Effectiveness of educational interventions to improve the quality use of medicines in Australian general practice for people with gout and older adults prescribed antidepressants

Participating general practices will be randomised to receive a co-designed, tailored and facilitated intervention (virtual educational visits and peer group learning seminars) designed to improve the provision of evidence-based care for either people with gout (Group 1) or older adults prescribed antidepressant medication (Group 2). Each group will act as the other’s control. Key messages of the program for gout will include: - Start urate-lowering therapy at a low dose - Commence flare prophylaxis concomitantly with urate-lowering therapy - Slowly titrate urate-lowering therapy to achieve target serum urate levels and monitor regularly Key messages of the program for older adults prescribed antidepressants will include: - Tailor antidepressant choice to the individual and use informed consent to agree on treatment goals and patient expectations - Review antidepressant treatment early and regularly, assessing the need for additional support to optimise outcomes - GPs and patients to develop a plan for the safe reduction or cessation of antidepressants that incorporates appropriate supports The virtual educational visits and peer group learning seminars will be delivered online by an experienced education facilitator. Virtual educational visits involve a trained facilitator meeting with health professionals (general practitioners (GPs), practice nurses and pharmacists) in their practice setting to deliver information with the aim of improving care. The experienced education facilitator will discuss the key messages of the program for gout and antidepressants topics, explore barriers to best practice and provide strategies (e.g., clinical care scenarios) to support best practice care. The education is tailored to the needs of the health professionals and the practice. A case study may be used to highlight salient points. Although health professionals other than GPs may be involved in the educational visits, this trial focusses on GP outcomes. Peer group learning seminars involve a trained facilitator meeting with health professionals from multiple settings to deliver education with the aim of improving care. The experienced education facilitator will discuss the key messages of the program for gout and antidepressants topics and may use a case study to highlight salient points. Large groups will be separated into smaller groups (up to 10 participants) for break-outs and facilitated discussions. Seminars will generally include a subject matter expert (eg specialist or specialised GP) sharing expert commentary of the topic. Sessions encourage discussion and exchange of ideas between participants. GPs within each practice will be offered a virtual educational visit and/or a peer group learning seminar for the topic to which they are randomised (i.e. gout management or antidepressant prescription in older adults) at a time which has been mutually negotiated. The duration of engagement with each intervention will be approximately 45-60 minutes. Facilitated and tailored educational interventions for adults with gout will be offered from 1 August 2024 until 31 January 2025 while these educational interventions for antidepressant prescription in older adults will be offered from 1 November 2024 until 30 April 2025. These end-dates will be flexible to optimise participation. The facilitator with record participant attendance and complete a checklist to monitor intervention fidelity of each intervention. Both groups will have access to webinars, mini-audits, case-based blogs/online modules, podcasts and clinical decision support tools for both topics via the Medcast online education platform, and access to these will be recorded.