Prevention in Primary Health Care Project Is this

Prevention in Primary Health Care Project: Is this evaluation, research or just quality improvement? And does it matter? Wendy Oakes Primary Health Care Program Manager Heart Foundation NSW © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 1

Project partners and collaborators: NSW Health (Centre for Health Advancement) Wentwest Northern Rivers General Practice Network NSW Outback Division of General Practice 15 general practices across NSW Centre of Primary Health Care and Equity (NSW University) PANORG (Sydney University) GPNSW Commonwealth Department of Health and Ageing Dr Annette Carruthers © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 2

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Prevention in Primary Health Care Project Objectives: 1. To enhance and support GP referral of patients to LRFM services 2. To investigate barriers and enabler to GP referrals 3. To investigate referral patterns between general practice and the wider primary care setting, and the social and cultural conditions that influence these © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 9

Cochrane review (2010) 12, 097 articles Reference: Flodgren G, Deane K, Dickinson HO, Kirk S, Alberti H, Beyer FR, Brown JG, Penney TL, Summerbell CD, Eccles MP. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese adults. Cochrane Database of Systematic Reviews 2010, Issue 3. Art No. CD 000984. DOI: 10. 1002/14651858. CD 000984. pub 2. © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 10

Cochrane review (2010) 12, 097 articles 11, 698 excluded Reference: Flodgren G, Deane K, Dickinson HO, Kirk S, Alberti H, Beyer FR, Brown JG, Penney TL, Summerbell CD, Eccles MP. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese adults. Cochrane Database of Systematic Reviews 2010, Issue 3. Art No. CD 000984. DOI: 10. 1002/14651858. CD 000984. pub 2. © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 11

Cochrane review (2010) 12, 097 articles 11, 698 excluded 399 articles read in full Reference: Flodgren G, Deane K, Dickinson HO, Kirk S, Alberti H, Beyer FR, Brown JG, Penney TL, Summerbell CD, Eccles MP. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese adults. Cochrane Database of Systematic Reviews 2010, Issue 3. Art No. CD 000984. DOI: 10. 1002/14651858. CD 000984. pub 2. © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 12

Cochrane review (2010) 12, 097 articles 11, 698 excluded 399 articles read in full 393 articles excluded Reference: Flodgren G, Deane K, Dickinson HO, Kirk S, Alberti H, Beyer FR, Brown JG, Penney TL, Summerbell CD, Eccles MP. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese adults. Cochrane Database of Systematic Reviews 2010, Issue 3. Art No. CD 000984. DOI: 10. 1002/14651858. CD 000984. pub 2. © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 13

Cochrane review (2010) 12, 097 articles 11, 698 excluded 399 articles read in full 393 articles excluded 6 articles included in review Reference: Flodgren G, Deane K, Dickinson HO, Kirk S, Alberti H, Beyer FR, Brown JG, Penney TL, Summerbell CD, Eccles MP. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese adults. Cochrane Database of Systematic Reviews 2010, Issue 3. Art No. CD 000984. DOI: 10. 1002/14651858. CD 000984. pub 2. © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 14

Cochrane Review (2010) “Most of the included trials had methodological or reporting weaknesses and were heterogeneous in terms of their participants, interventions, outcomes and settings so we cannot draw any firm conclusions about the effectiveness of the interventions. All of the evaluated interventions would need further investigation before it was possible to recommend them as effective strategies. ” © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 15

Cochrane Review (2010) “Most of the included trials had methodological or reporting weaknesses and were heterogeneous in terms of their participants, interventions, outcomes and settings so we cannot draw any firm conclusions about the effectiveness of the interventions. All of the evaluated interventions would need further investigation before it was possible to recommend them as effective strategies. ” © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 16

Cochrane Review (2010) “Most of the included trials had methodological or reporting weaknesses and were heterogeneous in terms of their participants, interventions, outcomes and settings so we cannot draw any firm conclusions about the effectiveness of the interventions. All of the evaluated interventions would need further investigation before it was possible to recommend them as effective strategies. ” © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 17

© 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 18

Publications on Australian Primary Care Collaboratives 2005 - 2011 1. Farmer L, Knight A 2005 Systems change in Australian general practice – early impact of the National Primary Care Collaboratives Australian Family Physician 2. Knight AW 2009 Learning from four years of collaborative access work in Australia Quality in Primary Care 3. Dunbar J and Reddy P 2009 Integration and coordination of care Australian Journal of Rural Health 4. Civil M et al 2009 Attitudes and practices of recording diabetic patient information within an Australian general practice setting: an exploratory study Informatics in Primary Care 5. Bonney A, Farmer EA 2009 Will the NHHRC recommendations drive quality performance Australian Family Physician 6. Kelly J et al 2009 Are general practice networks ‘ready’ for clinical data management? Australian Family Physician 7. Reddy P, Ford D, Dunbar JA 2010 Improving the quality of diabetes care in general practice The Australian Journal of Rural health 8. Ford DR, Knight AW 2010 The Australian Primary Care Collaboratives: an Australian general practice success story Medical Journal of Australia 9. Knight A, Lembke T 2011 Appointments – getting it right Australian Family Physician © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 19

Publications on Australian Primary Care Collaboratives 2005 - 2011 1. Farmer L, Knight A 2005 Systems change in Australian general practice – early impact of the National Primary Care Collaboratives Australian Family Physician 2. Knight AW 2009 Learning from four years of collaborative access work in Australia Quality in Primary Care 3. Dunbar J and Reddy P 2009 Integration and coordination of care Australian Journal of Rural Health 4. Civil M et al 2009 Attitudes and practices of recording diabetic patient information within an Australian general practice setting: an exploratory study Informatics in Primary Care 5. Bonney A, Farmer EA 2009 Will the NHHRC recommendations drive quality performance Australian Family Physician 6. Kelly J et al 2009 Are general practice networks ‘ready’ for clinical data management? Australian Family Physician 7. Reddy P, Ford D, Dunbar JA 2010 Improving the quality of diabetes care in general practice The Australian Journal of Rural health 8. Ford DR, Knight AW 2010 The Australian Primary Care Collaboratives: an Australian general practice success story Medical Journal of Australia 9. Knight A, Lembke T 2011 Appointments – getting it right Australian Family Physician © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 20

Publications on Australian Primary Care Collaboratives 2005 - 2011 1. Farmer L, Knight A 2005 Systems change in Australian general practice – early impact of the National Primary Care Collaboratives Australian Family Physician 2. Knight AW 2009 Learning from four years of collaborative access work in Australia Quality in Primary Care 3. Dunbar J and Reddy P 2009 Integration and coordination of care Australian Journal of Rural Health 4. Civil M et al 2009 Attitudes and practices of recording diabetic patient information within an Australian general practice setting: an exploratory study Informatics in Primary Care 5. Bonney A, Farmer EA 2009 Will the NHHRC recommendations drive quality performance Australian Family Physician 6. Kelly J et al 2009 Are general practice networks ‘ready’ for clinical data management? Australian Family Physician 7. Reddy P, Ford D, Dunbar JA 2010 Improving the quality of diabetes care in general practice The Australian Journal of Rural health 8. Ford DR, Knight AW 2010 The Australian Primary Care Collaboratives: an Australian general practice success story Medical Journal of Australia 9. Knight A, Lembke T 2011 Appointments – getting it right Australian Family Physician © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 21

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Prevention in Primary Health Care Project 2010 - 2012 © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 23

Participatory Action Research Principles • • Collaborative partnership at all stages Balancing research and action Building on strengths and resources of community Systems development through cyclical and iterative processes • Promoting learning and building capacity • Involving partners in dissemination of findings © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 24

Features of Prevention in Primary Health Care Project • Divisions collaborated on designing project and evaluation • Each general practice undertakes its own needs assessment and develops its own quality improvement project • Funding for Divisions and general practices to quarantine staff time • NHF and Division provide practice specific support and professional development © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 25

Project Design © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 26

Realist Evaluation What works, for whom, how, and in what circumstances ? © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 27

Benefits of Realist Evaluation • It maintains the complexity of the issue • It’s an emergent and generative process © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 28

Project Evaluation Framework © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 29

Sharing the learnings • Develop a specific research component using qualitative methodology and submit for peerreviewed publication • Write up what we can - regardless of whether we think it will be accepted • Self-publish on the Heart Foundation website © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 30

Thank you… any questions? © 2011 National Heart Foundation of Australia AES Conference Aug 2011 Slide 31