[Professor Jennifer Reath]
Well, I guess I've had an amazing, very fortunate career in Aboriginal and Torres Strait Islander health and even as a medical student at University of Queensland, it seemed to me that Aboriginal health was an area that that really needed a lot of work done. I always wanted to understand why things were so and how things could be improved.
Yeah, look, I think clinical trials are incredibly important in providing evidence for what we do every day in general practice. I think we rely on that quality of evidence really to guide us in what we do in terms of management across so many areas of medicine, things like use of medications in terms of heart disease, in stroke prevention. All of the decisions we make day to day in general practice are based on that sort of evidence. And where we don't have that evidence, it's much more challenging in clinical practice to know that you're doing the best thing you can for your patients.
The first clinical trial that I was involved with was more as a GP, helping out, advising and recruiting patients was one. Looking at a polypill strategy for prevention of cardiovascular disease in high-risk populations to see whether putting a whole range of recommended medications in the one pill might improve adherence to those medications and therefore lower the risk of cardiovascular disease for those people. That was learning for me about the importance of recruitment to trials that I know they had quite a number of problems getting enough patients recruited.
The watch trial, which is a randomised controlled trial of antibiotics versus watchful waiting in Aboriginal children from urban communities. That's the trial that we've initiated here and we've received NHMRC funding for which we're very grateful. There's a tendency in general practice to over prescribe antibiotics, and I think most people are aware of the risks of antibiotic resistance related to that.
So, looking at best management is really important and yet if we're denying antibiotics in this situation, we need to be sure that it's safe. I think the challenge is that often trials are carried out in environments that aren't relevant to us as clinicians and that was one of the joys of running this trial. We were able to set up in an Aboriginal primary healthcare environment. We're working with six urban Aboriginal medical services and we know that our findings in relation to this trial will be directly relevant to practice in those communities. The patients are generally interested in it. Once you explain this is going to be about improving the care for your children and for other children in this community they're interested to be involved and to be a part of finding the solution.
I think the challenge is more for clinicians in this trial, particularly for GPs, where you're working in a busy practice, you've got a waiting room full of patients. We’ve set it up very carefully with the clinicians in mind. We also provide quite a lot of support to the service that we're working with, so we have a half time or a full-time salary depending on the commitment of the service to the trial for a research officer who is employed in that service to help with the follow up. And they actually undertake a lot of the recruitment process. And those research officers are absolutely linchpin in what we're doing. They're Aboriginal themselves, they know the community, they know the working of the service, and without them we wouldn't recruit anything like the numbers that we need. We also have provided equipment for the service. What we found is that the research officers, once they're trained up in use of that equipment, they're fantastic for training up the GPs.
One of our key aims with the research is to improve the practice in the clinics that we're working with in terms of both diagnosis and management. It's vitally important that we as GPs practicing in primary health care, make sure that the evidence we use is based in our communities and in our practices, and for that we need to be involved. It's a time challenge, but it's also exciting to be involved in something that will come up in the next set of guidelines. So, we not only follow the guidelines, but we can contribute to the development of those guidelines.
I am a general practitioner working in Aboriginal and Torres Strait Islander health. Even as a medical student at the University of Queensland it seemed to me that Aboriginal health was an area where there was an opportunity to make a difference. I always wanted to understand why things were so and how things could be improved.
It's vitally important that we as GPs practicing in primary healthcare make sure that the evidence we use is based in our communities and in our practices.
I think clinical trials are incredibly important in providing evidence for what we do every day in general practice. We rely on that quality of evidence to guide us in terms of management across so many areas of medicine, things like use of medications in heart disease, diabetes management, in stroke prevention, all of the decisions we make day to day in general practice are based on that evidence. Where we don't have that evidence it's much more challenging in clinical practice to know that you're doing the best thing you can for your patients.