People who have experienced a previous heart attack or stroke are at greatest risk of having another cardiovascular event. Drug treatment, with aspirin and medication to lower blood pressure and cholesterol, has been shown to substantially reduce this risk. Despite good evidence that these drugs are effective, and that their use is recommended in both Australian and international guidelines, many people who should be taking these medications on a long-term basis are not. This may partly be due t ....People who have experienced a previous heart attack or stroke are at greatest risk of having another cardiovascular event. Drug treatment, with aspirin and medication to lower blood pressure and cholesterol, has been shown to substantially reduce this risk. Despite good evidence that these drugs are effective, and that their use is recommended in both Australian and international guidelines, many people who should be taking these medications on a long-term basis are not. This may partly be due to under-prescribing by doctors, but it is also likely that asymptomatic patients are discouraged by the cost and inconvenience of taking many tablets. In the first study of its kind in this country, we will determine whether a strategy based on the provision of recommended treatments in a single pill (a polypill) will result in better use of these drugs, and as a consequence, will achieve optimum practice in patients with heart disease or stroke. Under the care of their general practitioner, 1000 such patients will be randomly allocated to the polypill, or to continuing their usual treatment. At the end of 2 years, both groups will be assessed for the proportion of people still prescribed and taking all recommended treatments. We will also collect information on the attitudes and experiences of those participating in the study of prescribing (by doctors), dispensing (by pharmacists) and taking (by patients) the polypill. As cardiovascular diseases are the leading causes of illness and death in Australia, finding new ways to ensure the maximum use of known, effective preventive treatments in patients with heart disease and stroke, particularly to those who have less access to health care, is of critical importance. The polypill represents a novel strategy with the potential to achieve this objective, and to improve the clinical care and well-being of many thousands of Australians.Read moreRead less
A Cluster Randomised Controlled Trial Of Nurse And General Practitioner Partnership For Care Of COPD
Funder
National Health and Medical Research Council
Funding Amount
$449,377.00
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that can progress to severe disability and use of hospital services. It is an important cause of both death and disability in Australia. Specifically it is the third leading cause of disease burden after heart disease and stroke. Smoking is the most important cause of the disease and there is strong evidence that smoking cessation will largely prevent progression of COPD. National evidence based guidelines for management of COPD w ....Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that can progress to severe disability and use of hospital services. It is an important cause of both death and disability in Australia. Specifically it is the third leading cause of disease burden after heart disease and stroke. Smoking is the most important cause of the disease and there is strong evidence that smoking cessation will largely prevent progression of COPD. National evidence based guidelines for management of COPD were published in 2003 but these need to be implemented in the community. General practice is well placed to have a key role in early intervention and evidence based management of COPD. There is evidence that specialised nurses working in collaboration with GPs can improve the care the chronic illnesses including COPD. Care Plans with input from health professionals from a range of disciplines have been recommended for COPD but there are barriers to implementing these in general practice. This project brings together nurse assistance and care planning in a model of care designed to deliver best practice management of COPD in the community. The aim of this research is to evaluate the impact of anurse and GP partnership for care of COPD. We will examine the effect on quality of care and health outcomes at 6 and 12 months follow up. Our hypothesis is that the use of a nurse to work as a team with the patient and GP to develop and implement a care plan based on clinical practice guidelines will improve the quality of care received and have a beneficial effect on the patients' respiratory and overall health. This research will be of major significance for improving COPD care in the community and will have far reaching implications for both policy and practice. It will also define a new role for nurses and GPs working in partnership.Read moreRead less
Implementing Guidelines To Routinely Prevent Chronic Disease In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$764,446.00
Summary
High quality, evidence-based guidelines for preventive activities and for the implementation of prevention in general practice have been developed by the Royal Australian College of General Practitioners and other bodies, yet available information suggests that many patients miss out on evidence-based preventive care. This project aims to evaluate current practice and develop a model of practice aimed at improving the implementation of preventive guidelines in general practice.
A Perntership Intervention Trial To Redress TreatmentDelay And Improve Outcomes In Rural Cancer Patients
Funder
National Health and Medical Research Council
Funding Amount
$1,258,784.00
Summary
Improving the poor outcomes in Australian cancer patients living in rural and remote areas is a national priority, but there is as yet insufficient evidence on how the problem is best tackled. In this project, partner organisations that deliver cancer services in non-metropolitan WA will team with experienced researchers to develop a ‘best prospects’ package of interventions targeting the community, medical and other health practitioners and patients with cancer; and to evaluate the effectivenes ....Improving the poor outcomes in Australian cancer patients living in rural and remote areas is a national priority, but there is as yet insufficient evidence on how the problem is best tackled. In this project, partner organisations that deliver cancer services in non-metropolitan WA will team with experienced researchers to develop a ‘best prospects’ package of interventions targeting the community, medical and other health practitioners and patients with cancer; and to evaluate the effectiveness of the package using a scientifically valid randomised controlled trial.Read moreRead less
Improving Asthma Control: General Practice Strategies To Optimise Medication Adherence
Funder
National Health and Medical Research Council
Funding Amount
$460,820.00
Summary
Asthma is a major health problem for Australia. Many patients have frequent symptoms and need urgent health care because they do not use a preventer inhaler regularly. This may be intentional e.g. fear of side-effects, and-or unintentional e.g. forgetting. This real-life study will test two simple strategies for GPs to improve their patients' use of preventer medications, to improve asthma control. Innovative technology will allow GPs to tailor the approach to each patient during a normal visit.
Implementing Clinical Practice Guidelines In General Practice: A Cluster Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$426,000.00
Summary
Evidence based clinical practice guidelines have the potential to improve clinical practice through providing health care workers with the most reliable information on which to base their treatment decisions. Many governments and organisations are investing significantly in the development of guidelines for common and important clinical disorders. To date, however, we do not fully understand how to increase the uptake of guidelines and facilitate health care workers to change their practice in l ....Evidence based clinical practice guidelines have the potential to improve clinical practice through providing health care workers with the most reliable information on which to base their treatment decisions. Many governments and organisations are investing significantly in the development of guidelines for common and important clinical disorders. To date, however, we do not fully understand how to increase the uptake of guidelines and facilitate health care workers to change their practice in line with the guideline's recommendations. This project aims to work with general practitioners to develop a method or strategy to increase the uptake of guidelines for the treatment of acute low back pain, particularly to reduce the number of patients who are unnecessarily x-rayed, and to increase advice to stay active. The effectiveness of the developed strategy will be tested by randomly assigning general practice clinics to either receive the intervention or to have access to the guidelines without any extra interventions (such as training and reminders) to help doctors change their practice. Both the doctor's practice, and patient outcomes of pain and disability will be measured to determine not only if the doctors followed the guidelines, but whether this resulted in an improvement in patient outcome. The findings of this study will help us understand the best ways to improve adhesion to guidelines and so has the potential to be applied to other conditions presenting to general practice where there are recommendations not currently being implemented into practice.Read moreRead less
A Randomised Controlled Trial Of Evidence Based Medicine In The Management Of Hypertension
Funder
National Health and Medical Research Council
Funding Amount
$319,475.00
Summary
Hypertension is a major condition managed in general practice. The condition is under diagnosed and under treated. Where hypertension is treated, it is often with drugs that are expensive rather than with equally efficacious inexpensive drugs. Hypertension is associated with higher risk of stroke, coronary artery disease, cardiac failure, renal disease and peripheral vascular disease. Clear evidence-based information has been available for some years that provide reasonably guidelines to practit ....Hypertension is a major condition managed in general practice. The condition is under diagnosed and under treated. Where hypertension is treated, it is often with drugs that are expensive rather than with equally efficacious inexpensive drugs. Hypertension is associated with higher risk of stroke, coronary artery disease, cardiac failure, renal disease and peripheral vascular disease. Clear evidence-based information has been available for some years that provide reasonably guidelines to practitioners of the treatment thresholds for hypertension. However, the incorporation of this evidence into general practice has been slow. This project will build upon extensive pilot work to create a system to collect diagnostic, treatment and outcome data from general practice patients. The use of peer-compared feedback, particularly related to a readily understandable health outcome measure such as blood pressure, can change clinical behaviour when provided to the treating clinician. The aim of this project is to show whether or not training in the use of an evidence-based guideline to assist doctors in the decision of whether or not to initiate antihypertensive treatment, and to provide guidance on the type of treatment, leads to better outcomes than that of feedback alone. A cost-benefit analysis will clarify the impact of guideline implementation on health care costs. The incorporation into the cost-benefit analysis of patients perceptions of treatment by doctors using a guideline will show how such practice, compared with standard care, is valued by patients. While the project will focus on hypertension, the database members will continue to develop the research capability of the database, and expand it to incorporate a range of evidence-based information to improve the quality of care for other conditions. The database could achieve an expanding and sustainable influence on the quality of primary health care.Read moreRead less