Impact of Sustained Use of a Multifaceted Computerized Quality Improvement Intervention for Cardiovascular Disease Management in Australian Primary Health Care

INTRODUCTION: Auckland District Health Board was one of four District Health Boards to trial the Breakthrough Series (BTS) methodology to improve the management of long-term conditions in New Zealand, with support from the Ministry of Health. AIM: To improve clinical outcomes, facilitate planned care and promote quality improvement within participating practices in Auckland. METHODS: Implementation of the Collaborative followed the improvement model / Institute for Healthcare Improvement methodology. Three topic areas were selected: system redesign, cardiovascular disease/diabetes, and self-management support. An expert advisory group and the Improvement Foundation Australia helped guide project development and implementation. Primary Health Organisation facilitators were trained in the methodology and 15 practice teams participated in the three learning workshops and action periods over 12 months. An independent evaluation study using both quantitative and qualitative methods was conducted. RESULTS: Improvements were recorded in cardiovascular disease risk assessment, practice-level systems of care, self-management systems and follow-up and coordination for patients. Qualitative research found improvements in coordination and teamwork, knowledge of practice populations and understanding of managing long-term conditions. CONCLUSION: The Collaborative process delivered some real improvements in the systems of care for people with long-term conditions and a change in culture among participating practices. The findings suggest that by strengthening facilitation processes, improving access to comprehensive population audit tools and lengthening the time frame, the process has the potential to make significant improvements in practice. Other organisations should consider this approach when investigating quality improvement programmes. KEYWORDS: Chronic disease; primary health care; quality improvement

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PT207 Availability of Guidelines, Medications and Equipment for Cardiovascular Disease Management at Primary Health Care Level in 7 African Countries

Global Heart ◽

10.1016/j.gheart.2016.03.559 ◽

2016 ◽

Vol 11 (2) ◽

pp. e158-e159

Author(s):

P. Bovet ◽

H. Gamra ◽

E. Gatumia ◽

D. Houinato ◽

C. Mondo ◽

...

Keyword(s):

Cardiovascular Disease ◽

Health Care ◽

Primary Health Care ◽

Disease Management ◽

African Countries ◽

Care Level ◽

Primary Health ◽

Primary Health Care Level

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Cardiovascular disease management: time to advance the practice nurse role?

Australian Health Review ◽

10.1071/ah080044 ◽

2008 ◽

Vol 32 (1) ◽

pp. 44 ◽

Cited By ~ 37

Author(s):

Elizabeth J Halcomb ◽

Patricia M Davidson ◽

Rhonda Griffiths ◽

John Daly

Keyword(s):

Cardiovascular Disease ◽

Health Care ◽

General Practice ◽

Primary Health Care ◽

General Practitioner ◽

Disease Management ◽

Practice Nurse ◽

Practice Nurses ◽

Primary Health ◽

Nurse Role

Objective: More than two-thirds of health expenditure is attributable to chronic conditions, of which a significant proportion are related to cardiovascular disease. This paper identifies and explores the factors cited by practice nurses as impacting on the development of their role in cardiovascular disease management. Methods: Sequential mixed methods design combining postal survey (n = 284) and telephone interviews (n = 10) with general practice nurses. Results: The most commonly cited barriers to role extension were legal implications (51.6%), lack of space (30.8%), a belief that the current role is appropriate (29.7%), and general practitioner attitudes (28.7%). The most commonly cited facilitators of role extension were collaboration with the general practitioner (87.6%), access to education and training (65.6%), the opportunity to deliver primary health care (61.0%), a high level of job satisfaction (56.0%) and positive consumer feedback (54.6%). Conclusions: Australian government policy demonstrates a growing commitment to an extended role for general practice in primary health care and cardiovascular disease management. In spite of these promising initiatives, practice nurses face a range of professional and system barriers to extending their role. By addressing the barriers and enabling features identified in this investigation, there is potential to further develop the Australian practice nurse role in cardiovascular disease management.

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