Engaging primary care practitioners in quality improvement: making explicit the program theory of an interprofessional education intervention

Introduction. In 2009, the Royal New Zealand College of General Practitioners commissioned the development of a framework to facilitate quality-improvement activity in primary care settings. This paper outlines the development of the framework, which integrates concepts of quality with the reality of practice-based clinical care, and discusses its value for primary care quality improvement. Method. Framework development involved: (1) literature review of theoretical approaches to healthcare quality; (2) field work utilising a mixed methods approach to obtain empirical data; and (3) model design. Results. Primary care practitioners are juggling competing priorities. Models and tools that promote quality-related activity at practice level need to take into account, and incorporate by design, day-to-day clinical and practice functions. Conclusions. The quality framework identifies the components of primary care practice and locates this model within the concepts and activities necessary for quality improvement. It may be used by primary care organisations and practices to facilitate focussed quality-improvement activity and self-directed process review. The framework was developed for, and within a New Zealand primary care setting, and is applicable internationally and within other healthcare settings. What is known about the topic? Primary care practitioners are frequently juggling competing priorities while participating in an array of professional development, quality assurance, and improvement activities, some perceived to be of little relevance to day-to-day clinical care. What does this paper add? The framework integrates concepts of quality with the reality of practice-based clinical care. The function of the framework is to ensure all relevant aspects of practice are considered in a systematic and comprehensive manner to obtain quality improvement. What are the implications for practitioners? The framework is a practical tool that can guide practices and organisational stakeholders to continually deconstruct, examine and reassemble any practice-based clinical care activity. Practices wishing to undertake quality-improvement activity within the context of clinical care may use the framework to guide critical thinking at practice level.

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A Nurse Practitioner–led, Computer-based Diabetes Education Intervention Implemented for Quality Improvement in Primary Care

The Journal for Nurse Practitioners ◽

10.1016/j.nurpra.2016.04.019 ◽

2016 ◽

Vol 12 (8) ◽

pp. e363-e366

Author(s):

Maria L. Walls ◽

Anne F. Fish ◽

Roberta P. Lavin ◽

Shirley L. Porterfield

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Nurse Practitioner ◽

Diabetes Education ◽

Education Intervention ◽

Computer Based

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A cycling and education intervention for the treatment of hip osteoarthritis: A quality improvement replication programme

SAGE Open Medicine ◽

10.1177/2050312120946522 ◽

2020 ◽

Vol 8 ◽

pp. 205031212094652

Author(s):

Thomas W Wainwright ◽

Louise C Burgess ◽

Tikki Immins ◽

Neil Cowan ◽

Robert G Middleton

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Secondary Care ◽

Weight Bearing ◽

Hip Osteoarthritis ◽

Hip Pain ◽

Education Intervention ◽

Timed Up And Go ◽

Original Cohort ◽

Patient Reported

Objectives: The Cycling against Hip Pain programme is a 6-week exercise and education treatment pathway for people with hip osteoarthritis. Preliminary results of the Cycling against Hip Pain programme found significant improvements in clinical and patient-reported outcome measures for patients referred from primary care. This article evaluates the effectiveness of the changes made to the pathway in a quality improvement replication programme. Methods: The replicated Cycling against Hip Pain programme was delivered between February 2018 and September 2019 in a region of England with a high percentage of adults aged over 65 years. All participants were referred from the orthopaedic outpatient department of the funding hospital (secondary care). The programme was delivered at a local leisure centre and combined 30 min of education on osteoarthritis with 30 min of progressive static cycling, once a week for 6 weeks. Results: The participants on the replicated Cycling against Hip Pain programme did not differ from the original cohort in terms of age or pre-programme weight, however, presented with worse hip symptoms at baseline. Consistent with the findings from the original cohort, participants demonstrated significant improvements to their Oxford Hip Score, 30-s chair stand performance, Timed Up and Go score, Hip Osteoarthritis Outcome Score function and pain, EQ5D health rating, EQ5D-5L score and pain at rest and on weight bearing. In addition, participants reported an increase in knowledge, confidence and motivation to exercise. Conclusion: A 6-week cycling and education intervention for the treatment of hip osteoarthritis provided benefits to function, pain and quality of life for patients referred from secondary care. These results are consistent with findings from patients who were referred from primary care and further support the potential of the pathway in the conservative management of hip osteoarthritis.

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Upskilling the Primary Care Workforce in Cancer Survivorship

Journal of Global Oncology ◽

10.1200/jgo.18.61500 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 132s-132s

Author(s):

J. Emery ◽

K. Smith ◽

M. Shibaoka ◽

M. Barrett

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Community Of Practice ◽

Cancer Survivorship ◽

Nurse Practitioners ◽

Online Survey ◽

Online Discussions ◽

Real Patient ◽

Allied Health Professionals ◽

Primary Care Practitioners

Introduction/background: There is a rapidly increasing population of people living with and beyond cancer due to ageing and improvements in detection and treatment. This has impacted on the complexity of the primary care practitioners' role in managing cancer survivorship. The Massive Open Online Course (MOOC) was developed to address this need for a sustainable education model. Aim/Objectives: The Cancer Survivorship for Primary Care Practitioners program aims to enhance the knowledge and skills in the transition of survivors from oncology treatment into shared care. The Victorian Comprehensive Cancer Centre's (VCCC) goal was to develop a freely accessible, relevant, flexible, evidence based and sustainable resource for a global audience. Methods: Aimed at primary healthcare practitioners including general practitioners, nurses (general practice nurses, community nurses and nurse practitioners) and allied health professionals; the program was developed to adhere to best practice survivorship care in the areas of: survivorship fundamentals; communication and coordination of care; promoting self-management, psychosocial and community-based support; surveillance, long term and late effects; and new and emergent technologies. The MOOC is contextualised in the narrative of a patient story and includes a series of real patient stories, interactive presentations, interviews, readings, online discussions, quizzes and peer reviewed assessments. Alumni from the program will contribute to a growing community of practice and contribute to the teaching and quality improvement of the program. An online survey will be distributed to all participants before and after their completion of the program. Paired tests will be conducted and compared for the participant craft groups that attend the MOOC. We will measure the effect of participation in either the MOOC and/or workshop on confidence, knowledge and intention to change practice. Results: A description of the sustainable MOOC delivery model and evaluation results from the first cohort will be presented. Conclusion: The program will deliver an innovative and sustainable professional development opportunity for PCPs in response to the evolving population health landscape. Alumni from the program will contribute to a growing community of practice and contribute to the teaching and quality improvement of the program.

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