COVID-19: protocol for observational studies utilizing near real-time electronic Australian general practice data to promote effective care and best-practice policy—a design thinking approach

Abstract Background Health systems around the world have been forced to make choices about how to prioritize care, manage infection control and maintain reserve capacity for future disease outbreaks. Primary healthcare has moved into the front line as COVID-19 testing transitions from hospitals to multiple providers, where tracking testing behaviours can be fragmented and delayed. Pooled general practice data are a valuable resource which can be used to inform population and individual care decision-making. This project aims to examine the feasibility of using near real-time electronic general practice data to promote effective care and best-practice policy. Methods The project will utilize a design thinking approach involving all collaborators (primary health networks [PHNs], general practices, consumer groups, researchers, and digital health developers, pathology professionals) to enhance the development of meaningful and translational project outcomes. The project will be based on a series of observational studies utilizing near real-time electronic general practice data from a secure and comprehensive digital health platform [POpulation Level Analysis and Reporting (POLAR) general practice data warehouse]. The study will be carried out over 1.5 years (July 2020–December 2021) using data from over 450 general practices within three Victorian PHNs and Gippsland PHN, Eastern Melbourne PHN and South Eastern Melbourne PHN, supplemented by data from consenting general practices from two PHNs in New South Wales, Central and Eastern Sydney PHN and South Western Sydney PHN. Discussion The project will be developed using a design thinking approach, leading to the building of a meaningful near real-time COVID-19 geospatial reporting framework and dashboard for decision-makers at community, state and nationwide levels, to identify and monitor emerging trends and the impact of interventions/policy decisions. This will integrate timely evidence about the impact of the COVID-19 pandemic related to its diagnosis and treatment, and its impact across clinical, population and general practice levels.

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COVID-19 – Protocol for Observational Studies Utilising Near Real-Time Electronic Australian General Practice Data to Promote Effective Care and Best-Practice Policy – A Design Thinking Approach

10.21203/rs.3.rs-136810/v1 ◽

2020 ◽

Author(s):

Andrew Georgiou ◽

Julie Li ◽

Christopher Pearce ◽

Adam McLeod ◽

Nasir Wabe ◽

...

Keyword(s):

General Practice ◽

Real Time ◽

Best Practice ◽

Design Thinking ◽

Digital Health ◽

Health Networks ◽

Primary Health ◽

Effective Care ◽

General Practices ◽

The Impact

Abstract Background: Health systems around the world have been forced to make choices about how to prioritise care, manage infection control and maintain reserve capacity for future disease outbreaks. Primary health care has moved into the frontline as COVID-19 testing transitions from hospitals to multiple providers, where tracking testing behaviours can be fragmented and delayed. Pooled general practice data are a valuable resource which can be used to inform population and individual care decision-making. This project aims to utilise near real-time electronic general practice data to promote effective care and best-practice policy. Methods: The project will utilise a design thinking approach involving all collaborators (Primary Health Networks [PHNs], general practices, consumer groups, researchers, and digital health developers, pathology professionals) to enhance the development of meaningful and translational project outcomes. The project will be based on a series of observational studies utilising near real-time electronic general practice data from a secure and comprehensive digital health platform [POpulation Level Analysis and Reporting (POLAR) general practice data warehouse]. The study will be carried out over 1.5 years (July 2020 – December 2021) using data from over 350 general practices within three Victorian Primary Health Networks (PHNs) and Gippsland PHN, Eastern Melbourne PHN and South Eastern Melbourne PHN, supplemented by data from consenting general practices from two PHNs in New South Wales, Central and Eastern Sydney PHN and South Western Sydney PHN. Discussion: Developed using a design thinking approach, this project will deliver: 1) A near real-time geo-spatial reporting framework at community, state and nation-wide levels to identify emerging trends and monitor the impact of interventions/policy decisions. 2) Timely evidence about the impact of the COVID-19 pandemic related to its diagnosis, treatment and medications prescribed and its impact on patients. 3) A predictive geo-spatial analytics dashboard for timely, evidence-based decision-making at community, state and nation-wide levels. 4) An evidence-based suite of general practice outcome measures to monitor incidence, prevalence, recovery and mortality in response to the COVID-19 pandemic.

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COVID-19 – Protocol for Observational Studies Utilising Near Real-Time Electronic Australian General Practice Data to Promote Effective Care and Best-Practice Policy – A Design Thinking Approach

10.21203/rs.3.rs-142622/v1 ◽

2021 ◽

Author(s):

Andrew Georgiou ◽

Julie Li ◽

Christopher Pearce ◽

Adam McLeod ◽

Nasir Wabe ◽

...

Keyword(s):

General Practice ◽

Real Time ◽

Best Practice ◽

Design Thinking ◽

Digital Health ◽

Health Networks ◽

Primary Health ◽

Effective Care ◽

General Practices ◽

The Impact

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‘Motivational work’: a qualitative study of preventive health dialogues in general practice

BMC Family Practice ◽

10.1186/s12875-020-01249-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Marie Broholm-Jørgensen ◽

Siff Monrad Langkilde ◽

Tine Tjørnhøj-Thomsen ◽

Pia Vivian Pedersen

Keyword(s):

General Practice ◽

General Practitioners ◽

Support System ◽

Preventive Intervention ◽

Digital Health ◽

Clinical Encounter ◽

Preventive Health ◽

Structured Interviews ◽

General Practices ◽

Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

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Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations

Journal of Primary Health Care ◽

10.1071/hc16023 ◽

2017 ◽

Vol 9 (1) ◽

pp. 47 ◽

Cited By ~ 2

Author(s):

Robyn Taylor ◽

Eileen McKinlay ◽

Caroline Morris

Keyword(s):

General Practice ◽

General Practitioner ◽

Access To Health Care ◽

Timely Manner ◽

Face To Face ◽

Standing Order ◽

Access To Health ◽

General Practices ◽

Pharmacy Data ◽

The Impact

ABSTRACT INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders’ views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

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IoT-Based Patient Movement Monitoring: The Post-Operative Hip Fracture Rehabilitation Model

Future Internet ◽

10.3390/fi13080195 ◽

2021 ◽

Vol 13 (8) ◽

pp. 195

Author(s):

Akash Gupta ◽

Adnan Al-Anbuky

Keyword(s):

Hip Fracture ◽

Real Time ◽

System Performance ◽

Digital Health ◽

Time Behavior ◽

Functional Requirements ◽

Rehabilitation Process ◽

Rehabilitation Model ◽

The Impact ◽

Movement Monitoring

Hip fracture incidence is life-threatening and has an impact on the person’s physical functionality and their ability to live independently. Proper rehabilitation with a set program can play a significant role in recovering the person’s physical mobility, boosting their quality of life, reducing adverse clinical outcomes, and shortening hospital stays. The Internet of Things (IoT), with advancements in digital health, could be leveraged to enhance the backup intelligence used in the rehabilitation process and provide transparent coordination and information about movement during activities among relevant parties. This paper presents a post-operative hip fracture rehabilitation model that clarifies the involved rehabilitation process, its associated events, and the main physical movements of interest across all stages of care. To support this model, the paper proposes an IoT-enabled movement monitoring system architecture. The architecture reflects the key operational functionalities required to monitor patients in real time and throughout the rehabilitation process. The approach was tested incrementally on ten healthy subjects, particularly for factors relevant to the recognition and tracking of movements of interest. The analysis reflects the significance of personalization and the significance of a one-minute history of data in monitoring the real-time behavior. This paper also looks at the impact of edge computing at the gateway and a wearable sensor edge on system performance. The approach provides a solution for an architecture that balances system performance with remote monitoring functional requirements.

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Round table: Online anti-vaccination movements: the role of social media in public health communications

European Journal of Public Health ◽

10.1093/eurpub/ckz185.681 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

Keyword(s):

Public Health ◽

Social Networks ◽

Social Media ◽

Real Time ◽

Hpv Vaccine ◽

Digital Health ◽

World Health ◽

Swine Flu ◽

Potential Impact ◽

The Impact

Abstract Digital health has revolutionised healthcare, with implications for understanding public reaction to health emergencies and interventions. Social media provides a space where like-minded people can share interests and concerns in real-time, regardless of their location. This can be a force for good, as platforms like Twitter can spread correct information about outbreaks, for example in the 2009 swine flu pandemic. However, social media can also disseminate incorrect information or deliberately spread misinformation leading to adverse public health sentiment and outcomes. The current issues around trust in vaccines is the best-known example. Vaccine hesitancy, traditionally linked to issues of trust, misinformation and prior beliefs, has been increasingly fueled by influential groups on social media and the Internet. Ultimately, anti-vaccination movements have the potential to lead to outbreaks of vaccine-preventable diseases, especially if refusal is concentrated locally, creating vulnerable populations. For example, 2018-19 saw a large increase in incidence of measles in the US and Europe (where cases tripled from 2017), two regions where the disease was already or almost eliminated. In 2019, the World Health Organisation listed anti-vaccination movements as one of the top 10 threats to global public health. HPV vaccination is another example of the impact of anti-vaccination movements. As viral videos originating on YouTube spread across social networks, uptake has tumbled in a number of countries, with Japan, Denmark, Colombia and Ireland being badly hit. In Japan, the government came under sufficient pressure that they de-recommended HPV vaccine, seeing an 80% uptake rate fall below 1% in 2014. There have been reports of successful interventions by national governments. A recent campaign run by the HPV Alliance (a coalition of some 35 private companies, charities and public institutions) in Ireland has seen rates below 40% back up to a national average of 75%. A combination of hard-hitting personal testimonials, social media and traditional media promoted the HPV vaccine. Despite this, systematic engagement and supranational strategies are still in the early stages of being formulated. As misleading information spread through social media and digital networks has undesirable impact on attitudes to vaccination (and uptake rates), urgent actions are required. Analysis and visualisation techniques mining data streams from social media platforms, such as Twitter, Youtube enable real-time understanding of vaccine sentiments and information flows. Through identification of key influencers and flashpoints in articles about vaccination going viral, targeted public health responses could be developed. This roundtable discussion will showcase different ways in which media and social networks, accessible in real-time provide an opportunity for detecting a change in public confidence in vaccines, for identifying users and rumors and for assessing potential impact in order to know how to best respond. Key messages Social media has significantly enhanced our understanding of anti-vaccination movements and potential impact on public health attitudes and behaviors regarding vaccination. Innovative methods of analysing social media data, from digital health, data science and computer science, have an important role in developing health promotions to counter anti-vaccination movements.

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‘Motivational work’: a qualitative study of preventive health dialogues in general practice

10.21203/rs.2.13275/v4 ◽

2020 ◽

Author(s):

Marie Broholm-Jørgensen ◽

Siff Monrad Langkilde ◽

Tine Tjørnhøj-Thomsen ◽

Pia Vivian Pedersen

Keyword(s):

General Practice ◽

General Practitioners ◽

Support System ◽

Preventive Intervention ◽

Digital Health ◽

Clinical Encounter ◽

Preventive Health ◽

Structured Interviews ◽

General Practices ◽

Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center.Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients.Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between GP and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues.Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

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Factors influencing variation in participation in the National Diabetes Audit and the impact on the Quality and Outcomes Framework indicators of diabetes care management

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2018-000554 ◽

2018 ◽

Vol 6 (1) ◽

pp. e000554 ◽

Cited By ~ 3

Author(s):

Caroline E Wright ◽

Stephen Yeung ◽

Helen Knowles ◽

Antoinette Woodhouse ◽

Emma Barron ◽

...

Keyword(s):

General Practice ◽

Diabetes Management ◽

Geographic Area ◽

Related Factors ◽

Practice Size ◽

Practice Population ◽

Quality And Outcomes ◽

General Practices ◽

The Impact ◽

Quality And Outcomes Framework

ObjectiveParticipation in the National Diabetes Audit (NDA) has become a contractual requirement for all general practices in England and is used as part of the assessment framework for sustainability and transformation partnership (STP) footprints. The study aimed to investigate general practice-related factors which may influence participation in the NDA, and the impact that participation in the NDA may have on diabetes management and patient care.Research designA cross-sectional analysis of routine primary care data from 45 725 646 patients aged 17+ years registered across 7779 general practices in England was performed using logistic regression. The main outcome measures included general practice voluntary participation in the NDA, general practice-related factors (practice size, deprivation, diabetes prevalence, geographic area, practice population age) and diabetes management outcomes (cholesterol, blood pressure, hemoglobin A1c (HbA1c)).ResultsParticipation in the NDA differed significantly according to practice size (t(7653)=−9.93, p=0.001), level of deprivation (χ2(9)=36.17, p<0.0001), diabetes prevalence (p<0.0001), practice population age (p<0.0001), and geographic area (χ2(26)=676.9, p<0.0001). In addition, the Quality and Outcomes Framework diabetes indicator HbA1c (OR 1.01, CI 1.0 to 1.01, p=0.0001) but not cholesterol (p=0.055) or blood pressure (p=0.76) was independently associated with NDA participation when controlling for practice-related factors.ConclusionVariation in NDA participation exists. It is suggested that some practices may need additional support when submitting data to the NDA and that NDA participation may have an impact on diabetes outcomes. However, the use of NDA outcomes as a measure of progress with diabetes care by STPs is still unclear and further investigation is needed.

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Accreditation in Primary Health: RACGP Standards for General Practice

Health Information Management ◽

10.1177/183335830303100202 ◽

2003 ◽

Vol 31 (2) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Halina Hili

Keyword(s):

General Practice ◽

Continuous Quality Improvement ◽

Health Expenditure ◽

Accreditation Process ◽

Accreditation System ◽

Continuous Quality ◽

Primary Health ◽

Profound Influence ◽

General Practices ◽

The Impact

General Practitioners play a crucial role as “gate-keepers” to the health system. In this context, they have a profound influence on both health outcomes and health expenditure. Since the introduction in 1999 of a formal, peer-driven external accreditation process, over 4,590 Australian general practices have achieved full accreditation. The process of re-ccreditation has commenced, subsequent to a review of the original standards, and with an ongoing focus on continuous quality improvement. This article describes a typical accreditation survey visit, and explains the accreditation criteria and how they are reviewed by the surveyors. There is discussion also of the impact of this new accreditation system on general practice.

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Integrated Technologies Ensuring Integrity Throughout the Facility Lifecycle

10.2118/206185-ms ◽

2021 ◽

Author(s):

Aarti Dange ◽

George Varghese ◽

Hossam Mesbah

Keyword(s):

Corrosion Inhibitor ◽

Real Time ◽

Best Practice ◽

Predictive Analytics ◽

Injection Rate ◽

Injection System ◽

Corrosion Monitoring ◽

Field Development ◽

Long Run ◽

The Impact

Abstract Objective/Scope Integrity of the wells and facilities is planned right from the reservoir development phase. In the pilot phase all the contributing parameters are collected and considered in the design of the production facilities. As the corrosion/erosion is very important aspect to determine the operating condition and the metallurgy of the facilities/completion, due consideration must be given to the technologies helping the infrastructure planning. However, once the production begins, the real time corrosion monitoring is essential as the reservoir produces from multiple zones along with solids during the complete lifecycle. The sand erosion aggravates the corrosion and can cause leaks around the wellheads and areas with changes in cross section. There are several processes such as inhibitor dosage, chemical treatment are performed from the startup and continued throughout the pilot. The paper covers integrated technologies to minimize the risk of corrosion damages by providing predictive analytics for corrosion and erosion impact. This includes chemical injection system, trace detector, non-intrusive corrosion monitoring, sand detector technologies as a holistic solution and best practice for ensuring asset integrity. Methods, Procedures, Process With the given information on the fluid corrosivity, the corrosion inhibitor and its dosing rate gets identified. Continous injection leads to the formation of a thin film on the entire system which need to be protected. However, many times the dosage is not optimized often leading to over injection or under injection of the chemicals. The injection rate is important to be monitored and optimized with a Realtime corrosion monitoring and gauging the impact on the asset integrity. The non-intrusive easy to install Realtime corrosion monitoring probe can provide real time monitoring for all the above requirements and in remote locations inaccessible during inspection A tracer is added to the chemicals to identify the residual through the tracer meter, which is hooked up with the chemical injection system, to optimize the set dosing rate. The corrosion monitoring system is in a corrosion prone location where the highest corrosion rate is expected to optimize the dosage. The sand detector can be considered in case we are producing from unconsolidated sand reservoir. This helps to identify erosion and where more sand is expected. Results, Observations, Conclusions Integrating all these technologies helps optimize the chemical used by around 20% and maximize the lifetime for the integrity by 70%. Also, it predicts potential failures in the system. As the data is stored and accessed from different locations, the organization will have a better control on the full integrity which lead to better design and alternating the corrosion inhibitor without any risk on the integrity. However, the combined technologies will be high CAPEX, but it will save a lot of OPEX on the long run which is demonstrated in the paper and will provide a good historical data for the field development and overall production enhancement

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