Implementation of a guideline-based cardiovascular risk assessment and decision aid tool for General Practice (CHAT-GP)

This study will test implementation strategies (an app that auto-populates decision support tools from medical records, supported by a GP/patient website and training) for evidence-based interventions (risk calculator, decision aid, audit & feedback) to improve guidelines-based assessment of cardiovascular disease risk in general practice. The intervention will run continuously for 6 months in a stepped wedge trial format. Primary Health Networks will start in the control group, then be randomly allocated to receive the intervention in a specified month. All Primary Health Networks will begin in the control group and then each month 2 Primary Health Networks will begin the intervention. A 1 hour training meeting with the practice manager and interested staff will be conducted at the time of randomisation, using Zoom to demonstrate the intervention via screenshare and answer any questions. It is completely at GP staff discretion whether they choose to attend the training and use the CVD risk calculator and/or decision aid during a consultation with an eligible patient. If they do, a 20 minute consultation is required for a MBS-funded Heart Health Check, but they may choose other billing codes. The study does not require a specific number of consultations to be performed irrespective of whether the general practice is in a PHN in either the control or intervention group. GPs may also choose to do the self-directed audit and feedback interactive activity for CPD points at their discretion, which is recommended by the RACGP to take 6 hours. Patients may choose to use the consumer version of the risk calculator and decision aid in the waiting room or in their own time. Our team developed and piloted the intervention in 2016-18 including testing: 1. Interactive CVD risk calculator that automatically combines CVD risk assessment and management algorithms to help GPs identify the correct risk category and guidelines, to address GP capability barriers using best practice risk communication principles; 2. Personalised patient decision aid that shows the effect of medication/lifestyle interventions on CVD risk to help GPs discuss the benefits and harms of different options, addressing patient capability barriers based on international shared decision making standards; 3. Self-directed audit & feedback including cases that GPs find challenging for CVD risk assessment and communication, and comparison of management to guidelines, using evidence-based behaviour change techniques to address GP motivation barriers. Feasibility testing indicated a need to better integrate these tools into the general practice context. This stepped wedge trial will implement the intervention using a Pen CS Topbar app that auto-populates the website tool from a patient’s medical record during the consultation. This will be supported by a website offering: 1) additional guideline information and the self-directed audit and feedback training for GPs and practice nurses, and 2) a consumer version of the risk calculator/decision aid tool with a lifestyle change action plan to facilitate patient engagement in risk assessment and management. Training will be provided to practice managers (including waiting room resources and monthly practice-level audit & feedback reports) and individual staff (including demonstration of the tools and a lifestyle prescription pad to refer patients to the supporting consumer resources). The development and feasibility testing is detailed in https://implementationscience.biomedcentral.com/articles/10.1186/s13012-019-0927-x. The intervention content is hosted at www.auscdvrisk.com.au. At the time of randomisation practices will receive access to the Pen CS Topbar app that autopopulates this tool from patient records and log in details for the audit and feedback component. A process evaluation will be conducted to evaluate intervention use in this study, including recorded use of the Topbar app and associated website, and self-reported uptake of different components via staff interviews. The outcome of complete CVD risk assessment data for eligible patients will involve Pen CS CAT4 auditing medical record software.