Volume 49, Issue 3, March 2020

March correspondence

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The opinions expressed by correspondents in this column are not endorsed by the editors or The Royal Australian College of General Practitioners.

Lifestyle interventions for mental health

I thank Dr Manger for his article on lifestyle interventions for mental health, and his highlighting of the link between sleep disorders and psychiatric disorders.1

Patients presenting to their general practitioner (GP) are rarely asked about their sleep health, despite the prevalence and consequences of sleep disorders.2 Sleep disorders and issues with sleep affect up to 56% of the adult population in Australia,3 with significant multisystem health, cognitive, social and occupational consequences.4

As highlighted by Dr Manger, sleep disorders are found in 40% of patients with psychiatric illness.1 It is difficult to ascertain whether issues with sleep may contribute to the aetiology of psychiatric illness, or whether the sleep disorder is simply a manifestation of the psychiatric illness.

Regardless, improvements in sleep may not only benefit people with their psychiatric illnesses,5 but may also lead to improvements in cognition, immune function, social behaviour, cardiovascular performance and blood glucose control.6 Given the widespread health implications of poor sleep, further awareness by GPs may lead to an increase in sleep disorder identification.

Phillip Cantwell
Plastic Surgery Registrar
Perth Children’s Hospital, WA

  1. Manger S. Lifestyle interventions for mental health. Aust J Gen Pract 2019;48(10):670–73. doi: 10.31128/AJGP-06-19-4964.
  2. Papp KK, Penrod CE, Strohl KP. Knowledge and attitudes of primary care physicians toward sleep and sleep disorders. Sleep Breath 2002;6(3):103–09. doi: 10.1007/s11325-002-0103-3.
  3. Appleton SL, Gill TK, Lang CJ, et al. Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey. Sleep Health 2018;4(1):13–19. doi: 10.1016/j.sleh.2017.10.006.
  4. Xie Z, Chen F, Li WA, et al. A review of sleep disorders and melatonin. Neurol Res 2017;39(6):559–65. doi: 10.1080/01616412.2017.
  5. Hombali A, Seow E, Yuan , et al. Prevalence and correlates of sleep disorder symptoms in psychiatric disorders. Psychiatry Res 2019;279:116–22. doi: 10.1016/j.psychres.2018.07.009.
  6. Vyazovskiy V. Sleep, recovery and metaregulation: Explaining the benefits of sleep. Nat Sci Sleep 2015;7:171–84. doi: 10.2147/NSS.S54036.

Measuring continuity of care in primary healthcare: Brazil’s contribution

Michael Wright’s editorial ‘Continuity of care is in the eye of the beholder’ (AJGP October 2018)1 presents to us the challenge of one of the most difficult attributes attainable by general practitioners (GPs) in Australia. He mentions Professor Barbara Starfield as one of the most important researchers who, in the 1980s, wondered how to define continuity of care. So we wonder, why not first measure the degree of extension and affiliation of all attributes proposed by the team of Professors Barbara Starfield and Leiyu Shi from Johns Hopkins Bloomberg School of Public Health over the past decades as a cross-country comparasion?2

Over the past few years, the SoFIE-Primary Care survey3 and the Primary Care Assessment Tool (PCAT) have attracted significant international interest. In Brazil in August 2019, the Brazilian Institute of Geography and Statistics (IBGE) and Ministry of Health started the largest household sample survey for all regions (National Health Survey – Pesquisa Nacional de Saúde [PNS] 2019).4 This included the Brazilian Amazon area, and involved visiting approximately 100,000 households and including in one of its questionnaire modules the adult PCAT items validated in Brazil by a research team of the Federal University of Rio Grande do Sul with the support of Professor Barbara Starfield herself.5 We encourage the Australian Census Bureau to follow the same steps, as, like Brazil, Australia is a country of continental dimensions. In addition to continuity of care, being able to create a nationally and internationally comparable baseline can assist governments in decision making to always improve the evaluation of quality of primary care services.

Erno Harzheim
General Practitioner and Associate Professor, Federal University of
Rio Grande do Sul, Brazil

Luiz Felipe Pinto
Statistician and Associate Professor,
Federal University of Rio de Janeiro, Brazil; Postdoctoral Research Fellow in Primary Care Evaluation, Instituto de Higiene e Medicina Tropical/Universidade Nova de Lisboa, Portuga

Otávio Pereira D’Ávila
Dentist in Primary Health Care and Adjunct Professor, Federal University of Pelotas, Brazil

Lisiane Hauser
Statistician and Professor, Primary Health Care in Telehealth, Federal University of
Rio Grande do Sul, Brazil


  1. Wright M, Mainous AG 3rd. Can continuity of care in primary care be sustained in the modern health system? Aust J Gen Pract 2018;47(1):667–69. doi: 10.31128/AJGP-06-18-4618.
  2. John Hopkins Bloomberg School of Public Health. Primary care assessment tools. Baltimore, MD: John Hopkins University, 2016. Available at [Accessed 7 February 2020].
  3. Jatrana S, Crampton P, Richardson K. Continuity of care with general practitioners in New Zealand: Results from SoFIE-primary care. N Z Med J 2011;124(1329):16–25.
  4. TelessaúdeRS. Launch of fieldwork of Brazilian National Health Survey (PNS-2019) from Brazilian Institute of Geography and Statistics (IBGE). Porto Alegre, RS: TelessaúdeRS, 2019. Available at [Accessed 7 February 2020].
  5. Harzheim E, Starfield B, Rajmil L, Álvarez-Dardet C, Stein AT. Internal consistency and reliability of Primary Care Assessment Tool (PCATool-Brasil) for child health services. Cad Saúde Pública 2006;22(8):1649–59. doi: 10.1590/s0102-311x2006000800013.
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