Background and Aim:
The misuse of proton-pump inhibitors (PPIs) was a concern to both clinicians and pharmacists in the Western Cape for many years. This medicine was reported as ‘problem prone’ by clinicians and an unnecessary ‘high use’ item by the pharmacists. This misuse was however based on perception. In 2019 the Provincial Pharmacy and Therapeutics Committee (PPTC) prioritised the investigation of the use of PPIs in the public sector of the Western Cape.
Methods:
A narration of a HSI journey steered by the three authors (members of the PPTC) to investigate the concerns about the misuse of PPIs using the medicine-use-evaluation (MUE) methodology. Once confirmed, MN and YJ proceeded to co-ordinate a solution-seeking process by interviewing and working with identified relevant stakeholders to produce a tool that would guide the deprescribing of PPIs. These stakeholders included primary care clinicians, pharmacology and pharmacy students from local universities, members of the PPTC & MUE committee and the gastroenterologists from the 2 tertiary hospitals of the province.
Results:
The outcome: An official Western Cape circular was released in 2021 to provide guidance for safe use of PPI. Subsequently, various PTCs embarked on a training drive for prescribers, dispensers and using a tool in circular H29/2021.
Conclusion:
This is an example of a collaborative project to improve medicine safety for communities in the Western Cape that was co-led by a Family Physician.

1. In every setting where medicines are prescribed and/or dispensed, there should be a monitoring and evaluation system in place to prevent harms that are related medicine-misuse. 2. Family physicians have skills to lead, to facilitate, to co-ordinate and to collaborate in matters related to governance of clinical services. 3. Successful projects at primary level are made possible by an engaged provincial government.

Supporting patients experiencing distress is an everyday part of primary care clinical encounters. Whole-person care offers the potential to improve clinician responses to distress, however clinicians need guidance in practicing and applying the tenets of whole person care, particularly to integrate both objective biomedical and subjective psychosocial forms of knowledge. Previous research has found that attending to a person’s sense of safety (the domains or areas in their life in which they feel safe and the dynamics or processes they use to build safety), offers clinicians an organizing framework to provide whole person care. This research builds on this by exploring through focus groups, what language can help people to describe how safe they feel in themselves and in their world, and how practitioners can observe patterns of behaviour that are suggestive of how safe a patient is feeling, to inform the development of practical clinical tools. A total of 76 practitioners from Norway, USA, Netherlands, and Australia participated from a range of disciplines including general practice, social work, education, and allied health. Through qualitative analysis, practical observations clinicians used to sense safety were identified as well as reflective questioning that clinicians engaged with to assess safety. Additional themes included the dynamics of the practitioner and patient relationship, such as the clinician noticing self, other (patient) and the interactions within. The findings presented in this research presentation will contribute to practitioner knowledge of how to assess patient safety and provide whole person care in the context of distress.

1. Practical observations and questions to inform reflective clinical practice to assess whether a patient is experiencing distress
2. Increased knowledge of how the Sense of Safety framework can support clinicians to understand how a patient may need to be supported to build their sense of safety
3. Increased appreciation for the complex dynamics and barriers within a clinical encounter that can impact patient and practitioner safety

Introduction
The core functions of primary care (PC) are first-contact access, continuity, comprehensiveness, coordination and person-centredness. These should be measured to evaluate PC performance. No previous study has evaluated the core functions of primary care in Kenya. This study aimed to measure these key elements in the primary care clinics in the private sector in Nairobi.

Aim
Evaluation of the quality of service delivery in primary care facilities in the private sector in Nairobi.

Methods
Five descriptive cross-sectional studies measured PC performance. Firstly, a survey of patient perceptions on the comprehensiveness of care (N=162). Secondly, a survey of patient satisfaction using the General Practice Assessment Questionnaire (N=378). Thirdly, an evaluation of recorded consultations using the Stellenbosch University Observation Tool (N=23). Fourthly, an evaluation from the patient’s perspective, using the Primary Care Assessment Tool (KE-PCAT) that was validated for the Kenyan context (N=412). Lastly, a survey measured clinical skills of the General Practitioners (N=25).

Results
Primary-care doctors were mostly young, without postgraduate training in family medicine, and lacked basic skills. First-contact access was good for acute minor problems, although older patients and those with chronic conditions appeared to primarily use the specialists at the tertiary hospital. Informational continuity was well supported by an electronic patient record linked with the associated tertiary hospital, that enabled care-coordination. Care comprehensiveness showed gaps in management of chronic conditions, women’s health and preventative care. There was little need for sequential care coordination. Consultations were brief, of low-to-moderate complexity and doctor-centred. The mean PC score was 2.64 (SD=0.23) implying poor overall performance.

Conclusion
The studies confirmed that this private health care system was not offering comprehensive and high-quality primary care. Care and performance could be improved by re-designing the model of care, deploying family physicians and training the PC doctors. Quality improvement cycles using KE-PCAT is recommended.

1. Importance of measuring primary care performance in the key
domains of high quality service delivery.
2. Use of validated and adapted tools such as KE-PCAT, GPAQ, and
SUOT.
3. Competencies and training of general practitioners.

Since the Covid 19 pandemic a lot of valuing doctor’s exchanges or temporarily medical missions in remote areas have been stopped. For instance in our country, some 87 non-governmental organizations (NGO) are established and some 52 has a primary medical program. We wanted to find out how far this exchange, as it will be reactivated nowadays, is still a good medical collaboration between remote populations without access to local GPs and the temporarily expatriated GPs. A standardized methodology has to be applied in order to find out positive and negative aspects that might be targeted or questioned. SWOT analysis is one of the tools that may combat our too narrow vision and be more objective about our processes. The acronym stands for: strengths, weaknesses, opportunities and threats. A) Strengths in this field means: to bring the medical expertise where local GPs are missing; to get knowledge on diseases which you never saw in your own country B) Weaknesses: by sending regularly expatriated physicians, you will not allow local organizations to fill in the gap through local workforces; local authorities might get too much dependant on foreign GPs and local doctors might choose to leave their native areas. C) Opportunities: by a real exchange and training in two ways, both sides may have a win-win situation ; by the fact that both sides are looking on different cultures or medical approaches in siumilar diseases, there will be a better understanding in both surroundings D) Threats: it is always easy to start a kind of medical humanitarian aid, but it is much more difficult to let local GPs take over this whole task; keeping authorities dependant on GP and money transfer is not what most countries need or want. Mutual respect, understanding and trust are a minimum for a good collaboration.

1.impact of exchanges, 2.positive and negative aspects, 3.valuing both sides

Chronic Kidney Disease (CKD) affects 10% of adult Australians, causing significant health problems and putting a strain on the healthcare system. CKD is linked to other risk factors such as diabetes and high blood pressure, making it important to manage these conditions. An annual kidney health check is recommended for those at risk. Early detection of CKD can slow the progression of the disease by up to 50% and improve overall outcomes. However, a study found that only 20% of patients with laboratory evidence of CKD had received a diagnosis from their GP.
To address this gap in care, a trial clinical audit program was developed and delivered for 11 General Practices in Australia. The dual aims were to improve the coding of CKD in medical software and assess the program as an acceptable continuing professional development (CPD) activity for GPs in light of upcoming CPD changes. The program received positive feedback from 100% of the General Practitioners completing the audit, as they found it relevant to their everyday practice and a valuable opportunity for the whole practice team to discuss CKD care and provide feedback on improving their systems. However, 2 out of 11 practices were unable to complete the program due to COVID-related challenges.
Other key findings:
• The prevalence of CKD in practice populations was underestimated by most clinicians
• CKD risk factors were more common in the practice population than expected (over 50% of each practice's active adult population had at least one risk factor)
• Low level of coding for CKD is a major safety and quality risk in General Practice because prescribing safety relies on the coding to occur before renal issues are altered to the GP by the clinical software
• Attention to CKD management goals improved when reviewing practice data

At the conclusion of my presentation attendees will take away the following:
1. the prevalence of CKD and it's risk factors in Australian General Practice is far higher than they expect
2. Attending to clinical coding of CKD is major quality and safety activity in a general practice
3. Clinical audit activities as a practice team are an acceptable and under-utilised approach to CPD, team building and improving outcomes across the practice population

Aim
The Medical Pathway, formed in 2021 offers students the opportunity to train and prepare for a medical career in regional, rural and remote Queensland. The pathway is a unique partnership between 2 universities and 2 health services, allowing students to complete their medical training from undergraduate through to Fellowship in the Darling Downs and South West regions. This powerful collaboration is between The University of Queensland (UQ), The University of Southern Queensland (UniSQ), and two public hospital and health services (Darling Downs & South West) with a vision to deliver local ‘end-to-end’ medical education and training.

Content
The implementation of the Medical Pathway, an evidence-based workforce strategy, is pivotal in improving health service access for Darling Downs and South West communities. Longitudinal studies¹ have shown that students who study in regional and rural communities for longer than one year are four times more likely to continue to live and work in those communities after graduation. There have been fundamental changes undertaken across the partners including: creation of a local undergraduate program provided by UniSQ with a provisional entry pathway to the UQ medical program; changes to the UQ medical program to include specific curriculum content on rural general practice supporting more general practice education and experiences; and an education program with unique clinical rotations, designed to support general practice and rural generalism in prevocational training.

Goals
The foundation cohort of 22 students have commenced the Medical Pathway this year and are expected to graduate with a Doctor of Medicine in 2027. This presentation will describe the progress and changes to date, focussing on the hospital prevocational component, and outline the vision for future growth.

¹ Kondalsamy‐Chennakesavan, Srinivas, et al. "Determinants of rural practice: positive interaction between rural background and rural undergraduate training." Medical Journal of Australia 202.1 (2015): 41-45

1. Evidence-based strategies on how to train and retain a rural general practice workforce.
2. How organisations can collaborate across the training and employment continuum for a shared goal.
3. How to make changes to support to rural general practice education.

Sexually transmitted Diseases (STD) is a major public health concern in both resource-rich and limited clinical settings. The main aim of a STD friendly clinic is to screen, identify, educate, and treat infected persons and their sex partners. There were 2 HIV and 5 syphilis cases detected in Ayer Tawar Health Clinic (KKAT) from year 2018 to 2021. After utilizing existing resources and manpower, STD Clinic KKAT was established on 25 March 2022. Within a 2-month period, a total of 39 clients utilized this service. The strategies implemented for the success of this STD friendly clinic included allocating a private room and waiting area with a fast-track service. A day and time were fixed to be on Fridays, 3-5pm. This allowed privacy for clients away from other patients. Appointments were obtained via mobile line (012-59120520) to avoid overcrowding and reduce waiting time. This STD friendly clinic service was promoted in the key populations dating app such as Grindr for men-sex-men (MSM). Non-Governmental Organizations (NGO) nearby (eg.PEKASIH) was involved to identify and refer clients to the clinic. By 31st of December 2022, 75 new clients utilized this service. Ethnicity distribution were 56%(n=42) Malays, 25.3% (n=19) Chinese and 18.6% (n=14) Indians. 82.6%(n=62) of the clients were from the age group of 20–34 years old, predominantly within the age of 20-24 years old [32%(n=24)]. The highest risk factor identified was (MSM) behavior 82.7%(n=62). A total of 11 HIV cases were detected. 9 of them are still actively under KKAT follow up and adhered to the anti-retroviral therapy prescribed. Furthermore, 14 syphilis cases have been detected and treated. 11 confirmed chronic Hepatitis C cases were detected, and all achieved sustained virologic response (SVR12) after completing Direct acting antiviral (DAA) for 3 months. Lastly, there were 1 Hepatitis B and Gonorrhoea detected respectively.

At the conclusion of my presentation, attendees will take away
1. A community friendly STD clinic is the way forward to achieve the target 90-90-90 by WHO in eliminating AIDS by 2030.
2. The health promoting programs should reach out to key populations
3. The “Equalize” slogan is a call to action, one shall not discriminate the minority and the key populations.

New pregnancy is a period of intense development; physically for the growing foetus, and both physically and mentally for the parent to be. Early optimisation of health in pregnancy can promote better health outcomes in new babies, so much so that interventions like the supplementation of folate and iodine are considered routine in antenatal care (Department of Health, 2020). Many other areas of preventative health are also important in the early care of pregnant people, for example abstaining from alcohol, an awareness of potentially toxic foods to the foetus, and the options for vaccines and chromosomal screening (Department of Health, 2020). This equates to an enormous amount of information that needs to be conveyed to the pregnant person, as early as possible in the pregnancy. How do General Practitioners (GPs) manage early antenatal care in the time pressured, multi-priority primary care setting?

The study being presented is a qualitative look into the way GPs are currently approaching this clinical problem in Victoria, Australia. Via focus groups with GPs and thematic analysis techniques, the barriers and facilitators to providing antenatal care in General Practice will be explored and described. Some take home tips learnt from this study will aim to help primary care doctors optimise their provision of early antenatal care.

1. An understanding of the current methods GP's use to provide early antenatal care
2. An overview of the key barriers to providing early antenatal education in primary care
3. An understanding of tools and facilitators that help GP's to provide this vital education in early pregnancy