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
DESPATCH: DElivering Stroke Prevention For Atrial Fibrillation: Assisting Evidence-based CHoice In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$561,447.00
Summary
Non-valvular atrial fibrillation (NVAF) is a common heart condition associated with a major risk of fatal and disabling stroke. Inexpensive anticoagulant medication has been proven to reduce all-causes of death and stroke in patients with NVAF. Anticoagulant treatment for NVAF is substantially under-used resulting in avoidable patient deaths and disabling stroke. The National Institute of Clinical Studies of Australia summarised the large, unrealised benefit of anticoagulation, stating that 'eac ....Non-valvular atrial fibrillation (NVAF) is a common heart condition associated with a major risk of fatal and disabling stroke. Inexpensive anticoagulant medication has been proven to reduce all-causes of death and stroke in patients with NVAF. Anticoagulant treatment for NVAF is substantially under-used resulting in avoidable patient deaths and disabling stroke. The National Institute of Clinical Studies of Australia summarised the large, unrealised benefit of anticoagulation, stating that 'each year, for every 1000 patients with NVAF given anticoagulants, we can assume that about 25 fewer people will experience a stroke and 12 fewer will die from a stroke than would be the case if they were not given them'. Despite this realisation, there is a lack of evidence to support any strategy to improve the care of patients with NVAF. This study seeks to optimise the management of NVAF in general practice. The DESPATCH study will employ a rigorous randomised design to evaluate an innovative educational intervention intended to overcome barriers to the best management of NVAF. If successful, DESPATCH will inform policy and practice aimed at overcoming barriers to best practice for the large and growing number of people with NVAF to reduce the risk of fatal and disabling stroke.Read moreRead less
A Randomised Trial Of A Clinical Prediction Tool For Targeting Depression Care (Target-D)
Funder
National Health and Medical Research Council
Funding Amount
$944,774.00
Summary
The Target-D Study uses a novel clinical prediction tool to test a new approach to depression care in general practice based upon sub-grouping patients into low, medium and high risk of ongoing depression. Participants will be randomly allocated to targeted treatments based upon their risk profile or to usual general practice care. We will measure whether the new approach results in greater improvements in depressive symptoms, quality of life and functioning and whether there are cost benefits.
The Role Of Spirometry In Managing Chronic Respiratory Diseases In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$487,427.00
Summary
This study will compare the use of spirometry (a lung function test) in general practice, with and without feedback of results, against the delivery of usual medical care without spirometry. If positive, the trial will result in better health outcomes for patients with chronic respiratory disease.
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 Randomised Controlled Trial To Evaluate The Effectiveness And Cost-effectiveness Of Chlamydia Testing In General Practice.
Funder
National Health and Medical Research Council
Funding Amount
$1,377,557.00
Summary
Chlamydia is a very common sexually transmissible infection in Australia that can lead to infertility in women. About 4% of young adults have it. Most people with chlamydia do not have any symptoms and will be unaware they have it. Chlamydia is easy to diagnose and treat, but it is not known whether regular testing can reduce its spread. We propose to conduct a trial to evaluate whether annual testing for 16 to 29 year olds works and whether it would be a good use of public health funds.
Can Preventive Care Activities In General Practice Be Sustained When Financial Incentives And External Audit Plus Feedback Are Removed? A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$1,201,443.00
Summary
There is increasing debate about the effectiveness of incentive payments and audit plus feedback on the clinical behaviour of general practitioners (GPs). Governments both in Australia and the UK are raising the threshold targets for payment eligibility making it more difficult for GPs to get payments. We will conduct a trial that will investigate the impact of removing financial incentives and/or external audit plus feedback on the preventive care activities of GPs.
Translating Risk Models To Improve Prevention And Early Diagnosis Of Cancer In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$479,882.00
Summary
Primary care plays a key role in prevention and early diagnosis of cancer. This fellowship will apply evidence about cancer risk to help GPs provide tailored advice to patients about preventing common cancers. It will also use new risk tools to assess people with symptoms suggestive of cancer to support earlier diagnosis. The research extends to studies relating to how people interpret symptoms and ways of promoting earlier presentation to the GP in patients who are at higher risk of cancer.
Increasing The Use Of Long-acting Reversible Contraception: The Australian Contraceptive ChOice PRoject (ACCORd)
Funder
National Health and Medical Research Council
Funding Amount
$726,144.00
Summary
Of all reversible contraceptive methods, long-acting reversible contraceptives (LARCs), such as intrauterine devices and hormone implants, are by far the most highly effective at preventing pregnancy. However, the prescription and use of LARCs amongst Australian women who are at risk of pregnancy is very low. To increase the uptake of LARCs, our study will trial a complex intervention that involves providing counselling to women and developing rapid referral pathways to LARC insertion.