Stepping Up To Insulin: A Cluster Randomised Trial Of Team-based Transition To Insulin In Primary Care For Patients With Poorly Controlled Type 2 Diabetes
Funder
National Health and Medical Research Council
Funding Amount
$796,751.00
Summary
Helping people control their diabetes through the best possible medical care is important. Most people with diabetes eventually need insulin yet this is a step in treatment that is often resisted by patients and GPs. This study will help GPs and Practice Nurses work with patients who have reached this stage make the change to insulin treatment in a safe, effective, convenient and timely way. This will have enormous benefits through reduced diabetes complications and improved quality of life.
Primary Health Care Errors Study: Qualification And Quantification Of Errors Occurring In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$191,000.00
Summary
The General Practice Errors Study (GPES) is a project that aims to examine errors that GPs notice in their daily practice, that affect patient well-being or care. Very little work has been done on this subject in General Practice in any other country, and Australia is the only country with previous research that has attempted to describe GP errors with the Quality in Australia Health Care Study (QAHCS). However, we have so far not had any research that has been done on a representative sample of ....The General Practice Errors Study (GPES) is a project that aims to examine errors that GPs notice in their daily practice, that affect patient well-being or care. Very little work has been done on this subject in General Practice in any other country, and Australia is the only country with previous research that has attempted to describe GP errors with the Quality in Australia Health Care Study (QAHCS). However, we have so far not had any research that has been done on a representative sample of GPs, or been able to quantify the frequency with which different types of errors occur. This study plans to ask a representative sample of GPs in both urban and rural areas to report their errors, so that we can try to quantify the incidence and prevalence of these different error types. No previous work has been done in Primary care which has attempted to determine the rate of recognized errors that occur in the community. In addition, since the last major work on this topic was done between 1993 and 1998, there have been many changes to General Practice, especially in the area of computerisation, and the types of problems that GPs face now may have changed significantly. Anonymous reporting is very important in order to encourage health professionals to admit to their mistakes, and in the past, projects have used paper based reporting forms, making it difficult to offer anonymity and requiring protection for participants under a Commonwealth Act of Parliament. However the GPES project will be the first major study of General Practice errors that uses an on-line anonymous reporting form, and high level encryption, located on a secure web-site, to encourage honest reporting. The reporting form was trialled in the 2001 pilot study. By analysing the types of errors occurring, and their contributing factors, we can target at-risk population groups and develop strategies to improve patient care and prevent future harm.Read moreRead less
Trial Of Structured Support To Enhance The Role Of Non-GP Staff In Chronic Disease Management In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$780,625.00
Summary
Chronic disease presents a significant burden to individuals and the health care system , contributing to both an increasing proportion of the work of primary health care practitioners and to health expenditure. A number of interventions have been shown to result in sustained improvement of health outcomes for people with chronic diseases, including: more effective use of non-physician providers of care and nurse case management; integration of self-management support programs with guideline bas ....Chronic disease presents a significant burden to individuals and the health care system , contributing to both an increasing proportion of the work of primary health care practitioners and to health expenditure. A number of interventions have been shown to result in sustained improvement of health outcomes for people with chronic diseases, including: more effective use of non-physician providers of care and nurse case management; integration of self-management support programs with guideline based treatment plans; more intensive follow up and registries that provide reminders and feedback. While some of these approaches have been pursued within the Coordinated Care Trials and the Enhanced Primary Care (EPC) program in Australia, the role of non medical staff within general practice in chronic disease care has not been systematically investigated. In 2001 the Commonwealth introduced a number of initiatives to support better quality of care for diabetes and asthma in general practice and $104.2 million over four years was provided for general practices in areas of high workforce pressure to employ more Nurses. The roles of the Practice Manager and Receptionist have received much less attention. They include faclitating access to care, supporting the delivery of quality clinical care by the practitioners through the provision of expert management services (primarily information technology, staff, financial and facilities management) to the practice. With recent government initiatives expanding the role of general practice in Australia, effective management structures and processes within general practices are vital. Non-GP general practice staff may be the means by which more effective chronic disease management can be achieved at a time of increasing workforce pressure. This project aims to evaluate the impact of a program in which non-GP staff are trained and facilitated to be involved in the management of patients with chronic disease.Read moreRead less
Systematic Practice-based Asthma Care In The Australian Setting
Funder
National Health and Medical Research Council
Funding Amount
$563,625.00
Summary
Asthma is an illness which increasingly is affecting the health and quality of life of millions of Australians. Much effort has been focused in recent years on ways of improving the management of those people who suffer from moderate and severe asthma. A recent government initiative has been to promote the use of the 3+ Visit Plan, which encourages a more proactive, systematic approach to assessing and treating asthma in general practice. There is currently no evidence about exactly how practice ....Asthma is an illness which increasingly is affecting the health and quality of life of millions of Australians. Much effort has been focused in recent years on ways of improving the management of those people who suffer from moderate and severe asthma. A recent government initiative has been to promote the use of the 3+ Visit Plan, which encourages a more proactive, systematic approach to assessing and treating asthma in general practice. There is currently no evidence about exactly how practices can best be organized to provide this systematic care, in a way which improves the process of care and the health outcomes for patients. This study aims to evaluate the effectiveness of changing aspects of practice organization and structure, such as setting up registers of asthma patients, providing recalls or reminders to patients to come in for regular review, having the GPs provide education and self-management skills to patients, focusing on the contributions which practice staff can make to the process, and initiating quality assurance measures such as audit and feedback to the GPs about their quality of care. We anticipate that these changes will provide positive benefits for the patients, but will also investigate what it costs the practices, patients and government to bring these changes about, within the perspective of efficiency and cost-effectiveness. The evidence generated by this study will provide an excellent base for providing advice to policy makers, as well as contributing to the development of best-practice models of care for asthma patients in general practice.Read moreRead less
PEACH Study- Patient Engagement And Coaching For Health: An Intensive Treatment Intervention For Patients With Type 2 Di
Funder
National Health and Medical Research Council
Funding Amount
$499,263.00
Summary
This study uses practice nurses integrated in existing general practice structures to implement telephone coaching for patients with type 2 diabetes (T2D) in a disadvantaged community. This is an evidence based patient empowerment strategy designed to increase patient self-management and engagement with the health care system to improve health outcomes.
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
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.
Testing, Translation And Uptake Of Evidence In General Practice: A Systems Approach To Rapid Translation
Funder
National Health and Medical Research Council
Funding Amount
$2,411,050.00
Summary
Testing, Translation & Uptake of Evidence in General Practice: A systems approach. Though General Practice is the frontline of Australia’s health system, new research findings are often ignored by busy GPs, resulting in suboptimal care. We plan to improve this by: A. A network of influential GPs practices to test new research, B. Practice support units who provide GP and patient summaries of new research, C. Active transfer of successful new practices via social media, guidelines, and courses.