A cluster randomised controlled trial of a MedicineInsight educational quality improvement program to improve the diagnosis and treatment of chronic hepatitis C in Australian general practice - the EQUIP-HEPC trial
NPS MedicineWise (Not-for-profit)
300 participants
Jul 29, 2019
Interventional
Conditions
Summary
Just over 180,000 people in Australia are living with chronic hepatitis C (CHC) and at risk of liver disease, liver cancer and death. Since 2016, medicines for CHC can be prescribed by GPs, which cure >95% of patients and prevent ongoing liver damage. So far 10% of GPs in Australia have prescribed CHC medicines, but to meet World Health Organisation targets for hepatitis C elimination all GPs will need to identify patients in their practice with the disease and recall them for treatment. NPS MedicineWise has developed an educational intervention delivered by their field force of clinical service specialists (CSS) to general practice staff to support GPs in the diagnosis and management of CHC. The intervention includes a 1-hour educational small group meeting at the general practice, a personalised ‘audit and feedback’ report from the MedicineInsight program, that includes data specific to their practice, benchmarked against all practices, and an online audit tool. The intervention aims to raise awareness, provide education and increase confidence in management of CHC, as well as facilitating links between GPs and specialists who can provide approval for treatment and support GPs while they increase their experience in CHC management. During the 1-hour meeting, in addition to discussing the feedback reports, the education will include a case study, educational materials developed by ASHM, and an action sheet completed by the CSS during the visit. The intervention also includes encrypted patient lists from MedicineInsight identified as requiring follow-up at the practice. This cluster randomised controlled trial will evaluate whether the NPS MedicineWise educational intervention, with data-based insights from MedicineInsight, is effective at improving case finding, assessment and treatment of patients with CHC. We will test the hypothesis that compared to control practices, those practices randomised to receive the NPS MedicineWise educational intervention will have a higher number and proportion of patients with CHC initiating direct acting antiviral (DAA) therapy and a higher number of patients being tested with an HCV (hepatitis C virus) RNA PCR test for diagnosis. Data will be evaluated using the general practice data program, MedicineInsight. MedicineInsight is a leading large-scale primary care data set of longitudinal de-identified electronic health records (EHR) used for quality improvement and research. The results of this trial will help inform future initiatives in Australia as well as internationally to continue the treatment momentum to help eliminate CHC.
Eligibility
Inclusion Criteria6
- General Practice sites:
- Participates in the MedicineInsight Program and meets MedicineInsight data quality requirements
- Located in a geographical area serviced by one of the CSS field force delivering the intervention
- Use of Medical Director or Best Practice for EHR management
- Has 5 or more patients with possible or confirmed CHC* who visited the practice at least once in the 2 years prior to randomisation
- As part of a previous project related to hepatitis C, we have developed a set of search algorithms that scan the data in MedicineInsight for terms that indicate confirmed or possible CHC. These algorithms and terms are outlined in detail by Chidwick et al (2018) . The algorithms search for a patient’s most recent docle and pyefinch codes as well as free text expressions pertaining to hepatitis C in clinical system records that describe reason for encounter, reason for prescription, or diagnosis. Additional criteria are applied to confirm CHC in patients whose most recent status is indeterminate, including prescriptions, tests, and complications related to CHC.
Exclusion Criteria2
- Practices that participated in the 2017 NPS MedicineWise educational program on Hepatitis C will be excluded.
- Practices that withdraw their consent to participate in this study, or in the MedicineInsight program, during the period of analysis will not be included in this study. Practice-level withdrawals are rare in MedicineInsight. Data for patients who opt-out from the program will be excluded from the study.
Interventions
NPS MedicineWise has developed an educational intervention to be delivered to general practices to support GPs in the diagnosis and management of CHC. The 150 practices that are randomised to the intervention arm will be offered the intervention as described below: The one-off educational intervention will be delivered at each practice by trained clinical service specialists (CSS) from NPS MedicineWise. The majority of CSS are pharmacists. The intervention involves a 1-hour facilitated discussion among the health professionals at the practice, led by one of the CSS. The intervention supports GPs to take an active role in identification, diagnosis and management of people with CHC including treatment or referral as appropriate. The intervention aims to raise awareness, provide education and increase confidence in management of CHC, as well as facilitating links between GPs and specialists who can provide approval for treatment and support GPs while they increase their experience in CHC management. The materials used during the intervention include: 1. A one-off personalised MedicineInsight practice ‘audit and feedback’ report that includes data specific to their practice and which benchmarks this information against the average of all MedicineInsight practices. This MedicineInsight practice report describes the management of patients with possible or confirmed CHC who visited their practice in the last two years, against the average of all MedicineInsight practices. 2. An accompaying patient case study developed by NPS MedicineWise. 3. Educational materials and guidelines developed by ASHM. 4. An action sheet completed by the CSS during the visit. 5. Encrypted patient lists from MedicineInsight identified as requiring follow-up at the practice. 6. An online audit tool will be made available following the practice visit, to support practice staff to initiate care of patients identified by MedicineInsight as requiring follow-up. 7. The NPS MedicineWise CSS will be trained to deliver the intervention in a systematic way at each practice by following the NPS MedicineWise "Topic Discussion Guide"
Locations(1)
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ACTRN12619000508178