None listed
Conditions
Brief summary
This project will evaluate a multifaceted educational intervention for Australian general practitioners (GPs). The educational intervention will be conducted by Medcast Pty Ltd on behalf of the funding body, the Australian Digital Health Agency (ADHA), and is designed to support best-practice clinical behavior and practice for prescribing, pathology and diagnostic imaging ordering utilising My Health Record (MHR - the Australian national patient-controlled electronic health record). The project is an extension of an earlier pilot study (HE 2018/047) which reported promising outcomes from the educational intervention. The research will evaluate the effectiveness of the educational intervention for GPs, regarding use of MHR and rational use of medicines, pathology and imaging, in achieving the following objectives set by the ADHA: 1. improve practitioner knowledge 2. change practitioner behaviour 3. facilitate incorporation of clinical changes and technology usage into routine care 4. make meaningful improvements in clinical care and, 5. result in tangible economic benefits While the mixed-methods study will address the objectives using a combination of quantitative and qualitative methods, we will use resource utilisation as a composite primary quantitative outcome measure for hypothesis testing: • The study will test the composite primary hypothesis that the education intervention will result in a difference between intervention and control groups in changes in 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.
Interventions
The education intervention is multi-faceted and includes participation in online webinars, online seminars, self-paced online learning modules, reflection activities, guided online forums and clinical audit.
The study has three arms. A prescribing education arm, a pathology test ordering education arm and a diagnostic imaging ordering education arm. The Choosing Wisely Australia recommendations form the basis of the specific medications and tests targetted in the intervention.
The specific me
The education intervention is multi-faceted and includes participation in online webinars, online seminars, self-paced online learning modules, reflection activities, guided online forums and clinical audit. The study has three arms. A prescribing education arm, a pathology test ordering education arm and a diagnostic imaging ordering education arm. The Choosing Wisely Australia recommendations form the basis of the specific medications and tests targetted in the intervention. The specific medication, pathology and imaging tests addressed for each of the topic streams are: Prescribing Proton pump inhibitors Diuretics Inhaled corticosteroids Benzodiazepmnes Opiates NSAIDS Pathology Ordering FBC Urea, creatinine and electrolytes LFT TFT Vitamin D MSU Diagnostic Imaging Low back pain imaging - lumbosacral spine xray and CT scanning The modes of the training delivery and schedule are summarised below: Month 1 Initial engagement webinar (45-60 mins) Evening webinar meeting facilitated by expert GPs. Study information to be presented to participants including key timelines. Opportunity for Q+A about the study process. Short didactic presentation introducing the topic (safe use of medicines, pathology or radiology) Introduction to MHR, benefits and application. Case studies where the theory is applied in practice, plus case study examples. Month 2 Online learning module (60 mins) To include data of national, current trends in inappropriate prescribing and testing ordering. Information about MHR, the future of MHR and current uptake. Tips and tricks for engagement, barriers, algorithms that can be used. Information about where MHR can fit into practice - checking the record, look for duplicates, identifying medications prescribed or test results from elsewhere. A case study scenario demonstrating using MHR. Case studies will be incorporated to apply the information delivered in the module. Month 2 Online Forum - Community of Practice (30 mins) Online forum for participants to reflect on learning and to discuss with peers the best approach in managing cases. The forum will be monitored by a GP Medical Educator who will seed topical content and cases for discussion. This forum will be available to participants for the duration of the study. Month 2 Clinical Audit - Quality Improvement (30-60 mins) Study participants will be required to complete a clinical audit (quality improvement) activity related to the study arm that they are in. The clinical audit activity will involve the collection and analysis of patient data with the intention to implement changes to clinical practice to improve patient outcomes. No identifying patient information will be collected or reported as part of the audit. The information will only be used by the GP for quality improvement activities. The information collected as part of the audit will be each participant’s reflection on the changes to clinical practice as a result of the study and audit activity. Month 3 Two (2) Case-based learning webinars / podcast (45-60 mins each) Two webinars will be held concurrently with the participants conducting the patient audits. The webinars will be facilitated by expert GPs and will provide participants with a virtual network to learn from via case-based learning. Short case presentations will be delivered during the study period and the participants will discuss the management. Participants will be encouraged to bring a case presentation from their clinical practice for discussion with the group. The webinars will be recorded and made available online or as a podcast. Webinar will be run during lunch time and evening to maximise the options for participation. Months 3-4 Post-intervention quiz and case scenarios (30 mins) Post intervention case scenarios to assess intention to treat and use of MHR. Length of education intervention The education intervention will be delivered over three to four months with an anticipated six hours invlovement for participants. Intervention adherence monitoring Adherence to the educational activies will be monitored by electronic records of participants' logging in to sesssions and repsonses to online activities.
Sponsors
Medcast
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
As a pragmatic trial, the inclusion criteria for the study are as broad as possible to replicate real-world conditions. The target research population is the Australian primary care medical workforce. Inclusion criteria: • Participants must hold an Australian Pharmaceutical Benefits Scheme (PBS) prescriber number and Medicare provider number • Participants must undertake clinical work at least one day per week in a clinical practice having compatible electronic health records with PenCS data extraction tools installed and MHR access • Participants must reside in a jurisdiction where pathology and imaging results are included in MHR
Exclusion criteria
The exclusion criteria are aimed to minimise the inclusion of participants who would not be able to provide meaningful data. • Absence from clinical work for more than 8 weeks over the study period
Outcome results
None listed