Case studies learning outcomes
Click on the case study title below to view its learning outcomes
Asthma: optimising control in children
How would you help a 4-year-old boy presenting with worsening asthma symptoms (asthma diagnosed 6 months ago)?
This case study examines and clarifies this question, using a single patient presentation.
Learning outcomes
On completion of this case study, you should be able to:
- select age-appropriate preventer medicines and devices to support asthma management in young children
- monitor treatment and incorporate regular assessment of inhaler technique to improve medication efficacy and optimal symptom control
- use and apply the Australian Asthma Handbook guidelines when making treatment recommendations
- develop written asthma action plans that are individualised to the patient.
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Blood pressure: measure, manage and monitor
A 55-year-old man presents for a routine consultation to pick up a repeat prescription for his asthma medicine and to discuss recent blood test results. During the consultation you learn of his concern about having a heart attack.
Learning outcomes
On completion of this case study, you should be able to:
- implement a systematic approach to assessment of absolute cardiovascular risk to identify patients that need BP lowering medicines
- identify appropriate treatment options for starting therapy, intensifying therapy and de-prescribing when warranted
- apply in-clinic and out-of-clinic blood pressure measurements when starting and reviewing therapy
- verify the active ingredient(s) contained in blood pressure lowering medicine(s) and explain them to patients to minimise potential confusion and improve adherence
- recognise the importance of recommending lifestyle changes and assessing adherence to medicines.
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Chronic pain: Supporting patients to taper opioids
A 42-year-old woman requests a repeat prescription for opioids at a first consultation with a GP she has not seen before. She has chronic non-cancer pain and has been taking opioids for 4 years. Where do you go from here?
Learning outcomes
On completion of this case study, you should be able to:
- Discuss contributing psychosocial factors with patients with chronic non-cancer pain to develop individualised goals that improve function and quality of life.
- Explain the limited role of opioids in the management of chronic non-cancer pain to better inform patients of their treatment options.
- Review and identify patients who may benefit from tapering opioids to reduce adverse effects of long-term opioid use.
- Implement effective communication when discussing tapering with patients to support lowering or stopping opioids.
- Apply referral criteria to identify patients who may require additional support and access to specialists to improve health outcomes.
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Diagnostic imaging in acute ankle and knee injuries
This course presents two case histories of injuries (ankle and knee) commonly seen in general practice, with questions designed to lead you through the diagnosis and management of each injury.
Learning outcomes
On completion of this case study, you should be able to:
- Apply Ottawa Knee Rules and Ottawa Ankle Rules to help decide whether an X-ray is required for a probable acute knee/ankle fracture.
- Identify appropriate physical tests based on a targeted history to diagnose acute knee/ankle injury.
- Explain the limited role of MRI in diagnosing acute ACL/meniscal tear.
- Explain the limited role of ultrasound in diagnosing lateral ankle sprain.
- Identify relevant clinical information to include in a detailed imaging referral for acute knee/ankle injury.
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Intensifying treatment in type 2 diabetes
Two patients with diabetes at different stages – how do you individualise your approach?
Learning outcomes
General practitioners
On completion of this case study, you should be able to:
- Use a stepped approach to managing glucose control, based on the latest treatment algorithm.
- Choose between glucose-lowering medicines, based on their relative advantages and disadvantages and individual patient characteristics.
- Assess adherence to medicines and lifestyle modifications and address factors that influence poor adherence in patients with type 2 diabetes.
- Monitor blood glucose control, adverse effects of medicines and adherence in diabetes medicines at regular intervals.
Pharmacists
On completion of this case study, you should be able to:
- Outline the glucose-lowering medicine options available, based on their relative advantages and disadvantages.
- Assess adherence to medicines and lifestyle modifications and address factors that influence poor adherence in patients with type 2 diabetes.
- Review medicines use in line with an individualised stepped treatment approach to type 2 diabetes management.
- List and explain the importance of monitoring parameters for patients with type 2 diabetes.
Nurses and other health professionals
On completion of this case study, you should be able to:
- Outline the glucose-lowering medicine options available, based on their relative advantages and disadvantages.
- Assess adherence to medicines and lifestyle modifications and address factors that influence poor adherence in patients with type 2 diabetes.
- Explain the individualised, stepped and progressive treatment approach to type 2 diabetes management.
- List and explain the importance of monitoring parameters for patients with type 2 diabetes.
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Navigating inhaled medicines management in COPD
How do we navigate the confusing array of inhaled medicines for chronic obstructive pulmonary disease (COPD) to ensure optimal symptom management with minimal side effects?
This case study has content and questions tailored to different health professions.
Learning outcomes
General practitioners
On completion of this case study, you should be able to:
- Tailor a patient’s medicines to the level and progression of COPD symptoms, using stepwise management based on COPD-X Guidelines.
- Describe the place of inhaled corticosteroids in therapy and outline the risks associated with their use in COPD.
- Review a patient’s medicines list when changing therapy, after an exacerbation or after transitions in care, to avoid harmful duplications.
- Describe key considerations that may influence choice of inhaler.
- Implement a practice-based approach to ensure patients receive training in inhaler technique and both technique and adherence are regularly monitored.
Pharmacists, nurses and other health profesionals
On completion of this case study, you should be able to:
- Outline the stepwise approach to medicines management in COPD, based on COPD-X Guidelines
- Review a patient's medicines list after therapy is changed, exacerbations or transitions in care, to avoid harmful duplications
- Recognise the importance of assessing and demonstrating inhaler technique to help patients use inhalers effectively
- Implement a systematic (or practice-based) approach to ensure patient inhaler technique and adherence are regularly taught and monitored.
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Optimising rheumatoid arthritis treatment
How do pharmacists counsel patients taking medicines for rheumatoid arthritis and address barriers to low-dose methotrexate use that their patients may face?
This case study has content and questions tailored to pharmacists.
Learning outcomes
On completion of this case study, you should be able to:
- Identify methotrexate as the recommended first line therapy in rheumatoid arthritis (RA) for most patients.
- Define the role of folic acid in managing adverse effects of methotrexate therapy.
- Recognise potential barriers to patient adherence and help overcome them by counselling patients and dispelling common myths about methotrexate therapy.
- Reinforce the importance of ongoing monitoring in RA to assess disease activity, treatment efficacy and adverse effects.
- Recommend strategies to help patients with RA undertake lifestyle modifications such as stopping smoking and managing their weight.
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Optimising statin therapy
How do we optimise a patient's statin therapy for the management of dyslipidaemia with minimal side effects?
This case study has content and questions tailored to different health professions.
Learning outcomes
General practitioners
On completion of this case study, you should be able to:
- Interpret lipid levels in the context of absolute CV risk.
- Discuss the factors to consider when selecting and tailoring statin therapy.
- Use an adequate trial of statins to optimise lipid lowering before adding a second lipid-modifying agent.
- Identify the symptoms and risk factors of statin-associated muscle symptoms (SAMS) and apply a systematic approach to assessing and managing SAMS.
Pharmacists, nurses and other health profesionals
On completion of this case study, you should be able to:
- Recognise the role of overall absolute CV risk approach in patients with dyslipidaemia.
- Discuss the factors to consider when selecting and tailoring statin therapy.
- Counsel patients on what to expect when starting a statin.
- Recognise that true statin-associated muscle symptoms (SAMS) are less common than expected and rarely life-threatening.
- Assess suspected SAMS systematically and refer appropriately for further management.
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Otitis media: Clarifying the role of antibiotics
This activity examines and clarifies the role of antibiotics for acute otitis media, using two different patient presentations.
Learning outcomes
General practitioners
On completion of this case study, you should be able to:
- Outline recommended pharmacological management of acute otitis media (AOM)
- Assess the need for antibiotic therapy in patients with AOM
- Reassure patients and/or their carers that in most cases, AOM can be adequately managed without antibiotics
- Recognise appropriate prevention strategies for AOM
- Deliver appropriate management of AOM using risk factor assessment and shared decision making with the patient and/or their carer
Pharmacists, nurses and other health profesionals
On completion of this case study, you should be able to:
- Outline recommended pharmacological management of acute otitis media (AOM)
- Reassure patients and/or their carers that in most cases, AOM can be adequately managed without antibiotics
- Identify appropriate prevention strategies for AOM
- Recognise when antibiotic therapy may be needed in patients with AOM
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PPIs: reviewing treatment for gastro-oesophageal reflux disease
Bill, a 69-year-old man, is requesting a repeat prescription for his PPI. He has been taking pantoprazole 40 mg daily for the last 6 months. What now?
Learning outcomes
General practitioners
On completion of this case study, you should be able to:
- Apply guideline recommendations for proton pump inhibitor (PPI) use in gastro-oesophageal reflux disease (GORD)
- List rare but serious adverse effects associated with PPI therapy
- Explain the advantages of and barriers to stepping down and stopping PPI therapy in patients with adequately controlled GORD symptoms
- Develop a plan when starting treatment for GORD, including lifestyle changes and PPI therapy, with clarity on stepping down and stopping, and review times
- Discuss and manage expectations when stepping down or stopping PPI therapy, and provide strategies to manage potential rebound acid hypersecretion
Pharmacists, nurses and other health profesionals
On completion of this case study, you should be able to:
- Describe guideline recommendations for proton pump inhibitor (PPI) use in gastro-oesophageal reflux disease (GORD)
- List rare but serious adverse effects associated with PPI therapy
- Explain the advantages of and barriers to stepping down and stopping PPI therapy in patients with adequately controlled GORD symptoms
- Explain what is involved in stepping down and stopping PPI for GORD, including clear expectations and review times, and appropriate lifestyle changes
- Discuss strategies to manage potential rebound acid hypersecretion when stepping down or stopping PPI
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Practical tools for osteoarthritis management
How do healthcare professionals meet the challenges of putting into practice the non-pharmacological treatment options that are the core management for patients with osteoarthritis (OA)
Learning outcomes
On completion of this case study, you should be able to:
- Recognise the central role of non-pharmacological management, including education, self-management, weight management and exercises.
- Explain the appropriateness of OA management strategy based on guidelines, considering patient safety, preferences, motivations, needs and goals.
- Contribute to the development of an individualised OA management plan with a patient.
- Contribute to the implementation of a weight loss program, including adherence.
- Identify different types of exercises and their role in OA management.
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Preventing fractures: where to start with osteoporosis
During a recent hospital admission, a chest X-ray revealed a vertebral fracture in a 57-year-old man. How would you assess for risk of osteoporotic fracture risk, and what are the management options?
Learning outcomes
On completion of this case study, you should be able to:
- implement a systematic approach to assess, manage and monitor osteoporotic fracture risk
- recognise risk factors for osteoporotic fractures to determine those requiring investigation
- recognise secondary causes of osteoporosis for prevention of osteoporosis or management of osteoporotic fracture risk
- outline management options for those at increased risk of osteoporotic fractures (the role of lifestyle as a complement to pharmacotherapy)
- identify strategies to promote adherence to management in patients being treated for osteoporosis.
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Tailoring initial treatment in depression: Re-examining the options
Two different patients with depression. How would you progress their initial care?
Learning outcomes
General practitioners
On completion of this activity, you should be able to:
- Develop management plans in collaboration with patients who have depression.
- Suggest non-pharmacological interventions first-line for mild and moderate depression when these can be as or more effective than antidepressant medicines.
- Select and trial a suitable antidepressant considering both medicine and patient characteristics, when starting pharmacological treatment.
- Employ strategies to improve patient adherence to treatment.
- Implement a systematic approach to starting and assessing treatment for depression, in line with current guidelines.
Pharmacists
On completion of this activity you should be able to:
- Discuss management plans with patients who have depression.
- Outline non-pharmacological interventions for mild and moderate depression that are likely to be as or more effective than antidepressant medicines.
- Assess for, and discuss, adverse effects of antidepressants.
- Employ strategies to improve patient adherence to treatment with antidepressant medicines.
Nurses and other health professionals
On completion of this activity you should be able to:
- Develop management plans with patients who have depression.
- Outline non-pharmacological interventions for mild and moderate depression that are likely to be as or more effective than antidepressant medicines.
- Assess for, and discuss, adverse effects of antidepressants.
- Employ strategies to improve patient adherence to treatment with antidepressant medicines.
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Taking action for acute low back pain
Kyle, a 47-year-old man, presents with a history of low back pain for 8 days. He wants to know if he has damaged his back and is requesting imaging. What now?
Learning outcomes
General practitioners
On completion of this activity, you should be able to:
- Use a targeted history and physical examination to diagnose low back pain.
- Identify the limited role of imaging for low back pain, except when an underlying serious condition is suspected.
- Use a risk stratification approach to identify risk factors for poor prognosis for patients with low back pain at the first or second consultation.
- Outline the benefits of activity and the limited role of medicines in managing low back pain.
Nurses, pharmacists and other health professionals
On completion of this activity you should be able to:
- Explain to a patient that low back pain is diagnosed through a targeted history and physical examination.
- Identify the limited role of imaging for low back pain, except when an underlying serious condition is suspected.
- Use a risk stratification approach to identify risk factors for poor prognosis for patients with low back pain.
- Outline the benefits of activity and the limited role of medicines in managing low back pain.
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Urinary tract infections: exploring antibiotic treatment
In this case study you will meet an 82-year-old woman who is a resident in the local residential aged-care facility. Today her carer reports the symptom of urge incontinence and goes to the toilet frequently at night.
Learning outcomes
On completion of this case study, you should be able to:
- classify diagnosis based on presenting symptoms
- define management of a urinary tract infection to reduce antibiotic resistance
- determine prophylactic management options for recurrent urinary tract infections
- implement a systematic approach to review patient’s current medicines and their ongoing use.
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