Evaluating the Implementation of a Pilot Quality Improvement Program to Support Appropriate Antimicrobial Prescribing in General Practice

Inappropriate antimicrobial prescribing contributes to increasing antimicrobial resistance. An antimicrobial stewardship (AMS) program in the form of quality improvement activities that included audit and feedback, clinical decision support and education was developed to help optimise prescribing in general practice. The aim of this study was to evaluate the implementation of this program (Guidance GP) in three general practices in Melbourne, Australia, between November 2019 and August 2020. Thirty-one general practitioners (GPs) participated in the program, with 11 GPs and three practice managers participating in follow-up focus groups and interviews to explore the acceptability and feasibility of the program. Our findings showed that the quality improvement activities were acceptable to GPs, if they accurately fit GPs’ decision-making process and workflow. It was also important that they provided clinically meaningful information in the form of audit and feedback to GPs. The time needed to coordinate the program, and costs to implement the program were some of the potential barriers identified. Facilitators of success were a “whole of practice” approach with enthusiastic GPs and practice staff, and an identified practice champion. The findings of this research will inform implementation strategies for both the Guidance GP program and AMS programs more broadly in Australian general practice, which will be critical for general practice participation and engagement.

Download Full-text

Learning from the Implementation of a Quality Improvement Intervention in Australian General Practice: A Qualitative Analysis of a CVD Preventive Care Project

10.21203/rs.3.rs-941941/v1 ◽

2021 ◽

Author(s):

Charlotte Hespe ◽

Edwina Brown ◽

Lucie Rychetnik

Keyword(s):

General Practice ◽

Quality Improvement ◽

Health System ◽

Financial Incentives ◽

Clinical Care ◽

Quality Improvement Intervention ◽

Successful Implementation ◽

Full Potential ◽

Australian General Practice ◽

General Practices

Abstract BackgroundQuality-improvement collaborative (QIC) initiatives aim to reduce gaps in clinical care provided in the healthcare system. This study provides a qualitative evaluation of a QIC project (QPulse) in Australian general practice focused on improving cardiovascular disease (CVD) assessment and management. MethodsThis qualitative-methods study explored implementing a QIC project by a Primary Health Network (PHN) in 34 general practices. Qualitative analyses examined in-depth interviews with participants and stakeholders focusing on barriers and enablers to implementation in our health system. They were analysed thematically using the Complex Systems Improvement framework (CSI), focusing on strategy, culture, structure, workforce, and technology.ResultsDespite strategic engagement with QPulse objectives across the health system, implementation barriers associated with this program were considerable for both PHN and the general practices. Adoption of the QIC process was reliant on engaged leadership, practice culture, systems for clear communication, tailored education and regular clinical audit and review. Practice ownership, culture and governance, rather than practice size and location, were related to successful implementation. Financial incentives for both the PHN and general practice were identified as prerequisites for systematised quality improvement (QI) projects in the future, along with individualised support and education provided to each practice. Technology was both an enabler and a barrier, and the PHN was seen as key to assisting the successful adoption of the available tools. ConclusionsImplementation of QI programs remains a potential tool for achieving better health outcomes in General Practice. However, enablers such as individualised education and support provided via a meso-level organisation, financial incentives, and IT tools and support are crucial if the full potential of QI programs are to be realised in the Australian healthcare setting. Trial registrationACTRN12615000108516, UTN U1111-1163-7995.

Download Full-text

Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice

Australian Journal of Primary Health ◽

10.1071/py11164 ◽

2013 ◽

Vol 19 (2) ◽

pp. 150 ◽

Cited By ~ 19

Author(s):

Diann S. Eley ◽

Elizabeth Patterson ◽

Jacqui Young ◽

Paul P. Fahey ◽

Chris B. Del Mar ◽

...

Keyword(s):

Quality Of Life ◽

General Practice ◽

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management ◽

Models Of Care ◽

Practice Nurses ◽

Australian General Practice ◽

General Practices

The Australian government’s commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model’s feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients’ stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

Download Full-text

Implementation of a multimodal patient safety improvement program “SafetyLEAP” in intensive care units

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-04-2017-0067 ◽

2018 ◽

Vol 31 (2) ◽

pp. 140-149 ◽

Cited By ~ 4

Author(s):

Chantal Backman ◽

Paul C. Hebert ◽

Alison Jennings ◽

David Neilipovitz ◽

Omar Choudhri ◽

...

Keyword(s):

Patient Safety ◽

Intensive Care ◽

Quality Improvement ◽

Intensive Care Units ◽

Audit And Feedback ◽

Improvement Program ◽

Convenience Sample ◽

Content Type ◽

Safety Improvement ◽

Patient Safety Improvement

Purpose Patient safety remains a top priority in healthcare. Many organizations have developed systems to monitor and prevent harm, and have invested in different approaches to quality improvement. Despite these organizational efforts to better detect adverse events, efficient resolution of safety problems remains a significant challenge. The authors developed and implemented a comprehensive multimodal patient safety improvement program called SafetyLEAP. The term “LEAP” is an acronym that highlights the three facets of the program including: a Leadership and Engagement approach; Audit and feedback; and a Planned improvement intervention. The purpose of this paper is to evaluate the implementation of the SafetyLEAP program in the intensive care units (ICUs) of three large hospitals. Design/methodology/approach A comparative case study approach was used to compare and contrast the adherence to each component of the SafetyLEAP program. The study was conducted using a convenience sample of three (n=3) ICUs from two provinces. Two reviewers independently evaluated major adherence metrics of the SafetyLEAP program for their completeness. Analysis was performed for each individual case, and across cases. Findings A total of 257 patients were included in the study. Overall, the proportion of the SafetyLEAP tasks completed was 64.47, 100, and 26.32 percent, respectively. ICU nos 1 and 2 were able to identify opportunities for improvement, follow a quality improvement process and demonstrate positive changes in patient safety. The main factors influencing adherence were the engagement of a local champion, competing priorities, and the identification of appropriate resources. Practical implications The SafetyLEAP program allowed for the identification of processes that could result in patient harm in the ICUs. However, the success in improving patient safety was dependent on the engagement of the care teams. Originality/value The authors developed an evidence-based approach to systematically and prospectively detect, improve, and evaluate actions related to patient safety.

Download Full-text

Quality and general practice accreditation: The approach of Australian General Practice Accreditation Limited

Australian Health Review ◽

10.1071/ah990161 ◽

1999 ◽

Vol 22 (4) ◽

pp. 161 ◽

Cited By ~ 1

Author(s):

Rob Pegram ◽

David Wright

Keyword(s):

General Practice ◽

Quality Improvement ◽

Continuous Quality Improvement ◽

Continuous Quality ◽

Australian General Practice

The purpose of this article is to outline the underlying assumptions, principles and processes of a continuous quality improvement approach which underpins the accreditation of general practice offered by Australian General Practice Accreditation Limited.

Download Full-text

The AgED Study. Age-related eye disease (AgED) in South Australian general practice: are we blind to early detection and intervention?

Australian Journal of Primary Health ◽

10.1071/py15189 ◽

2017 ◽

Vol 23 (1) ◽

pp. 75 ◽

Cited By ~ 2

Author(s):

Chelsea Guymer ◽

Robert Casson ◽

Cate Howell ◽

Nigel Stocks

Keyword(s):

General Practice ◽

Population Based ◽

Postal Questionnaire ◽

Eye Disease ◽

Cross Sectional ◽

Age Related ◽

Retrospective Audit ◽

Australian General Practice ◽

Related Quality ◽

General Practices

The AgED Study aimed to evaluate the detection, awareness and management of age-related eye disease (AgED) in South Australian general practice. Three South Australian metropolitan general practices were recruited and all patients aged 75 years and older were invited to participate. A cross-sectional postal questionnaire and retrospective audit of consenting patients’ medical records was performed. On average, patients had their last eye check 9 months ago; the majority (64.9%) performed by an optometrist. Only 7.6% had visited their GP for their last eye check, mostly (90.5%) for a mandatory ‘Fitness to Drive’ medical assessment. There were marked differences in GP recording v. self-reported AgED and a marked discrepancy in the prevalence rates of AgED, visual impairment and blindness in this study compared with Australian population-based prevalence surveys. Despite the lack of GP documentation of eye disease, the majority of patients engaged in timely eye checks with either an optometrist or ophthalmologist, and their overall visual function and vision-related quality of life (QoL) were satisfactory.

Download Full-text

Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence

The Medical Journal of Australia ◽

10.5694/j.1326-5377.2010.tb04071.x ◽

2010 ◽

Vol 193 (10) ◽

pp. 602-607 ◽

Cited By ~ 29

Author(s):

Christine B Phillips ◽

Christopher M Pearce ◽

Sally Hall ◽

Joanne Travaglia ◽

Simon Lusignan ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

General Practice ◽

Quality Improvement ◽

Clinical Governance ◽

Australian General Practice

Download Full-text

Undertaking general practice quality improvement to improve cancer screening - a thematic analysis of provider experiences

BMC Family Practice ◽

10.1186/s12875-021-01581-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Steven A. Trankle ◽

Christine Metusela ◽

Jennifer Reath

Keyword(s):

General Practice ◽

Quality Improvement ◽

Cancer Screening ◽

Thematic Analysis ◽

Community Education ◽

Practice Staff ◽

Health Network ◽

Primary Health ◽

Incidence And Mortality ◽

General Practices

Abstract Background Cancer is a major cause of illness and death, and its incidence and mortality can be reduced through effective screening. In order to improve below target screening rates in one region of Australia, the local Primary Health Network supported local general practices to implement a range of quality improvement initiatives. Methods We used a qualitative approach and interviewed 18 general practice staff and five Primary Health Network staff and contractors to understand their experiences with these quality improvement initiatives. Results In a thematic analysis, we identified four key themes related to program set-up and implementation; patient and community education and promotion; engaging patients and communities in screening; and general practice enhancement. Program roles were clear and understood, and the program received strong oversight and support. Practice staff felt supported and motivated. Information Technology was a challenge for many practices often requiring tailored assistance. Education provided by practices facilitated patient empowerment but practice staff noted difficulties engaging patients in screening. Practices were enhanced though strong leadership and teamwork and practice learning activities. Conclusions The tailored evidence-based quality improvement initiatives were considered effective in supporting general practices to increase their cancer screening. Key facilitators reported by participants included use of Plan-Do-Study-Act cycles, enhanced data entry and audit capacity, effective recall and reminder systems and maintaining staff motivation.

Download Full-text

Undertaking General Practice Quality Improvement to Improve Cancer Screening - A Thematic Analysis of Provider Experiences

10.21203/rs.3.rs-536624/v1 ◽

2021 ◽

Author(s):

STEVEN A TRANKLE ◽

CHRISTINE METUSELA ◽

JENNIFER REATH

Keyword(s):

General Practice ◽

Quality Improvement ◽

Cancer Screening ◽

Thematic Analysis ◽

Community Education ◽

Practice Staff ◽

Health Network ◽

Primary Health ◽

Incidence And Mortality ◽

General Practices

Abstract Background: Cancer is a major cause of illness and death, and its incidence and mortality can be reduced through effective screening. In order to improve below target screening rates in one region of Australia, the local Primary Health Network supported local general practices to implement a range of quality improvement initiatives.Methods: We used a qualitative approach and interviewed 16 general practice staff and five Primary Health Network staff and contractors to understand their experiences with these quality improvement initiatives.Results: In a thematic analysis, we identified four key themes related to program set-up and implementation; patient and community education and promotion; engaging patients and communities in screening; and general practice enhancement. Program roles were clear and understood, and the program received strong oversight and support. Practice staff felt supported and motivated. Information Technology was a challenge for many practices often requiring tailored assistance. Education provided by practices facilitated patient empowerment but practice staff noted difficulties engaging patients in screening. Practices were enhanced though strong leadership and teamwork and practice learning activities.Conclusions: The tailored evidence-based quality improvement initiatives were considered effective in supporting general practices to increase their cancer screening. Key facilitators reported by participants included use of Plan-Do-Study-Act cycles, enhanced data entry and audit capacity, effective recall and reminder systems and maintaining staff motivation.

Download Full-text

Future Health Today: codesign of an electronic chronic disease quality improvement tool for use in general practice using a service design approach

BMJ Open ◽

10.1136/bmjopen-2020-040228 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040228

Author(s):

Barbara Hunter ◽

Ruby Biezen ◽

Karyn Alexander ◽

Natalie Lumsden ◽

Christine Hallinan ◽

...

Keyword(s):

General Practice ◽

Quality Improvement ◽

Chronic Disease ◽

Service Design ◽

Design Approach ◽

Audit And Feedback ◽

Easy Access ◽

Successful Implementation ◽

Future Health ◽

Quality Improvement Tool

ObjectiveTo codesign an electronic chronic disease quality improvement tool for use in general practice.DesignService design employing codesign strategies.SettingGeneral practice.ParticipantsSeventeen staff (general practitioners, nurses and practice managers) from general practice in metropolitan Melbourne and regional Victoria and five patients from metropolitan Melbourne.InterventionsCodesign 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.ResultsParticipants 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.ConclusionStudy 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.

Download Full-text