The Treatment of cardiovascular Risk in Primary care using Electronic Decision suppOrt (TORPEDO) study: intervention development and protocol for a cluster randomised, controlled trial of an electronic decision support and quality improvement intervention in Australian primary healthcare

Peiris, David; Usherwood, Tim; Panaretto, Kathryn S; Harris, Mark; Hunt, Jenny; Patel, Bindu; Zwar, Nicholas; Redfern, Julie; MacMahon, Stephen; Colagiuri, Stephen; Hayman, Noel; Patel, Anushka

doi:10.1136/bmjopen-2012-002177

Cited by 43 publications

(51 citation statements)

References 35 publications

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“…20 In brief, a single screening and management algorithm were developed and then validated, based on a synthesis of recommendations from several screening and management guidelines for CVD, kidney disease, and diabetes mellitus. 21 The algorithm interfaces with 2 clinical practice software systems that together comprise ≈80% of primary healthcare record systems in Australia.…”

Section: Interventionmentioning

confidence: 99%

Effect of a Computer-Guided, Quality Improvement Program for Cardiovascular Disease Risk Management in Primary Health Care

Peiris

Usherwood

Panaretto

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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106

152

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C ardiovascular diseases (CVDs) are the greatest contributors to the global burden of disease, and finding ways to reduce this burden are a major challenge faced by health systems worldwide.1 Most guidelines recommend that the decision to use vascular disease preventive drug therapy should be on the basis of a patient's overall or absolute cardiovascular risk. 2 The broader application of risk-based care with safe, effective treatments has the potential to reduce disease burden substantially Background-Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited. Methods and Results-Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/ feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2)

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Section: Interventionmentioning

confidence: 99%

Effect of a Computer-Guided, Quality Improvement Program for Cardiovascular Disease Risk Management in Primary Health Care

Peiris

Usherwood

Panaretto

et al. 2015

Circ: Cardiovascular Quality and Outcomes

Self Cite

106

152

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“…Multifaceted approaches to improve adherence have been trialled internationally. 8,36,37 In Australian primary health care, a quality improvement intervention with pharmacists-led education to improve health literacy and electronic decision support for the prescribing of preventative medications has been shown to be effective. 36 Our study findings suggest that the polypill strategy could potentially be used successfully and synergistically with similar health service strategies to improve medication persistence in this setting.…”

Section: Discussionmentioning

confidence: 99%

Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care

Liu¹,

Massi²,

Laba³

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background-This study explores health provider and patient attitudes toward the use of a cardiovascular polypill as a health service strategy to improve cardiovascular prevention. Methods and Results-In-depth, semistructured interviews (n=94) were conducted with health providers and patients from Australian general practice, Aboriginal community-controlled and government-run Indigenous Health Services participating in a pragmatic randomized controlled trial evaluating a polypill-based strategy for high-risk primary and secondary cardiovascular disease prevention. Interview topics included polypill strategy acceptability, factors affecting adherence, and trial implementation. Transcribed interview data were analyzed thematically and interpretively. Polypill patients commented frequently on cost-savings, ease, and convenience of a daily-dosing pill. Most providers considered a polypill strategy to facilitate improved patient medication use. Indigenous Health Services providers and indigenous patients thought the strategy acceptable and beneficial for indigenous patients given the high disease burden. Providers noted the inflexibility of the fixed dose regimen, with dosages sometimes inappropriate for patients with complex management considerations. Future polypill formulations with varied strengths and classes of medications may overcome this barrier. Many providers suggested the polypill strategy, in its current formulations, might be more suited to high-risk primary prevention patients. Conclusions-The polypill strategy was generally acceptable to patients and providers in cardiovascular prevention.Limitations to provider acceptability of this particular polypill were revealed, as was a perception it might be more suitable for high-risk primary prevention patients, though future combinations could facilitate its use in secondary prevention. Participants suggested a polypill-based strategy as particularly appropriate for lowering the high cardiovascular burden in indigenous populations. Clinical Trial Registration-URL: http://www.anzctr.org.au. ANZCTRN: 12608000583347.(Circ Cardiovasc Qual Outcomes. 2015;8:301-308.

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“…The medical literature has many reports of well implemented research programs, often integrated with everyday care in ACCHSs, showing improved health outcomes. Sexual health, 17 maternal and child health, 18 smoking cessation 19 and cardiovascular programs 20 , 21 have been successfully run and monitored in ACCHSs. Recently ACCHSs have been building their capacity to collect and use health service data, enabling review of service delivery, performance tracking and monitoring of the health status of their patient cohorts.…”

Section: Quality Of Care Evaluation and Performancementioning

confidence: 99%

Aboriginal community controlled health services: leading the way in primary care

Panaretto

Wenitong²,

Button

et al. 2014

Medical Journal of Australia

160

114

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Summary The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross‐government‐sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector; its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: ➢models of comprehensive primary health care consistent with the patient‐centred medical home model; ➢coverage of the Aboriginal population higher than 60% outside major metropolitan centres; ➢consistently improving performance in key performance on best‐practice care indicators; and ➢superior performance to mainstream general practice. ACCHSs play a significant role in training the medical workforce and employing Aboriginal people. ACCHSs have risen to the challenge of delivering best‐practice care and there is a case for expanding ACCHSs into new areas. To achieve the best returns, the current mainstream Closing the Gap investment should be shifted to the community controlled health sector.

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The Treatment of cardiovascular Risk in Primary care using Electronic Decision suppOrt (TORPEDO) study: intervention development and protocol for a cluster randomised, controlled trial of an electronic decision support and quality improvement intervention in Australian primary healthcare

Cited by 43 publications

References 35 publications

Effect of a Computer-Guided, Quality Improvement Program for Cardiovascular Disease Risk Management in Primary Health Care

Effect of a Computer-Guided, Quality Improvement Program for Cardiovascular Disease Risk Management in Primary Health Care

Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care

Aboriginal community controlled health services: leading the way in primary care

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