Effectiveness of educational interventions on the quality use of medicines in Australian general practice for secondary prevention of stroke

Participating Primary Healthcare Networks (PHNs) in the state of Victoria, including the general practices and general practitioners (GPs) within their catchment areas, who are randomised to a tailored multicomponent educational intervention to improve the provision of evidence-based secondary stroke prevention care for people who have had a stroke and/or transient ischaemic attack (TIA) will have access to the following interventions provided by Medcast on their QHub platform: • A single 60-minute Educational Visit delivered virtually or face-to-face, depending on practice preferences and facilitator availability: A trained facilitator will meet with GP(s) +/- practice nurse(s) and pharmacists to deliver education to promote evidence-based care using a case-based academic detailing approach. Facilitators are pharmacists with experience in educational outreach and small-group facilitation, who have received program-specific training regarding educational content, facilitation approaches, behaviour change principles and delivery of key educational messages. The facilitator will discuss key guideline recommendations (Australian Stroke Living Guidelines and Therapeutic Guidelines) including antithrombotic therapy, blood pressure management, lipid management and medicine optimisation, explore barriers to best practice and provide strategies to support best practice care. The education will be tailored to the needs of clinicians and the practice, with facilitators adapting the case discussion, therapeutic emphasis and practical examples according to participant experience, patient population, local referral pathways and practice workflows while maintaining core educational objectives and key messages. Fidelity will be supported through use of a standardised facilitator guide, structured presentation materials, predefined key messages, facilitator training and consistent case-based activities. Facilitators will be encouraged to adhere to core learning outcomes and behaviour change objectives while allowing contextual tailoring. • Self-directed mini-audit (3 hours): GPs will be invited to identify a subset of 3 relevant patients for the secondary stroke prevention clinical topic and review their management in comparison to educational materials outlining evidence-based care (estimated time 60 minutes per patient). This mini audit reflective activity comprises four core components and one optional component: 1. Select patient encounter 2. Review best practice guidance 3. Reflect on practice 4. Upload your reflections 5. Discuss your reflections with peers (optional) • A single pre-recorded webinar (60 minutes) will deliver best practice advice to GPs in an online format. This will be case based and presented by a subject matter expert. The webinar will be available with live question time on one occasion in August 2026, with the webinar recording then available on demand throughout the trial period. • A Clinical Guide (2 page A4 PDF downloadable and printable), based upon the Australian and New Zealand Living Clinical Guidelines for Stroke Management and Therapeutic Guidelines, will provide summarised, step by step guidance outlining evidence-based care for secondary stroke prevention. The Clinical Guide will be developed to translate complex evidence into a clear, accessible format that supports rapid, consistent and evidence-based decision-making, improving efficiency, clinician confidence and patient care outcomes. • A patient Decision Aid (2 page A4 PDF downloadable and printable) will present the potential benefits and harms for each treatment option, encouraging patients to consider the best option for their personal situation and preferences. The aid will be designed as an interactive, fillable worksheet to be used by health professionals during or alongside a consultation to guide structured discussion in a step-based approach: Step 1: Introduce secondary stroke prevention concepts Step 2: Discuss treatment options Step 3: Elicit patient preferences Step 4: Co-develop an action plan Step 5: Plan follow-up and support Step 6: Encourage ongoing reflection (patients can use the decision aid between visits and add notes/questions over time • MedLuma, a curated clinical AI search tool for health professionals to ask questions and receive answers drawing from validated evidence-based Australian sources (e.g. Australian Living Stroke Guidelines and Therapeutic Guidelines and Medcast content). This is only available to GPs who have a Medcast account and have provided their AHPRA number. GPs may choose to engage with all, some or none of the allocated educational components, which are part of an educational program delivered by Medcast on their QHub platform. Participants in this arm will also have access to education on other topics available on the Medcast QHub platform, which include depression and/or anxiety in teenagers and young people, eczema, gout, antidepressants for older people, anticoagulants for people with atrial fibrillation, and menopause. Educational visits will be available on demand for depression and/or anxiety in teenagers and young people during the trial 4-month intervention delivery period. Fidelity will be monitored where feasible. Medcast will collect data for participation in Educational Visits. Participation data will also be available for Mini-audits, Webinar views and MedLuma use, as these components of the education require enrolment. Medcast will collate these data to record participation by Medcast ID for linkage with POLAR data.