Aim: To describe Australia’s new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care.
Content: Australia’s Royal Commission into Aged Care Quality and Safety highlighted an overreliance on psychotropic medications for chemical restraint. An 18-member multidisciplinary Guideline Development Group (GDG) was convened to develop new Guidelines. The Guidelines outline best practice for initiating, monitoring and discontinuing antipsychotics, benzodiazepines and antidepressants. Guideline development followed the National Health and Medical Research Council process. When formulating recommendations, the GDG considered the balance of benefits and harms, certainty of evidence, preferences and values of people living with dementia, carers and families, resources, equity, acceptability and feasibility. The Guidelines contain 15 conditional recommendations and 49 good practice statements. The Guidelines highlight the importance of facilitating the active involvement of people living with dementia in decision-making. General Practitioners (GPs) should identify and document target symptoms and anticipated treatment outcomes, complete an individual harm-benefit analysis and ensure informed consent is obtained from the person living with dementia and/or their substitute decision-maker. The Guidelines support GPs by providing guidance in relation to monitoring treatment effectiveness and adverse events and implementing discontinuation strategies. Following antipsychotic discontinuation, GPs should seek advice from a psychiatrist, geriatrician, outreach team or behavioural advisory service if recurrent symptoms are not adequately treated with other measures. The Guidelines recommend against the routine use of Pro Re Nata (PRN) antipsychotics and benzodiazepines.
Goals: The Guidelines outline steps for GPs when initiating, monitoring and discontinuing psychotropic medications. The Guidelines support GPs to regularly assess the balance of harms and benefits of psychotropic medications, monitor for effectiveness and adverse events and implement discontinuation strategies.

Key messages
1. The Guidelines outline 15 conditional recommendations and 49 good practice statements related to initiating, monitoring and discontinuing antipsychotics, benzodiazepines and antidepressants.
2. Psychotropic medications are not the preferred treatment option for changed behaviours in people living with dementia.
3. The Guidelines provide GPs with steps for ensuring the appropriate use of psychotropic medications.

Introduction: People who regularly use methamphetamine (PWRUM) are experiencing harms to physical and psychological health[1,2,3]. It is surprising, therefore, to learn that in Australia they visit General Practitioners (GPs) more frequently than the general population[4]. There is little in the literature to help us understand GPs’ opinions on caring for PWRUM and explain why these frequent attendances aren’t translating into better outcomes.

Method: Semi-structured interviews were conducted with 14 GPs practicing in Greater Sydney about their experiences of providing general practice-based care for PWRUM. Demographic & scope of practice data were collected to ensure a broad sample. Transcripts were analysed thematically using an established framework. Levesque (2013) conceptualises access to care as depending on the ability of consumers to navigate a series of provider domains[5] and is therefore patient-focused. We recruited to thematic saturation.

Key Findings: GPs described a range of barriers & enablers across the domains described by Levesque (2013). This presentation will focus on the practical factors identified. Barriers included appointment systems, billing practices and lack of GP education. Enablers included routine screening, advertising and relevant health resources, good links with specialist services. Other factors will be briefly described.

Implications for Practice: The barriers and enablers identified by our GP participants described via a patient-focused access framework, could be used to inform improved educational content for GPs in training, established GPs and practice staff; better funding models; and new models of care that will better meet the needs of this group – relating to both methamphetamine use and the effects this can have on health in general.

Introduction: Gender affirming hormone therapy (GAHT) is often managed in general practice in Australia. The increasing use of the informed consent model of care is likely to increase this practice in the future. Many GPs are not familiar with this practice and have concerns about the potential adverse effects that the hormone treatment may cause. By collecting data from GP clinics, this study aims to describe this population and also highlight any significant issues that might arise from this treatment in general practice.
Aim: The PUSH! Audit was a cross-sectional study collecting data from 9 GP clinics across Australia, which provide GAHT. This study describes the demographics of the patient population who are prescribed testosterone as GAHT. The study also collected data about serum testosterone levels. measured adverse effects and self-reported adverse effects experienced by this patient population
Results: This study shows the wide demographics of these patients, with many younger individuals seeking this treatment. It also collected information about diagnoses of anxiety and depression in this population. They achieved good testosterone levels on treatment and experienced minimal adverse effects- either measured or self-reported. The measured adverse effects included haemoglobin levels (for polycythemia), blood pressure readings (for hypertension), lipid levels( for hyperlipidemia), Liver function test results and renal function test results. The self-reported adverse effects included balding, acne, depression, aggression and mania.
Conclusion: GAHT with testosterone can be managed effectively in general practice with good results achieved. There is high rates of success and very few adverse effects associated with this treatment. This study also confirms the high incidence of mental health diagnoses (anxiety and depression in this study) in this population, which is consistent with many previous studies. This study should give confidence to general practitioners in providing this treatment as part of general practice.

Rationale: “Low-carb diets” are gaining the attention of health professionals and the public as a tool to manage overweight, obesity and diabetes. However, we know very little about GPs’ experiences with low carb diets. We aimed to explore GPs’ experiences discussing low-carb diets with patients and to identify the factors that influenced GP decisions to offer low-carb dietary advice as a potential treatment or not.

Methods: Semi-structured interviews were conducted with GPs in the ACT and surrounding regions. Participants were recruited via a combination of convenience and snowball sampling techniques via advertisements in the local Primary Health Network newsletters and ANU Medical School professional networks. Recruitment is ongoing with the aim of interviewing approximately 15 GPs. The COM-B framework was used to underpin analysis on behavioural change of GPs and patients. Multiple investigators independently coded the transcripts using a combination of inductive and deductive coding. Codes and themes were refined through team discussion.

Findings: Based on initial interviews, GPs reported that their personal experiences underpinned their motivation to offer low-carb dietary advice with patients. GPs valued the simplicity of low-carb dietary advice, which supported the opportunity to provide succinct and simple advice for patients within a usual GP consultation. Furthermore, due to the simplicity of the advice, GPs felt comfortable in their capacity to adapt the dietary advice to fit individual patient circumstances.

Implications: An increased understanding of what contributes to GP success or challenges when offering low-carb dietary advice to patients may help tailor diet and lifestyle messaging for GPs and patients. Hopefully GPs will feel more empowered to consider dietary advice for their patients and recognise the factors that might make it successful.

Rabies is a zoonotic viral disease, belonging to the Lyssavirus genus of the Rhabdoviridae family, which infects mammals and causes fatal encephalomyelitis. A bite by a rabid dog represents the source of infection in more than 99% of cases. Almost half of cases occur in children under the age of 15 years, but all ages can be affected by this infection. In humans, the incubation period of rabies is highly variable, ranging from days to years, with an average of 2–3 months, being influenced by: i) location, extent and depth
of the wound; ii) distance between the location of the wound and the central nervous system; iii) concentration of inoculated virus particles and iv) virus strain.

This study aims to identify the clinical profile of pediatric and adult rabies patients in San Lazaro Hospital from January 2018 to December 2020.

This is a Retrospective Observational study of all pediatric and adult rabies patients at San Lazaro Hospital from January 2018 to December 2020. Review of records and
logbooks will be utilized to acquire the required data for this study.

The results of this study showed that Rabies patients were continuously admitted to the hospital between 2018 and 2020. As to the clinical profile and characteristics of the
patients admitted, there were major similarities as compared to those patients in previous researches and articles mentioned in this study. Moreover, demographic characteristics of the population, distribution of clinical features in relation to form and stage of rabies, animal species involved and type of exposure, anti-rabies prophylaxis and treatment before admission and mortality were largely similar to those of the patients admitted in previous studies mentioned.

Aim and Goals:
To identify factors influencing herpes zoster (HZ) vaccination perceptions in selected Asia Pacific locales, and elicit physicians’ knowledge, attitudes, and practices towards HZ disease and vaccination.

Methods:
A cross-sectional study across Hong Kong (HK), Singapore (SG), South Korea (SK), and Taiwan (TW) was conducted in January–September 2022. Following concept elicitation interviews with 24 physicians, a 30-minute online survey was conducted with the same target population (infectious diseases specialists [n=15], geriatricians [n=5], dermatologists [n=20] and general practitioners/family medicine [n=180]; total N=220). Descriptive analyses were used to summarise study population responses and findings were presented as counts and percentages, based on categorical variables.

Results:
Most physicians knew about the risk factors for HZ (>80%). Top factors driving vaccine recommendations for patients ≥50 years of age (YOA) included disease prevalence, impact of disease on other health conditions, government recommendations/national vaccination lists, and patients’ underlying diseases. Physicians agreed that HZ impacts quality of life. Nearly 90% expressed that HZ vaccines were important to recommend to patients ≥50 YOA. However, HZ vaccination conversation was initiated with <30% of their patients ≥50 YOA, and <50% of patients ≥50 YOA with chronic conditions; proportions were lowest in SG and SK (23% of patients ≥50 YOA and 36% of patients ≥50 YOA with chronic conditions in both locales). Generally, time constraints/more urgent matters to discuss (>80%) and perceived low willingness among patients for vaccination (>60%) were the most reported barriers to initiating HZ vaccination conversations. Vaccine affordability was less of a concern and reported by approximately one-third of physicians.

Conclusion:
Efforts are needed to enhance translation of physicians’ understanding of HZ burden and vaccination benefits into clinical practice. This includes removing barriers to initiating HZ vaccination conversations and shared decision-making with patients, including those with underlying diseases.

• To highlight the importance of educational activities about HZ vaccination in addressing gaps in physicians’ knowledge, attitudes and practices towards HZ prevention and vaccination in Asia-Pacific locales.
• To highlight the need for public health programmes to support HZ vaccination advocacy by physicians with competing priorities.
• To elucidate the important role of physicians in raising public awareness about HZ vaccine availability in Asia-Pacific.

Background. To improve antibiotic prescribing practices for children, it is important to understand the antibiotic prescribing behaviour and incidence rates of (non)serious infections.
Subject. We aim to determine the antibiotic prescribing prevalence and rate (per acutely ill child) and incidence rates of (non)serious paediatric infections in Flemish (Belgium) general practices from 2002 to 2022.
Methods. Retrospective study using routinely collected data corrected for yearly contact group and, where relevant, stratified by gender and age groups (0-1, 2-6, 7-12 years old). We performed autoregressive moving average time-series analyses and seasonality analyses.
Results. The antibiotic prescribing prevalence and rate decreased significantly from 2002 to 2022 in children 2-6 and 7-12 years old. In 2022, 28.6% (95%CI 28.1-29.1%) of all acutely ill children received an antibiotic, down from 33.5% (95%CI 32.5-34.5%) in 2002. Between 2002 and 2022, the antibiotic prescribing rate for nonserious infections reduced from 46.9% (95%CI 45.3-48.8%) to 19.1% (95%CI 18.7-19.5%), while it remained unchanged for serious infections (70.1% (95%CI 62.2-74.7%) in 2022). The most substantial reduction in antibiotic prescribing rate over time is observed in upper respiratory tract infections, bronchitis/bronchiolitis, and otitis media: a relative reduction of 59%, 42%, and 19%, respectively. Nonetheless, these results do not meet the European quality indicators for outpatient antibiotic prescribing. In 2022, over half of prescribed antibiotics were amoxicillin and a fifth were broad spectrum. The ratio of broad spectrum to narrow spectrum antibiotics decreased from 3 in 2002 to 0.67 in 2022. 3% of all infections were serious.
Conclusion. From 2002 to 2022, Flemish general practitioners prescribed fewer antibiotics to (acutely ill) children. Since a fifth of prescriptions are broad spectrum, assessment of and further initiatives towards appropriate prescribing are needed.

As the burden of work intensifies, an alarming 48% of New Zealand general practitioners (GPs) have reported high levels of burnout in a recent College survey. To alleviate this pressure and ensure timely access to healthcare, telehealth services have emerged as a valuable solution, bridging the gap between patient demand and clinician availability. However, the impact of telehealth on healthcare disparities and its widespread usage across different demographics remain poorly understood. Are some age groups, ethnicities, or deprivation quintiles less likely to use telehealth and how acceptable is it to patients? This presentation aims to shed light on the first-year experience of a novel GP-led telehealth service that acts as an adjunct to conventional primary care.

Participating GP teams refer patients unable to secure timely appointments to an after-hours telehealth service for a video consultation. Throughout the inaugural 12-month period, the service catered to 6,965 patients from 534 distinct clinics. Comprehensive care was provided, including prescriptions, laboratory tests when necessary, and seamless integration of shared care records. Moreover, detailed encounter notes were forwarded to the enrolled practice, ensuring continuity of care.

Demographic distribution mirrored the overall population, with Māori patients accounting for 21% of consultations, patients under 20 years constituting 21%, and those over 60 years comprising 11%. Over 90% of patient concerns were resolved during telehealth appointments, with only 4% necessitating subsequent GP follow-up. Patient satisfaction was consistently high, with an average rating of 4.6 out of 5 from 878 respondents.

These findings demonstrate the efficacy of telehealth services in successfully managing a diverse range of primary care presentations, without compromising equity in healthcare provision. By expanding access and preserving continuity of care, telehealth emerges as a valuable tool in addressing the pressing healthcare challenges faced by New Zealand's GPs.