim of presentation

understand nature of primary care

challenges for GPs

possible approaches

David Baker – East Sydney Doctors

Syphilis

David Baker – East Sydney Doctors

What do GPs Do?

approx 30, 000 GPs in 10,000 practices

major activities– acute illness eg respiratory infections– chronic illness – hypertension, diabetes, asthma

David Baker – East Sydney Doctors

Challenges

general practice

patient factors

the disease

David Baker – East Sydney Doctors

general practice– low, medium, high case-load GPs – small businesses with changing staff with varying

level of knowledge– skills / training in sexual history taking– varying level of interest / knowledge / experience

in STI screening and testing

Challenges

David Baker – East Sydney Doctors

general practice – high case load– time– resources– increasing complexity of treatments eg 20 +

antiretroviral medications– fragmentation of treatment services eg who is

ordering regular screening bloods GP / Sexual health clinic / HIV specialist ?

Challenges

David Baker – East Sydney Doctors

patient factors– high rate of mental illness eg depression 30%, drug / alcohol use – co-morbidity– aging HIV +ve population – increased burden of recommended

screening– most patient at the GP s present for OTHER reasons than STI

testing

the disease itself– frequently asymptomatic– complex natural history and testing

Challenges

Challenges: complexity72 year old

Medications:Diaformin 500 mg 1 bdPlendil ER 10 mg 1 bdSpiriva 18 mcg for inhalation 1 dailyQuestran Lite 4 g 1 bdAvapro HCT 300/12.5 1 dailyLipitor 80 mg 1 nocteViramune 200 mg 1 bdKivexa 1 bdSeretide Accuhaler (250/50) 1 bdValtrex 500 mg 1 dailySustanon 250 / 2 weeksMinipress 2 mg nocteTemaze 10 mg 1 nocte prnNexium 40 mg 1 dailyAratac 200 mg 1 dailyWarfarin 6 mg /dRhinocort 64 mcg/dose 120 doses spray 1 bd

Major diagnosis:Knee osteoarthritisAtrial fibrillation Gastro-oesophageal reflux disease with oesophagitisMigraine Hyperlipidaemia HIV infectionHypertension essential Chronic obstructive pulmonary disease Depression Prostatic hypertrophy Sleep apnoea Throat cancer Diabetes

46 year old

Medications:Avanza 30 mg 1 nocteOxyContin 35 mg bd Valtrex 500 mg 1 dailyStocrin 600 mg 1 dailyKivexa 1 dailyCelebrex 200 mg 1 dailyZyloprim 100 mg 1 dailyPanamax 500 mg 1-2 q4h prnVentolin Inhaler 100 mcg/dose x 2 Inhaler 2 q4h prnZoton 30 mg 1 dailySeretide Accuhaler (250/50 Inhalation 1 bd

Major diagnosis:Liver function studies abnormal result Knee injury Genital herpes Pain chronic Alcohol excess Chronic obstructive pulmonary disease Lumbar spondylosis Cerebral aneury Depression HIV infection Gastro-oesophageal reflux disease GoutHip arthritis

35 year old

Medications:Kaletra 4 dailyTruvada 1 daily Allegron 25 mg 2 nocteStilnox7.5 mg 1 nocte prnTramal 50 mg 1 bd prnSymbicort Turbuhaler 1 bdNexium 20 mg bdPanadol osteo 2 tds

Major diagnosis:Smoker tobacco Gastro-oesophageal reflux diseaseNeuropathy drug induced Neck injuryHIV infection Hyperlipidaemia Asthma Depression

David Baker – East Sydney Doctors

Advantages

HIV +ve – patient attend for regular monitoring

HIV – ve – more difficult to ensure regular testing, will tend to be more opportunistic

opportunistic testing requires time and skills in history taking

David Baker – East Sydney Doctors

What may work

GP Education

patient education eg waiting room material

enhanced role of practice nursing – however no current Medicare item for STI screening by nurses

GP management plans

optimising computer systems

David Baker – East Sydney Doctors

GP education

pester power

STIGMA guidelines – regular distribution

ASHM

Australian Family Physician

division newsletters

IT: systematic approaches

David Baker – East Sydney Doctors

IT: sexual history

limited ability to record sexual history in standard medical software

role for CASI – computer assisted survey instrument

IT: recall systems

requires user to set up recall

no SMS capacity in most systems

Pathology: automated testing

GP management plans

Practice based reminder systems

David Baker – East Sydney Doctors

Summary

MSM have regular contact with GPs, especially if HIV +ve, however their are missed opportunities for testing

multiple competing demands on primary care resources

strategies need to be supportive, efficient and evidence-based: IT, CASI systems, funding for practice nurses, recalls, alerts, ongoing education

David Baker – East Sydney Doctors

GPs and syphilis

David BakerEast Sydney Doctors