General Practice and Primary Health Care Research Unit
The General Practice and Primary Health care Research Unit was established in 2005 with the opening of the School of Medicine.
Since its inception the objectives of the Unit have been:
- To identify research projects that will engage general practitioner (GP) interests and encourage sustained involvement in primary care research
- To participate (independently or collaboratively) in research which will inform practice
- To foster broader consumer involvement in primary care research
- To encourage GPs, practice nurses and other health professionals to have "hands on" roles in research projects
- To develop a group of general practices capable of undertaking clinically relevant research
- To support student interest in primary care research and early career primary care researchers
- To develop national and international links and collaborations in primary care research
The Unit has received competitive grant and industry funding and was part of the University’s Collaborative Research Network (CRN) funding success. The following link showcases the group’s achievement through CRN: https://www.notredame.edu.au/research/research-at-notre-dame/about-us/crn/crn-research-showcase
Current research projects are in primary prevention of cardiovascular disease, familial hypercholesterolaemia and multimorbidity, but our interests span the entire spectrum of identification and management of chronic diseases in the primary care setting. We are committed to publishing our research findings through peer reviewed papers and conference presentations and our research collaborator contributions are acknowledged in outputs.
We believe in contributing to scholarly advancement and members of the team are actively involved in research and clinical teaching through the School’s MD programme and have held grant review roles on national and international grant funding panels.
Featured Projects
An Intervention to improve the detection and management of FH in primary care.
This project is for a three year period with collaborations between the University of Notre Dame (Fremantle and Sydney Schools of Medicine), UWA, University of Sydney, JCU, Deakin University and the University of Tasmania.
Other partners include State Health Departments of WA and NSW, Royal Perth Hospital MRF and Mackay Hospital Research Foundation, Industry partners, Best Practice software, Heart Foundation WA. It is a pragmatic cluster intervention study of a Model of Care to target managing FH in primary care.
This project’s aim is to:
- Increase the number of new (index) cases diagnosed with FH;
- Reduce the LDL-cholesterol levels in affected patients by at least 50%;
- Cascade test close family relatives of newly diagnosed patients,
- Examine cost implications of managing FH in primary care rather than tertiary hospitals
The results of this project have shown:
- Increased numbers of FH patients identified and treated
- Improved outcomes in treated levels of LDL-cholesterol level through drug treatment and lifestyle changes
- Increased public awareness of FH among the general population
Qualitative study into patient and allied health provider perceptions of why patients attend the Fremantle Street Doctor (FSD) service.
Our research involved qualitative research interviews with patients attending the FSD as well as interviews with allied health personnel who help administer the Street Doctor Service. The study also examined patient perceptions of what they would do if the service ceased to exist.
The aim of this project was to examine patient and allied health provider perceptions of why patients attend the FSD service and what it means to them.
The FSD service was highly valued by patients attending the service. Most felt comfortable with the relaxed atmosphere and non-judgemental nature of the service and were grateful for the dedication of the service staff in helping to meet their health needs.
Increasing multimorbidity in an Australian street health service – a 10 year retrospective cohort study
Our 10 year retrospective review of patients attending the FSD shows that multimorbidity continues to increase in this vulnerable patient group. Chronic disease presentations in this cohort occur much earlier than in the housed, settled population and can present as physical or mental health problems. A notable feature of the study was the progressive increase in the number of Aboriginal patients attending the service – 31.5% compared to under 2% attending mainstream general practice Australia wide.
The aim of this project was to examine the prevalence, patterns and severity of multimorbidity among patients attending the Fremantle Street Doctor (FSD).
The results showed that multimorbidity and disease severity increased in the period from 2006-2011 to 2012-2015 with Aboriginality the highest predictor of multimorbidity. Psychiatric, musculoskeletal (especially skin) and respiratory conditions were most common. Disease severity was mild to moderate with 26.8% having at least one severe or extremely severe condition. Street-based health services such as the FSD provide a vital, easily accessed, accredited service that helps marginalised street health patients manage their chronic, early onset diseases.
Detection of familial hypercholesterolaemia (FH) at childhood immunisations
Some recent, emerging evidence suggests that a dedicated program involving screening of children presenting for routine immunisations in the 12-18 month age group can be effective in detecting new cases of FH especially if used in combination with reverse cascade testing of their parents. (This study is led by Andrew Martin, UWA, with Tom Brett (Notre Dame) as CI).
This study’s aim is to increase the number of new, index cases of FH and to reverse cascade test the parents of affected children. As first degree relatives, the parents have a 50% risk for inheriting the condition.
The study has just been funded and hopes to replicate similar findings to an English study by Wald et al. where 10,000 infants screened (85% uptake) yielded 40 new cases of FH with a further 40 cases detected among their parents. The WA study will involve 1,000 infants with an outcome of 4 new FH cases among the children and 4 among their parents anticipated.
Featured publications
Challenges in the care of FH: a community care perspective
Brett T, Watts G, Arnold-Reed D, Bell D et al.
Expert Review of Cardiovascular Therapy, 2015, Vol 13, Pg 1091-1100
Detection and management of familial hypercholesterolaemia in primary care in Australia: protocol for a pragmatic cluster intervention study with pre-post intervention comparisons
Arnold-Reed D E, Brett T, Troeung L, Vickery A, Garton-Smith J, Bell D, Jing Pang J, Grace T, Bulsara C, Li I, Bulsara M and Watts G F
BMJ Open, 2017
A New Electronic Screening Tool for Identifying Risk of Familial Hypercholesterolaemia in General Practice
Troeung L, Arnold-Reed D, Chan She Ping-Delfos W, Watts G F, Pang J, Lugonja M, Bulsara M, Mortley D, James M, Brett T
Heart, 2016
Beyond cascade screening: detection of FH at childhood immunisation and other strategies
Martin A, Bell D, Brett T, Watts G
Current Opinion Lipidology, 2017, Vol 28, Pg321-327
A general practice street health service - patient and provider perspectives
Strange C, Chan She Ping-Delfos W, Fisher C, Brett T, Arnold-Reed D
Australian Journal of General Practice, 2018
Increasing multimorbidity in an Australian street health service – a 10 year retrospective cohort study
Arnold-Reed D, Troeung L, Brett T, Chan She Ping-Delfos W, Strange C, Geelhoed E, Fisher C, Preen D
Australian Journal of General Practice, 2018
Familial hypercholesterolaemia: challenges in primary care
Brett T, Watts G F, Garton-Smith J, Bell D A, Vickery AW, Pang J, Arnold-Reed D
Medicine Today, 2015, Vol 16, Pg 20-26
Multimorbidity in patients attending two Australian Primary Care Practices
Brett T, Arnold-Reed D, Popescu A, Soliman B, Bulsara M, Fine H, Bovell G, Moorhead R
Annals of Family Medicine, 2013
Multimorbidity in a marginalised, street-health Australian population – a retrospective cohort study
Brett, T, Arnold-Reed D E, Troeung L, Bulsara M, Williams A and Moorhead R G
BMJ Open, 2014
Fremantle Primary Prevention Study- multicentre randomised trial of absolute cardiovascular risk reduction
Brett, T, Arnold-Reed, D E Phan, C T, Cadden, M F, Walker,W, Manea-Walley, W, Mora, N, Young, J and Bulsara, M K
British Journal of General Practice, 2012
HDR Student Opportunities
Our recent major areas of research have focussed in the areas of multimorbidity and familial hypercholesterolaemia. However, we still have ongoing research interests in the broader areas of cardiovascular research especially primary prevention, use of data extraction tools to target high risk patients from general practice data bases and are willing to help and support researchers with their research projects and higher degree aspirations.
Please contact A/Prof Diane Arnold-Reed diane.arnold-reed@nd.edu.au 08 9433 0698 or Prof Tom Brett tom.brett@nd.edu.au 08 9433 0571 if you are interested in further information about potential HDR projects within the General Practice and Primary Health Care Research Unit.
Collaborations
An intervention to improve the detection and management of Familial Hypercholesterolaemia (FH) in primary care
NHMRC Partnership Study: Dec 2017 – Nov 2020
University of Western Australia
Professor Gerald Watts
Chief Investigator – Cardio-metabolic Specialist
James Cook University
Professor Clare Heal
Chief Investigator, Clinical Lead Queensland
The University of Notre Dame Australia, Sydney
A/Professor Charlotte Hespe
Chief Investigator, Clinical Lead NSW
University of Sydney/Royal Prince Alfred Hospital/NSW Health Department
A/Professor David Sullivan
Chief Investigator, Cardio-metabolic Specialist
University of Tasmania
A/Professor Jan Radford
Chief Investigator, Clinical Lead Tasmania
Deakin University
Professor Gerard Gill
Chief Investigator, Clinical Lead Victoria
Partners
NHMRC Partnership Study: Dec 2017 – Nov 2020
An intervention to improve the detection and management of Familial Hypercholesterolaemia (FH) in primary care
Sanofi Aventis Australia
Department of Health, Western Australia
Department of Health, New South Wales
Royal Perth Hospital – Medical Research Foundation
Mackay Hospital Foundation
Best Practice Software
Heart Foundation WA
Clinipath
Australian Clinical Labs
Primary Health Networks (WA Primary Health Alliance, Murrumbidgee, North Queensland, Western Victoria, Central and Eastern Sydney and Primary Health Tasmania)
Contact
Professor Tom Brett
Director
A/Professor Diane Arnold-Reed
Research Programme Co-ordinator
Ms Carmen Condon
Research Fellow (Biostatistics)
Dr Wendy Chan She Ping-Delfos
Project Manager
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