scholarly journals Clinical and healthcare improvement through My Health Record usage and education in general practice (CHIME-GP): a study protocol for a cluster-randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Andrew Bonney ◽  
Christine Metusela ◽  
Judy Mullan ◽  
Stephen Barnett ◽  
Joel Rhee ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
General Practitioners ◽  
Educational Intervention ◽  
Health Record ◽  
Post Intervention ◽  
Rational Use ◽  
Cluster Randomised ◽  
Test Ordering

Abstract Background There is an international interest in whether improved primary care can lead to a more rational use of health resources. There is evidence that educational interventions can lead to improvements in the quality of rational prescribing and test ordering. A new national platform for shared medical records in Australia, My Health Record (MHR), poses new opportunities and challenges for system-wide implementation. This trial (CHIME-GP) will investigate whether components of a multifaceted education intervention in an Australian general practice setting on rational prescribing and investigation ordering leads to reductions in health-service utilisation and costs in the context of the use of a national digital health record system. Methods The trial will be undertaken in Australian general practices. The aim of the research is to evaluate the effectiveness of components of a web-based educational intervention for general practitioners, regarding rational use of medicines, pathology and imaging in the context of the use of the MHR system. Our target is to recruit 120 general practitioners from urban and regional regions across Australia. We will use a mixed methods approach incorporating a three-arm pragmatic cluster randomised parallel trial and a prospective qualitative inquiry. The effect of each education component in each arm will be assessed, using the other two arms as controls. The evaluation will synthesise the results embedding qualitative pre/post interviews in the quantitative results to investigate implementation of the intervention, clinical behaviour change and mechanisms such as attitudes, that may influence change. The primary outcome will be an economic analysis of the cost per 100 consultations of selected prescriptions, pathology and radiology test ordering in the 6 months following the intervention compared with 6 months prior to the intervention. Secondary outcome measures include the rates per 100 consultations of selected prescriptions, pathology and radiology test ordering 6 months pre- and post-intervention, and comparison of knowledge assessment tests pre- and post-intervention. Discussion The trial will produce robust health economic analyses on the evidence on educational intervention in reducing unnecessary prescribing, pathology and imaging ordering, in the context of MHR. In addition, the study will contribute to the evidence-base concerning the implementation of interventions to improve the quality of care in primary care practice. Trial registration ClinicalTrials.gov ACTRN12620000010998. Registered on 09 January 2020 with the Australian New Zealand Clinical Trials Registry

scholarly journals Clinical and Healthcare Improvement through My Health Record usage and Education in General Practice (CHIME-GP): A study protocol for a cluster-randomised controlled trial

2021 ◽  
Author(s):  
Andrew Bonney ◽  
Christine Metusela ◽  
Judy Mullan ◽  
Stephen Barnett ◽  
Joel Rhee ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
General Practitioners ◽  
Educational Intervention ◽  
Digital Health ◽  
Health Record ◽  
Post Intervention ◽  
Record System ◽  
Cluster Randomised ◽  
Test Ordering

Abstract Background: There is international interest in whether improved primary care can lead to a more rational use of health resources and whether the use of a national digital health record system by primary health care professionals can help achieve this goal. This trial (CHIME-GP) will investigate whether a multifaceted education intervention in an Australian general practice setting on the use of a national digital health record system leads to reductions in health-service utilisation and costs.Methods: The trial will be undertaken in Australian general practices. The aim of the research is to evaluate the effectiveness of a web-based educational intervention for general practitioners, regarding use of a national digital health record system, My Health Record (MHR), and rational use of medicines, pathology and imaging. Our target is to recruit 120 general practitioners from urban and regional regions across Australia. We will use a mixed methods approach incorporating a three-arm pragmatic cluster randomised parallel trial and a prospective qualitative inquiry. The effect of the intervention in each arm will be assessed, using the other two arms as controls. The evaluation will synthesise the results embedding qualitative pre/post interviews in the quantitative results to investigate implementation of the intervention, clinical behaviour change and mechanisms such as attitudes, that may influence change. The primary outcome will be an economic analysis of the cost per 100 consultations of selected prescriptions, pathology and radiology test ordering in the six months following the intervention compared with six months prior to the intervention. Secondary outcome measures include the rates per 100 consultations of selected prescriptions, pathology and radiology test ordering six months pre and post intervention; and comparison of knowledge assessment tests pre and post intervention.Discussion: The trial will produce robust health economic analyses on the evidence on educational intervention in reducing unnecessary prescribing, pathology and imaging ordering, and in improving the use of MHR. In addition, the study will contribute to the evidence-base concerning the implementation of interventions to improve the quality of care in primary care practice.Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12620000010998. Registered on 09 January 2020.http://www.ANZCTR.org.au/ACTRN12620000010998.aspx

scholarly journals Effect of a price display intervention on laboratory test ordering behavior of general practitioners

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dennis M. J. Muris ◽  
Max Molenaers ◽  
Trang Nguyen ◽  
Paul W. M. P. Bergmans ◽  
Bernadette A. C. van Acker ◽  
...  
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Laboratory Test ◽  
General Practitioners ◽  
Laboratory Tests ◽  
Future Research ◽  
Post Intervention ◽  
Diagnostic Laboratory ◽  
The Mean ◽  
Test Ordering

Abstract Background Redundant use of diagnostic tests in primary care has shown to be a contributor to rising Dutch healthcare costs. A price display in the test ordering system of the electronic health records (EHRs) could potentially be a low-cost and easy to implement intervention to a decrease in test ordering rate in the primary care setting by creating more cost-awareness among general practitioners (GPs). The aim of this study was to assess the effect of a price display for diagnostic laboratory tests in the EHR on laboratory test ordering behavior of GPs in the Westelijke Mijnstreek region in the Netherlands. Methods A pre-post intervention study among 154 GPs working in 57 general practices was conducted from September 2019, until March 2020, in the Netherlands. The intervention consisted of displaying the costs of 22 laboratory tests at the time of ordering. The primary outcome was the mean test ordering rate per 1.000 patients per month, per general practice. Results Test ordering rates were on average rising prior to the intervention. The total mean monthly test order volume showed a non-statistically significant interruption in this rising trend after the intervention, with the mean monthly test ordering rate levelling out from 322.4 to 322.2 (P = 0.86). A subgroup analysis for solely individually priced tests showed a statistically significant decrease in mean monthly test ordering rate after implementation of the price display for the sum of all tests from 67.2 to 63.3 (P = 0.01), as well as for some of these tests individually (i.e. thrombocytes, ALAT, TSH, folic acid). Leucocytes, ESR, vitamin B12, anti-CCP and NT-proBNP also showed a decrease, albeit not statistically significant (P > 0.05). Conclusions Our study suggests that a price display intervention is a simple tool that can alter physicians order behavior and constrain the expanding use of laboratory tests. Future research might consider alternative study designs and a longer follow-up period. Furthermore, in future studies, the combination with a multitude of interventions, like educational programs and feedback strategies, should be studied, while potentially adverse events caused by reduced testing should also be taken into consideration.

scholarly journals The effects of audit and feedback and electronic referrals on the quality of primary care referral letters

2014 ◽  
Vol 6 (4) ◽  
pp. 324 ◽  
Author(s):  
Paul Corwin ◽  
Tim Bolter
Keyword(s):  
Primary Care ◽  
General Practice ◽  
General Practitioners ◽  
West Coast ◽  
Secondary Care ◽  
Referral Letter ◽  
The West ◽  
Electronic Referral ◽  
Referral Letters

INTRODUCTION: Appropriate referral from primary care to hospital specialists is a critical component of general practice patient management. This study investigated the quality of such referrals in a group of general practitioners (GPs) and nurses. AIM: To assess whether feedback improves the quality of referral letters from general practice to secondary care and how electronic referrals affect the quality of referral letters. METHODS: All 15 GPs working on the West Coast in New Zealand and the two nurses in this locality who regularly wrote referral letters agreed to participate in the study. For each participant, referral letters to hospital specialists were assessed using a nine-point checklist. Ten consecutive letters were assessed for each participant. Written feedback on referral letter quality was given and a further 10 letters from each participant were assessed five months later. After a further five months, 10 electronic referral letters from each participant were assessed. RESULTS: Feedback to general practitioners and nurses improved the quality of referral letters for participants whose original referral letters were of poorer quality. The average score for referral letters was 81.4% at baseline and this improved to 86.9% after feedback. The introduction of electronic referral letters did not lead to a further improvement in referral letter quality. DISCUSSION: This study demonstrated that feedback to general practitioners and nurses can improve the quality of referral letters to secondary care. The introduction of electronic referral letters as used on the West Coast did not lead to any further improvement in referral quality. KEYWORDS: Hospital referrals; primary health care; quality improvement

scholarly journals Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029760 ◽  
Author(s):  
H. Hofstede ◽  
H.A.M. van der Burg ◽  
B.C. Mulder ◽  
A.M. Bohnen ◽  
P.J.E. Bindels ◽  
...  
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
General Practice ◽  
Qualitative Study ◽  
General Practitioners ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Care Practice ◽  
Registration Number ◽  
Test Ordering

ObjectiveThere has been an increase in testing of vitamins in patients in general practice, often based on irrational indications or for non-specific symptoms, causing increasing healthcare expenditures and medicalisation of patients. So far, there is little evidence of effective strategies to reduce this overtesting in general practice. Therefore, the aim of this qualitative study was to explore the barriers and facilitators for reducing the number of (unnecessary) vitamin D and B12laboratory tests ordered.Design and settingThis qualitative study, based on a grounded theory design, used semistructured interviews among general practitioners (GPs) and patients from two primary care networks (147 GPs, 195 000 patients). These networks participated in the Reducing Vitamin Testing in Primary Care Practice (REVERT) study, a clustered randomized trial comparing two de-implementation strategies to reduce test ordering in primary care in the Netherlands.ParticipantsTwenty-one GPs, with a maximum of 1 GP per practice who took part in the REVERT study, and 22 patients (who were invited by their GP during vitamin-related consultations) were recruited, from which 20 GPs and 19 patients agreed to participate in this study.ResultsThe most important factor hampering vitamin-test reduction programmes is the mismatch between patients and medical professionals regarding the presumed appropriate indications for testing for vitamin D and B12. In contrast, the most important facilitator for vitamin-test reduction may be updating GPs’ knowledge about test indications and their awareness of their own testing behaviour.ConclusionTo achieve a sustainable reduction in vitamin testing, guidelines with clear and uniform recommendations on evidence-based indications for vitamin testing, combined with regular (individual) feedback on test-ordering behaviour, are needed. Moreover, the general public needs access to clear and reliable information on vitamin testing. Further research is required to measure the effect of these strategies on the number of vitamin test requests.Trial registration numberWAG/mb/16/039555.

scholarly journals Mental Illness in Primary Care Settings

1985 ◽  
Vol 9 (1) ◽  
pp. 12-13 ◽  
Author(s):  
Greg Wilkinson
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Social Security ◽  
General Practitioners ◽  
Research Unit ◽  
Practice Research ◽  
Policy Makers ◽  
Department Of Health ◽  
Primary Care Settings

A Conference on the above topic took place at the Institute of Psychiatry, London, on 17 and 18 July 1984. The Conference was sponsored by the Department of Health and Social Security and was organized by the General Practice Research Unit. Over 100 invited clinicians, research workers and policy-makers took part. The majority of the participants were either psychiatrists or general practitioners, but representatives of all relevant disciplines attended.

Recognition of and Response to Dementia Syndrome in Primary Care: Part 1

2009 ◽  
Vol 2 (4) ◽  
pp. 230-236 ◽  
Author(s):  
Steve Iliffe ◽  
Priya Jain ◽  
Jane Wilcock
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cognitive Function ◽  
General Practitioners ◽  
Function Tests ◽  
Dementia Syndrome

The theme of this article is the recognition of and response to dementia in general practice. Its aim is to clarify the tasks of diagnosing dementia, to advise on the use of cognitive function tests, to suggest ways of establishing the subtype of dementia where possible and to assist general practitioners in talking about dementia with their patients and their families.

Evaluation of a brief psychological treatment for emotional disorders in primary care

1991 ◽  
Vol 21 (4) ◽  
pp. 1013-1018 ◽  
Author(s):  
J. Catalan ◽  
D. H. Gath ◽  
P. Anastasiades ◽  
S. A. K. Bond ◽  
A. Day ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Problem Solving ◽  
Randomized Trial ◽  
Emotional Disorders ◽  
General Practitioners ◽  
Poor Prognosis ◽  
Psychological Treatment ◽  
Recent Onset

SYNOPSISA randomized trial in general practice compared: (i) a brief psychological treatment (problem-solving) given by a psychiatrist; (ii) any treatment of the GP's choice, whether psychological or pharmacological. The patients had recent onset emotional disorders of poor prognosis. Patients in the problem-solving group showed significantly greater reductions in symptoms. Problem-solving as given by a psychiatrist was feasible in primary care and acceptable to patients. Problem-solving is now being evaluated as given by general practitioners trained in the method.

scholarly journals The SOFIA pilot trial: a cluster-randomized trial of coordinated, co-produced care to reduce mortality and improve quality of life in people with severe mental illness in the general practice setting

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
M. P. Rozing ◽  
A. Jønsson ◽  
R. Køster-Rasmussen ◽  
T. D. Due ◽  
J. Brodersen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Illness ◽  
General Practice ◽  
Severe Mental Illness ◽  
General Practitioners ◽  
Pilot Trial ◽  
Care Program ◽  
Coordinated Care ◽  
Educational Training

Abstract Background People with severe mental illness (SMI) have an increased risk of premature mortality, predominantly due to somatic health conditions. Evidence indicates that primary and tertiary prevention and improved treatment of somatic conditions in patients with SMI could reduce this excess mortality. This paper reports a protocol designed to evaluate the feasibility of a coordinated co-produced care program (SOFIA model, a Danish acronym for Severe Mental Illness and Physical Health in General Practice) in the general practice setting to reduce mortality and improve quality of life in patients with severe mental illness. Methods The SOFIA pilot trial is designed as a cluster randomized controlled trial targeting general practices in two regions in Denmark. We aim to include 12 practices, each of which is instructed to recruit up to 15 community-dwelling patients aged 18 and older with SMI. Practices will be randomized by a computer in a ratio of 2:1 to deliver a coordinated care program or usual care during a 6-month study period. A randomized algorithm is used to perform randomization. The coordinated care program includes educational training of general practitioners and their clinical staff educational training of general practitioners and their clinical staff, which covers clinical and diagnostic management and focus on patient-centered care of this patient group, after which general practitioners will provide a prolonged consultation focusing on individual needs and preferences of the patient with SMI and a follow-up plan if indicated. The outcomes will be parameters of the feasibility of the intervention and trial methods and will be assessed quantitatively and qualitatively. Assessments of the outcome parameters will be administered at baseline, throughout, and at end of the study period. Discussion If necessary the intervention will be revised based on results from this study. If delivery of the intervention, either in its current form or after revision, is considered feasible, a future, definitive trial to determine the effectiveness of the intervention in reducing mortality and improving quality of life in patients with SMI can take place. Successful implementation of the intervention would imply preliminary promise for addressing health inequities in patients with SMI. Trial registration The trial was registered in Clinical Trials as of November 5, 2020, with registration number NCT04618250. Protocol version: January 22, 2021; original version

Sign in / Sign up

Export Citation Format

Share Document