Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Supporting general practice to make timely decisions for better health care: a population health approach

Deborah Davies
+ Author Affiliations
- Author Affiliations

Gold Coast Primary Health Network, 1/14 Edgewater Court, Robina, Qld 4226, Australia. Email: debbied@gcphn.com.au

Australian Journal of Primary Health 24(5) 368-371 https://doi.org/10.1071/PY17164
Submitted: 16 November 2017  Accepted: 11 March 2018   Published: 14 June 2018

Abstract

Primary Health Networks (PHNs) are tasked to enhance the efficiency and effectiveness of general practice. Gold Coast Primary Health Network (GCPHN) has been collecting de-identified aggregated clinical data from general practices and reporting back on areas for improvement on data coding and some clinical metrics, such as blood pressure not being recorded. However, aggregated data cannot be used to intervene at the individual patient level, and because of the collection-to-reporting time-lag, the data cannot help facilitate immediate action in the general practice. GCPHN developed a practice-based population health management approach based on mapping data from general practices to international coding classification systems, and applying evidenced-based algorithms and tools. General practices are provided with a health profile of their entire patient population, from the healthiest to the most complex comorbid patients. The information is conveyed as alerts and reports on areas including medication quality and safety, possible gaps in care and high-risk patients. The information is received based on the practice’s preferences; this can be at the time of data entry, the following day or as specified. Strong clinical governance has ensured GCPHN’s approach and methodologies are evidenced-based and appropriate. The consistent application of clinical governance within general practices is also needed to ensure the approach is sustainable and improves clinical outcomes.


References

Ancker JS, Edwards A, Nosal S, Hauser D, Mauer E, Kaushal R, HITEC Investigators (2017) Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC Medical Informatics and Decision Making 17, 36
Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.Crossref | GoogleScholarGoogle Scholar |

Australian Government (2017) Australia’s National Digital Health Strategy 2017. Safe, seamless and secure: evolving health and care to meet the needs of modern Australia. Australian Government, Canberra, ACT, Australia.

Australian Institute of Health and Welfare (2014) Australia’s health 2014. Australia’s Health Series number 14. Catalogue number AUS 178. (AIHW: Canberra, ACT, Australia). Available at http://www.aihw.gov.au/publication-detail/?id=60129547205 [Verified 31 August 2017]

Avery T, Barber N, Ghaleb M, Franklin B, Armstrong S, Crowe S, Dhillon S, Freyer A, Howard R, Pezzolesi C, Serumaga B, Swanwick G, Talabi O (2012) ‘Investigating the Prevalence and Causes of Prescribing Errors in General Practice: the PRACtICe Study.’ (General Medical Council: London, UK)

Avery AJ, Ghaleb M, Barber N, Franklin B, Armstrong SJ, Serumaga B, Dhillon S, Freyer A, Howard R, Talabi O, Mehta RL (2013) The prevalence and nature of prescribing and monitoring errors in English general practice: a retrospective case note review. The British Journal of General Practice 63, 543–553.
The prevalence and nature of prescribing and monitoring errors in English general practice: a retrospective case note review.Crossref | GoogleScholarGoogle Scholar |

Avery AJ, Rodgers S, Franklin B, Elliott RA, Howard R, Slight S, Swanwick G, Knox R, Gookey G, Barber N, Sheikh A (2014) Research into practice: safe prescribing. The British Journal of General Practice 64, 259–261.
Research into practice: safe prescribing.Crossref | GoogleScholarGoogle Scholar |

Department of Health (2016) Primary Health Networks Grant Programme Guidelines February 2016. Australian Government, Canberra, ACT, Australia.

Durán CE, Azermai M, Vander Stichele RH (2013) Systematic review of anticholinergic risk scales in older adults. European Journal of Clinical Pharmacology 69, 1485–1496.
Systematic review of anticholinergic risk scales in older adults.Crossref | GoogleScholarGoogle Scholar |

Fitzgerald J (2015) Options for finance in primary care in Australia. Deeble Institute Issues. Brief number 11. (Australian Healthcare and Hospitals Association: Canberra, ACT, Australia) Available at https://ahha.asn.au/system/files/docs/publications/deeble_institute_issues_brief_no._11_fitzgerald.pdf [Verified 12 September 2017]

Gordon J, Miller G, Britt H (2016) Reality check – reliable national data from general practice electronic health records. Deeble Institute issues brief number 18. (Australian Healthcare and Hospitals Association: Canberra, ACT, Australia) Available at https://ahha.asn.au/publication/issue-briefs/deeble-institute-issues-brief-no-18-reality-check-reliable-national-data [Verified 28 August 2017]

Harding C, Seal A, Duncan G, Huynh R, McWilliam R, Pilotto L, Blake S, Mackey K (2016) Accuracy of screening tools for Pap smears in general practice. Journal of Innovation in Health Informatics 23, 555–559.
Accuracy of screening tools for Pap smears in general practice.Crossref | GoogleScholarGoogle Scholar |

Horsky J, Schiff G, Johnston D, Mercincavage L, Bell D, Middleton B (2012) Interface design principles for usable decision support: a targeted review of best practices for clinical prescribing interventions. Journal of Biomedical Informatics 45, 1202–1216.
Interface design principles for usable decision support: a targeted review of best practices for clinical prescribing interventions.Crossref | GoogleScholarGoogle Scholar |

Johns Hopkins University (2011) The Johns Hopkins ACG System Bibliography. (Johns Hopkins University: Baltimore, MD, USA) Available at https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/dev_057915.pdf [Verified 10 July 2017]

Jones A, Killion S (2017) Clinical governance for Primary Health Networks. Deeble Institute Issues brief number 22. (Australian Healthcare and Hospitals Association: Canberra, ACT, Australia) Available at https://ahha.asn.au/system/files/docs/publications/210417_issues_brief_no_22-_clinical_governance_for_phns.pdf [Verified 12 September 2017]

Koper D, Kamenski G, Flamm M, Böhmdorfer B, Sönnichsen A (2013) Frequency of medication errors in primary care patients with polypharmacy. Family Practice 30, 313–319.
Frequency of medication errors in primary care patients with polypharmacy.Crossref | GoogleScholarGoogle Scholar |

Lavan AH, Gallagher P, O’Mahony D (2016) Methods to reduce prescribing errors in elderly patients with multimorbidity. Clinical Interventions in Aging 11, 857–866.

Liaw ST, Taggart J, Yu H, De Lusignan S (2013) Data extraction from electronic health records – existing tools may be unreliable and potentially unsafe. Australian Family Physician 42, 820–823.

Payne TH, Hines L, Chan R, Hartman S, Kapusnik-Uner J, Russ A, Chaffee B, Hartman C, Tamis V, Galbreth B (2015) Recommendations to improve the usability of drug-drug interaction clinical decision support alerts. Journal of the American Medical Informatics Association 22, 1243–1250.
Recommendations to improve the usability of drug-drug interaction clinical decision support alerts.Crossref | GoogleScholarGoogle Scholar |

Phillips CB, Pearce C, Hall S, Travaglia J, Lusignan S, Love T, Kljakovic M (2010) Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence. The Medical Journal of Australia 193, 602–607.

Royal Australian College of General Practitioners (2010a) ‘Standards for General Practices’, 4th edn. (RACGP: Melbourne, Vic., Australia)

Royal Australian College of General Practitioners (2010b) Standards for general practices. What’s different? 4th edn. (RACGP: RACGP: Melbourne, Vic., Australia) Available at http://www.medicaldirections.com.au/assets/files/Standards4thEd_KeyChanges.pdf [Verified 28 August 2017]

Roughead L, Semple S, Rosenfeld E (2013) ‘Literature Review: Medication Safety in Australia.’ (Australian Commission on Safety and Quality in Health Care: Sydney, NSW, Australia)

Scally G, Donaldson L (1998) Clinical governance and the drive for quality improvement in the new NHS in England. British Medical Journal 317, 61–65.
Clinical governance and the drive for quality improvement in the new NHS in England.Crossref | GoogleScholarGoogle Scholar |

Sweidan M, Reeve J, Dartnell J, Phillips S (2011a) Improving clinical decision support tools: challenges and a way forward. Australian Family Physician 40, 561–562.

Sweidan M, Williamson M, Reeve J, Harvey K, O’Neill J, Schattner P, Snowdon T (2011b) Evaluation of features to support safety and quality in general practice clinical software. BMC Medical Informatics and Decision Making 11, 27
Evaluation of features to support safety and quality in general practice clinical software.Crossref | GoogleScholarGoogle Scholar |

Ventola CL (2014) Mobile devices and apps for health care professionals: uses and benefits. Pharmacy and Therapeutics 39, 356–364.

World Organisation of Family Doctors (2011) WONCA working party: quality & safety. (WONCA: Bangkok, Thailand) Available at http://www.globalfamilydoctor.com/groups/WorkingParties/QualitySafety.aspx [Verified 28 August 21017]