ORCID Profile
0000-0002-1266-4731
Current Organisation
Western Health
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Publisher: Ubiquity Press, Ltd.
Date: 26-02-2021
DOI: 10.5334/IJIC.S4034
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/20552076231194948
Abstract: Interrelated chronic vascular diseases (chronic kidney disease (CKD), type 2 diabetes (T2D) and cardiovascular disease (CVD)) are common with high morbidity and mortality. This study aimed to assess if an electronic-technology-based quality improvement intervention in primary care could improve detection and management of people with and at risk of these diseases. Stepped-wedge trial with practices randomised to commence intervention in one of five 16-week periods. Intervention included (1) electronic-technology tool extracting data from general practice electronic medical records and generating graphs and lists for audit (2) education regarding chronic disease and the electronic-technology tool (3) assistance with quality improvement audit plan development, benchmarking, monitoring and support. De-identified data analysis using R 3.5.1 conducted using Bayesian generalised linear mixed model with practice and time-specific random intercepts. At baseline, eight included practices had 37,946 active patients (attending practice ≥3 times within 2 years) aged ≥18 years. Intervention was associated with increased OR (95% CI) for: kidney health checks (estimated glomerular filtration rate, urine albumin:creatinine ratio (uACR) and blood pressure) in those at risk 1.34 (1.26–1.42) coded diagnosis of CKD 1.18 (1.09–1.27) T2D diagnostic testing (fasting glucose or HbA1c) in those at risk 1.15 (1.08–1.23) uACR in patients with T2D 1.78 (1.56–2.05). Documented eye checks within recommended frequency in patients with T2D decreased 0.85 (0.77–0.96). There were no significant changes in other assessed variables. This electronic-technology-based intervention in primary care has potential to help translate guidelines into practice but requires further refining to achieve widespread improvements across the interrelated chronic vascular diseases.
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-040228
Abstract: To codesign an electronic chronic disease quality improvement tool for use in general practice. Service design employing codesign strategies. General practice. Seventeen staff (general practitioners, nurses and practice managers) from general practice in metropolitan Melbourne and regional Victoria and five patients from metropolitan Melbourne. Codesign sessions with general practice staff, using a service design approach, were conducted to explore key design criteria and functionality of the audit and feedback and clinical decision support tools. Think aloud interviews were conducted in which participants articulated their thoughts of the resulting Future Health Today (FHT) prototype as they used it. One codesign session was held with patients. Using inductive and deductive coding, content and thematic analyses explored the development of a new technological platform and factors influencing implementation of the platform. Participants identified that the prototype needed to work within their existing workflow to facilitate automated patient recall and track patients with or at-risk of specific conditions. It needed to be simple, provide visual snapshots of information and easy access to relevant guidelines and facilitate quality improvement activities. Successful implementation may be supported by: accuracy of the algorithms in FHT and data held in the practice the platform supporting planned and spontaneous interactions with patients the ability to hide tools links to Medicare Benefits Schedule and prefilled management plans. Participating patients supported the use of the platform in general practice. They suggested that use of the platform demonstrates a high level of patient care and could increase patient confidence in health practitioners. Study participants worked together to design a platform that is clear, simple, accurate and useful and that sits within any given general practice setting. The resulting FHT platform is currently being piloted in general practices and will continue to be refined based on user feedback.
Publisher: Oxford University Press (OUP)
Date: 06-2019
Publisher: SAGE Publications
Date: 04-2021
DOI: 10.1177/14604582211008227
Abstract: Worldwide, Chronic Kidney Disease (CKD), directly or indirectly, causes more than 2.4 million deaths annually with symptoms generally presenting late in the disease course. Clinical guidelines support the early identification and treatment of CKD to delay progression and improve clinical outcomes. This paper reports the protocol for the codesign, implementation and evaluation of a technological platform called Future Health Today (FHT), a software program that aims to optimise early detection and management of CKD in general practice. FHT aims to optimise clinical decision making and reduce practice variation by translating evidence into practice in real time and as a part of quality improvement activities. This protocol describes the co-design and plans for implementation and evaluation of FHT in two general practices invited to test the prototype over 12 months. Service design thinking has informed the design phase and mixed methods will evaluate outcomes following implementation of FHT. Through systematic application of co-design with service users, clinicians and digital technologists, FHT attempts to avoid the pitfalls of past studies that have failed to accommodate the complex requirements and dynamics that can arise between researchers and service users and improve chronic disease management through use of health information technology.
Publisher: Wiley
Date: 09-2015
DOI: 10.1111/IMJ.12859
Publisher: Oxford University Press (OUP)
Date: 06-2020
DOI: 10.1093/NDT/GFAA142.P0746
Abstract: Chronic kidney disease (CKD), type 2 diabetes (T2DM) and cardiovascular disease are interrelated chronic vascular diseases that cause substantial morbidity and mortality. A recent 15-month randomised stepped wedge trial targeting these conditions using an electronic technology audit tool together with education, monitoring and support to general practices (Chronic Disease IMPACT) showed increased diagnostic testing for CKD and T2DM in those at risk, increased urinary albumin monitoring in people with T2DM and increased coded diagnosis of CKD, no changes for cardiovascular disease and reduced coded eye examinations in patients with T2DM. This study aimed to test if these outcomes would be sustained 12 months after the initial study period (27 months after study commencement). 15 months after initial trial commencement the 9 practices involved in the original trial received further training on quality improvement and electronic technology tool use as well as a folder containing educational resources. They retained access to the electronic technology tool but received no further education or support for 12 months. Only 8 practices were included (as with the original analysis) due to compromised data quality in one practice resulting from a recent merging of practices with different electronic medical record systems. Active patients (having attended their GP practice ≥3 times within 24 months) age ≥18 were included. Variables with evidence for effect at 15 months were re-assessed at 27 months to test sustainability of outcomes. As there were no control practices at 27 months, time was considered as a linear predictor instead of a random intercept in the analysis. Net effect is defined as the product of effect over the course of the entire 27 months and change between effect at 15 and 27 months. Raw proportion and net effect odds ratio (OR) with 95% credible interval (CI) generated through stepped wedge analysis are presented below. Analysis was conducted with R version 3.5.1. In the 8 included practices, at baseline, prior to intervention, there were 37,946 patients, at 15 months 37,385 and at 27 months 37,813. Testing for kidney disease in those at risk was completed in 19% at baseline, 25% at 15 months and 26% at 27 months with OR 1.4 (CI 1.2-1.6). CKD diagnosis was coded in 4.5% at baseline, 5.8% at 15 months and 6.8% at 27 months with OR 1.9 (CI 1.6-2.2). Testing for diabetes in those at risk was completed in 34% at baseline, 50% at 15 months and 57% at 27 months with OR 1.1 (CI 0.95-1.2). Urine albumin:creatinine ratio testing in people with T2DM was up-to-date in 56% at baseline, 65% at 15 months and 66% at 27 months with OR 1.9 (CI 1.4-2.5). Up-to-date eye checks in people with T2DM were coded in 39% at baseline, 36% at 15 months and 36% at 27 months with OR 0.97 (0.71-1.3). These results are consistent with sustained improvement in diagnostic testing of people at risk of CKD, coded diagnosis of CKD and urinary albumin monitoring in people with T2DM. Evidence for a sustained change in diabetes diagnostic testing in those at risk and coded eye examinations in people with T2DM was inconclusive. There was evidence for sustained improvement in three out of four areas that improved with the initial intervention. These results suggest a lasting benefit in outcomes achieved through clinical audit facilitated by the electronic technology-based intervention, with persistent effects 27 months from the start of the intervention with ongoing access to the electronic technology tool. Qualitative research investigating which elements of the intervention led to long-term changes would be beneficial.
Publisher: BMJ
Date: 02-2022
Abstract: To evaluate the capacity of general practice (GP) electronic medical record (EMR) data to assess risk factor detection, disease diagnostic testing, diagnosis, monitoring and pharmacotherapy for the interrelated chronic vascular diseases—chronic kidney disease (CKD), type 2 diabetes (T2D) and cardiovascular disease. Cross-sectional analysis of data extracted on a single date for each practice between 12 April 2017 and 18 April 2017 incorporating data from any time on or before data extraction, using baseline data from the Chronic Disease early detection and Improved Management in PrimAry Care ProjecT. Deidentified data were extracted from GP EMRs using the Pen Computer Systems Clinical Audit Tool and descriptive statistics used to describe the study population. Eight GPs in Victoria, Australia. Patients were ≥18 years and attended GP ≥3 times within 24 months. 37 946 patients were included. Risk factor and disease testing/monitoring/treatment were assessed as per Australian guidelines (or US guidelines if none available), with guidelines simplified due to limitations in data availability where required. Risk factor assessment in those requiring it: 30% of patients had body mass index and 46% blood pressure within guideline recommended timeframes. Diagnostic testing in at-risk population: 17% had diagnostic testing as per recommendations for CKD and 37% for T2D. Possible undiagnosed disease: Pathology tests indicating possible disease with no diagnosis already coded were present in 6.7% for CKD, 1.6% for T2D and 0.33% familial hypercholesterolaemia. Overall prevalence: Coded diagnoses were recorded in 3.8% for CKD, 6.6% for T2D, 4.2% for ischaemic heart disease, 1% for heart failure, 1.7% for ischaemic stroke, 0.46% for peripheral vascular disease, 0.06% for familial hypercholesterolaemia and 2% for atrial fibrillation. Pharmaceutical prescriptions: the proportion of patients prescribed guideline-recommended medications ranged from 44% (beta blockers for patients with ischaemic heart disease) to 78% (antiplatelets or anticoagulants for patients with ischaemic stroke). Using GP EMR data, this study identified recorded diagnoses of chronic vascular diseases generally similar to, or higher than, reported national prevalence. It suggested low levels of extractable documented risk factor assessments, diagnostic testing in those at risk and prescription of guideline-recommended pharmacotherapy for some conditions. These baseline data highlight the utility of GP EMR data for potential use in epidemiological studies and by in idual practices to guide targeted quality improvement. It also highlighted some of the challenges of using GP EMR data.
No related grants have been discovered for Julia Jones.