BackgroundThe current model of care for the treatment of chronic hepatitis B (CHB) in Australia is through specialist Hepatology or Infectious Diseases clinics, and limited accredited primary care practices. Capacity is limited, and less than 5% of Australians living with CHB currently access therapy. Increasing treatment uptake is an urgent area of clinical need. Nucleos(t)ide analogue therapy is safe and effective treatment for CHB that is suitable for community prescribing. We have evaluated the success of a community-based model for the management of CHB in primary care clinics using a novel web-based clinical tool.MethodsUsing guidelines set out by the Gastroenterological Society of Australia, we developed an interactive online clinical management tool for the shared care of patients with CHB in primary care clinics, with remote oversight from tertiary hospital-based hepatologists and a project officer. We call this model of care the “B in IT” program. Suitable patients were referred from the specialist liver clinic back to primary care for ongoing management. Compliance with recommended appointments, pathology tests and ultrasounds of patients enrolled in “B in IT” was assessed and compared to that of the same patients prior to community discharge, as well as a matched control group of CHB outpatients continuing to attend a specialist clinic.ResultsThirty patients with CHB were enrolled in the “B in IT” program. Compliance with attending scheduled appointments within 1 month of the suggested date was 87% across all 115 visits scheduled. Compliance with completing recommended pathology within 1 month of the suggested date was 94% and compliance with completing recommended liver ultrasounds for cancer screening within 1 month of the suggested date was 89%. The compliance rates for visit attendance and ultrasound completion were significantly higher than the control patient group (p < 0.0001) and the “B in IT” patients prior to community discharge (p = 0.002 and p = 0.039, respectively).ConclusionsThe “B in IT” program’s novel web-based clinical tool supports primary care physicians to treat and monitor patients with CHB. This program promotes community-based care and increases system capacity for the clinical care of people living with CHB.

ObjectiveTo assess general practitioner (GP) perceptions of liaison with two local tertiary teaching hospitals. DesignQuestionnaire‐based survey of GP attitudes. SettingMelbourne and North West Melbourne Divisions of General Practice, in July and September 1994. ParticipantsAll GPs (587) practising in the Divisions (identified from Health Insurance Commission lists of consultations charged at GP rates). Outcome MeasuresDegree of agreement on a 5‐point Likert scale to statements about GP—hospital liaison, and relevant open comments. Results350 GPs (60%) responded, including 84% of vocationally registered GPs; 68% of the 350 were in full‐time practice and 70% had been in practice for over 10 years. GPs had no clear strategy for obtaining admission of semi‐urgent patients to public hospitals. For patients needing urgent admission, almost a third of GPs sometimes resorted to sending them to the emergency department without first telephoning. Most GPs agreed that hospitals did not notify them of patient admission (84%), major changes in patient condition, including death (87%), and patient discharge (75%). Most would interrupt a consultation to discuss a patient with hospital staff (92%). About half agreed they had poor access to outstanding results, and 65% were concerned that proposed early‐discharge practices would be detrimental to patient care. ConclusionsThe survey identified considerable GP dissatisfaction with hospital—GP communication and GP willingness to be more involved in liaison and communication with hospitals about patient care. Changes in hospital organisation and hospital staff attitudes are needed to allow this.

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Co-production is an emerging source of information about the world, but it is one that has not been adequately theorized in the legal literature. Because co-production contains aspects of both novel science and oral history, it is not clear how it can be admitted. I argue that coproduced information does not clearly fit into either of the admissibility frameworks. With respect to the novel science framework, co-produced information fits into the criteria of testability, peer review, and standards with only a few problems, but would likely fail the general acceptance criterion of the test. However, if scientists are educated about co-production, or if it is possible to delineate a group of scientists who are more likely to accept co-production as the “relevant group,” then it may be possible for co-production to be admitted as evidence through the novel science framework. Turning to the oral history framework, co-produced information is less likely to be admitted because oral history is only a part, and not a necessary part, of co-produced information. As such, courts will likely be reluctant to bend the rules of evidence to admit it. Further research is needed to determine whether co-produced information can be admitted under the novel science framework.