Murrumbidgee General Practice Network (MGPN) has established a partnership with the National Prescribing Service to deliver Quality Use of Medicine initiatives to GPs and other health service providers across the region.
Current goals for the program include:
Increase GP knowledge regarding current best practice prescribing; and
Improve quality use of medicines awareness, competence and skills for other health professionals.
MGPN employs an accredited Pharmacist, Len Wade to deliver the program. GP education is delivered via face to face academic detailing or in a small group learning environment, usually from the GP's surgery. Pharmacist education is also delivered via the academic detailing model. The NPS pharmacist provides small group education to practice and residential aged care nurses in addition to community groups and early childhood facilities. Regular articles appear in MGPN publications and occasionally in local media.
Recent topics delivered include:
COPD: Interventions for better outcomes;
Analgesic choices in persistant pain;
Preventing osteoporosis and reducing fracture risk;
Selective use of antibiotics;
Early use of Insulin and anti-diabeticagents; and
Treating the symptoms of dementia.
Prescribing Data in General Practice Demonstration (PDGPD) Project
Overview
The PDGPD Project was designed to implement and test a new quality improvement activity for general practitioners (GPs). The project was developed by the National Prescribing Service (NPS) and the Australian General Practice Network (AGPN) to enhance the quality use of medicines and patient care in Australian general practice. Up to 180 general practices across Australia will participate in the project.
The quality improvement activity allows GPs to use their own prescribing data for systematic review of patient management and for peer comparison. The PDGPD Project focuses on two clinical areas – chronic heart failure (CHF) and hypertension. A data extraction software tool is used to extract data for CHF and hypertension clinical indicators (see below). The clinical indicators were developed from evidence based best practice guidelines.
In the Murrumbidgee General Practice Network there are 5 practices participating in the PDGPD Project. 2 practices have been randomised to the hypertension arm, 1 practice to the CHF arm and 2 practices to the wait control arm. The topics run for 6 months each. The wait control arm is necessary to be able to compare the intervention (CHF and hypertension) groups to usual practice. The wait control practices do not have to do anything for 6 months. After this time they commence the topic of their choice for 6 months, followed by the other topic for 6 months. The participating GPs get 40 Group 1 CPD points per topic that they complete.
The data extraction tool supplies GPs with immediate feedback on their prescribing in these two patient groups, identifying for review those individual patients who may be receiving suboptimal treatment. The GPs then participate in peer group discussions with a trained Project Facilitator from the General Practice Network. Participating GPs will be able to compare their results to those of their peers in their practice, to their General Practice Network and nationally. Regular clinical meetings and analysis of data enables the GPs and practices to track their progress and plan further improvements.
These continuous cycles of patient review, data analysis and implementing practice improvements are designed to enhance patient outcomes and embed quality improvement in practices. There will be evaluation of the outcomes and feasibility of the activity at the completion of the project.
Chronic Heart Failure Indicators
CHF1. Adult patients with CHF NOT using an ACE inhibitor or angiotensin II-receptor antagonist.
CHF2. Adult patients with CHF using an ACE inhibitor or angiotensin II-receptor antagonist, and not using a heart failure specific beta blocker.
CHF3. Adult patients with CHF using an ACE inhibitor, and using the ACE inhibitor below the recommended dose.
CHF4. Adult patients with chronic heart failure using a drug that may exacerbate the disease.
Hypertension Indicators
HT1. Adult patients with hypertension using at least one antihypertensive drug whose latest blood pressure is 140/90 mmHg or higher (measured in the last 12 months).
HT2. Adult patients with hypertension using a pro-hypertensive drug whose latest blood pressure is 140/90 mmHg or higher (measured in the last 12 months).
HT3. Adult patients with hypertension and coronary heart disease, diabetes, chronic kidney disease, stroke or TIA, whose latest blood pressure is 130/80 mmHg or higher (measured in the last 12 months).
HT5. Adult patients using an ACE inhibitor or angiotensin II-receptor antagonist, who are also using a systemic NSAID and a diuretic.