Date of Award

2022

Degree Name

Doctor of Philosophy (College of Medicine)

Schools and Centres

Medicine

First Supervisor

Professor Lucie Rychetnik

Second Supervisor

Professor David Peiris

Third Supervisor

Professor Mark Harris

Abstract

Introduction

General practitioners (GPs) are central to cardiovascular disease (CVD) prevention and management. However, multiple studies show they have sub-optimal assessment and management of CVD risk. The central question addressed in this thesis was: How do we translate preventive care guidelines into the real world of Australian general practice through Quality Improvement Collaboration (QIC)?

Methods

The research comprised of four studies. The first examined the experiences of stakeholders participating in a quality improvement collaboration (QIC) intervention undertaken in Australian primary care [the Australian Primary Care Collaboratives [APCC] program], and the second assessed implementation of the 2012 CVD risk management guidelines in Australian general practices. It examined electronic medical record data from 95 general practices comprising 102 225 patients. In the third and fourth studies, a QIC intervention [QPulse] focused on improving CVD risk management was implemented in 34 general practices, and its effectiveness, barriers and enablers were evaluated.

Results

There were substantial gaps in the implementation of CVD guidelines, which remained after the brief QIC intervention aimed at achieving improvements in CVD screening and management (QPulse).

The qualitative evaluation interviews of stakeholders in the APCC and QPulse interventions highlighted that the Australian primary care environment is a complex and challenging setting to implement sustainable change, and obstacles at multiple levels impact the success of QI initiatives. Leadership, practice culture, access to accurate patient data and IT/practice support systems were elements required for the long-term adoption and implementation of systematic QI. Stakeholders identified two key factors that would assist Australian general practices to make QI sustainable: 7 practice support by an external support organisation and financial incentives for implementing QI programs.

Discussion

Significant gains in CVD morbidity and mortality could be achieved by improving CVD management in primary care. A ‘siloed’ QI program may not be effective, as there are several barriers to sustainable change. These are cultural factors, leadership and support systems to facilitate staff to implement QI. Additionally, QI programs need to be implemented with the assistance of an external agency to support practices, and incentives are required for practices and GPs to implement and sustain change.

Conclusions

CVD management in primary care has much scope for improvement, and QI is unlikely to address this effectively unless changes at the health system and practice levels alleviate key barriers. Future progress will require concerted efforts to realign the culture of primary healthcare and the practical and financial support provided to GPs and practices so that QI is valued and implemented in day-to-day patient management and the practice workflow.

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