What is General Internal Medicine research about?
General Internal Medical (GIM) services are tasked with providing care to patients who may have not just one, but a number of co-existing medical conditions that require attention. We often now refer to this as “multi-morbidity”, a phenomenon that is fast becoming the norm as our population ages, with most of us accumulating more than one chronic disease as we get older. This is in many ways the big challenge of modern healthcare: how do we provide effective co-ordinated care of patients whose multiplicity of problems creates a challenge of co-ordinating complex requirements in an effective way?
Given the rising rates of multi-morbidity in our ageing healthcare population, it is not surprising that GIM services are becoming more and more important in our healthcare system. At Western Health, GIM is now our largest non-obstetric inpatient service, as is the case for most Australian health services. As an example, so far, about two thirds of all inpatients treated for COVID-19 at Western Health have been managed by our GIM Unit. This reflects the fact both that multi-morbidity is so prevalent, but also that it is the major risk factor for poor outcomes of COVID-19 infection, as is the case with so many other infections. Understanding the relationship between infectious disease and chronic disease so that we can develop more effective care in this scenario is therefore a major aspect of our research.
Our flagship research
In recent years, our flagship research has been the landmark IMPROVE-GAP (IMPROVing Evidence-Based Treatment Gaps and Outcomes in Community Acquired Pneumonia: Standardizing Evidence-Based Interventions to Shorten Length of Stay, Reduce Readmissions, Reduce Hospital Costs and Improve Patient-Reported Outcomes) study. Supported by a grant from the HCF research foundation, this study aimed to evaluate a new model of care for managing community acquired pneumonia utilizing a novel “stepped-wedge” clinical research design to address the gap between evidence and practice. Commenced in 2016, it enrolled 816 participants, making it the largest clinical trial of pneumonia conducted in Australia. Its remarkable findings were that interventions previously shown to have efficacy (including routine use of steroids, early mobilization antibiotic stopping rules) failed to translate into improved patient- or heath service- outcomes when implemented as a bundled intervention in our GIM population. This research was published in the prestigious Journal of American Medical Association (Internal Medicine) and its findings incorporated into the Infectious Diseases Society of America/American Thoracic Society treatment guidelines for pneumonia. It has seen Western Health’s GIM unit emerge as Australia’s leading academic centre for research in the GIM population. It has prompted us to think deeply about whether and how evidence from clinical trials conducted under tightly controlled clinical trial conditions translates to real effectiveness when implemented in the “real world” under routine conditions of care. This and other areas of research interest are detailed below
What are our research priorities?
- Acute respiratory infections (including COVID-19 and community-acquired pneumonia) in elderly and multi-morbid patients.
- Health services research including care delivery models and health economic aspects.
- Infectious diseases complicating chronic illness.
- Nutritional deficiencies and interaction with infectious diseases and chronic disease.
- Migrant, refugee health and health needs of culturally and linguistically diverse patients.