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01.12.2012 | Study protocol | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Prescribing Data in General Practice Demonstration (PDGPD) project - a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2012
Autoren:
Margaret Williamson, Magnolia Cardona-Morrell, Jeffrey D Elliott, James F Reeve, Nigel P Stocks, Jon Emery, Judith M Mackson, Jane M Gunn
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-273) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests. Staff from the NPS Research and Development team had a role in project design and data analysis independently of the NPS health professional staff and decision support staff who designed the quality improvement activity, delivered the project facilitator training on the two clinical topics and managed the program implementation and data coordination. AGPN played an advisory role on the practicalities of working with, and in the recruitment of general practice networks, and had no involvement in data analysis or interpretation. The government funding body (Commonwealth Department of Health and Ageing) had no role in the conception or development of the study design, the writing of the manuscript or the decision to submit it for publication. This study has not received any funding from commercial organisations.

Abstract

Background

Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1) hypertension (HT) and 2) chronic heart failure (CHF). The objectives of this study were to improve general practitioner’s drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention.

Methods

A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI) intervention on prescribing practice among Australian general practitioners (GP) in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion) with each group undertaking the clinical topics (CHF and HT) in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a “control” for the other two groups.
De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs.

Discussion

This paper describes the study protocol for a project that will contribute to the development of acceptable and sustainable methods to promote QI activities within routine general practice, enhance prescribing practices and improve patient outcomes in the context of CHF and HT. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), Trial # 320870.
Zusatzmaterial
Additional file 1: Appendix 1. PDGPD Study Governance membership and functions. (DOCX 91 KB)
12913_2011_2290_MOESM1_ESM.docx
Additional file 2: Appendix 2. Scope of CHF and HT definitions. (DOCX 21 KB)
12913_2011_2290_MOESM2_ESM.docx
Additional file 3: Appendix 3. Medicines relevant to the intervention. (DOCX 29 KB)
12913_2011_2290_MOESM3_ESM.docx
Additional file 4: Appendix 4. Key Data Management and Data Cleaning Activities Undertaken by Facilitators or Practice Staff. (DOCX 20 KB)
12913_2011_2290_MOESM4_ESM.docx
Authors’ original file for figure 1
12913_2011_2290_MOESM5_ESM.pdf
Authors’ original file for figure 2
12913_2011_2290_MOESM6_ESM.pdf
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