Improving GP Access to and Use of Retrospective and Current Pathology Data to Increase Detection of Early Diabetes (IGT and IFG) in General Practice (2005)
Improving GP Access to and Use of Retrospective and Current Pathology Data to Increase Detection of Early Diabetes (IGT and IFG) in General Practice (2005)
Description
This project sought to look at education strategies for improving the detection and management of pre-diabetes in general practice.
Grant Recipient
Fremantle Regional GP Network
Aims and Objectives
establish current and best practice Request-Test-Report practice and identify gaps from both the pathology laboratory and the general practitioner (GP)
establish the basis for GP learning which will enable them to improve their role and performance in the Request-Test-Report cycle
establish current practice and prepare GPs for improved knowledge and practice
provide opportunity for GPs to build on their improved knowledge and changes to communication systems in order to improve compliance with existing guidelines and the use of disease registers and recall systems.
These aims and objectives were achieved by this project.
Outcomes
Detailed mapping of current practice in detection and management of pre-diabetes through focus groups, GP clinical audit activity and retrospective pathology reports. Best practice was established through a literature review and consultation with diabetes organisations and experts in the field. Gaps were then identified and an education plan developed and implemented.
Key recommendations arising from the outcomes of the mapping of current practice were developed and sent to all major pathology laboratories operating in the Fremantle Division boundaries in February 2005.
Development and implementation of a range of education opportunities for GPs and Practice Nurses (PNs) on the prevention of diabetes.
GPs were prepared for improved knowledge and practice by completing Phase 1 of the clinical audit, receiving an individual and group report of their results from the clinical audit, and reflecting on their current practice by completing a reflection and action plan.
Education opportunities for GPs included:
register and recall education
workshops
phase 2 of the clinical audit
receipt of regular retrospective pathology reports
best practice guidelines and patient resources.
Development, distribution and evaluation of best practice guidelines on the detection and management of pre-diabetes for general practice.
Development, implementation and roll out nationally of a five stage clinical audit for GPs on the detection and management of pre-diabetes.
Presentation of project resources at the 2004 Australian Diabetes Society (ADS) – Australian Diabetes Educators Association (ADEA) National Conference in Sydney.
“The Practical Management of Pre-diabetes – A Guide for General Practice” was completed in mid-June 2004 with 803 copies distributed throughout Australia as of 29 April 2005.
A patient information leaflet was developed in July 2004 with 4,892 copies ordered by GPs, PNs and Divisions of General Practice by 19 April 2005.
Sample copies of the pre-diabetes resources, along with an order form, were sent to all Divisions of General Practice in Australia in October 2005, with orders for multiple copies received from nine divisions.
The clinical audit was redesigned and submitted to the Royal Australian College of General Practitioners (RACGP) for accreditation to be run nationally.
The clinical audit was offered to all Divisions of General Practice in Australia in March 2005 with 65 divisions ordering copies as of 29 April 2005.
Findings
This pilot project demonstrated the successful implementation of a whole-of-practice approach to improving the detection and management of pre-diabetes in general practice.
Participant GPs changed their clinical practice in relation to measurement of weight, Body Mass Index (BMI) and waist circumference in patients at risk of diabetes.
Over 50% of GPs stated they had changed their practice as a result of participating in the clinical audit.
Data from entry and exit questionnaires show 67% of GPs had a register and recall system for pre-diabetes as compared to 42% prior to the clinical audit.
More practices have an effective register and recall system in place for patients with impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) to ensure they are tested regularly for the onset of Type 2 diabetes.
Recommendations
All Division programs should adopt a whole of practice approach in all projects in order to address all stakeholders in general practice rather than just focusing on the general practitioner.
Offer future clinical audits during the first or second year of the RACGP Quality Improvement & Continuing Professional Development Program (QA & CPD) triennium.
GPs who enroll in the QA & CPD should be required to complete Phase 1 and Phase 2 of the clinical audit, as there is significant educational value in completing Phase 2.
Ensure there is a clear understanding with project stakeholders of the timeframe when putting in a funding submission to ensure that circumstances do not change significantly between project planning and project implementation.
Continue to review current literature on best practice for the management of pre-diabetes to ensure resources remain up to date and relevant.
Offer the clinical audit to GPs every three years. This will ensure the GP Network has a current and accurate picture of gaps in the management of pre- diabetes. As the tools are already developed this would not be a time consuming exercise.
Continue to identify methods to overcome the barriers identified by general practice in the detection and management of pre-diabetes.
Continue to promote the ‘Practical Management of Pre-diabetes –A Guide for General Practice’ to general practice as a resource.
Joint Guidelines from the Australian Diabetes Society – Australian Diabetes Educators Association are due to be formalised shortly. These should be incorporated into the current resource as a tear out page.
Offer a variety of regular education and upskilling activities to general practice on the detection and management of diabetes
Offer funds to Divisions of General Practice across Australia to implement the clinical audit and associated educational activities.
Pathology laboratories offer, as part of their service to general practice, the regular provision of practice level data on test results of all types.
All training provided to practices on developing effective registers and recall systems for diabetes should also include pre-diabetes.
GP Network should continue to advocate for and support preventative health initiatives that utilise the professional expertise of the practice nurse.
Practice visits should be offered to all GP Network practices on an annual basis to offer support for their diabetes and pre-diabetes register and recall systems to ensure they are up to date and being maintained.
All practices have in place a protocol to update and maintain their register and recall systems. GP Network staff can assist practices to develop this.
GPs code patients with IFG/IGT prospectively as they are diagnosed to ensure they are included in the register and recall systems and practices have an accurate picture of their at-risk patient population.
Continue to promote the pre-diabetes resources and education activities developed through this project to general practice.
Run education events every triennium on the prevention of diabetes.
Key Project Learnings
Twenty-one GPs enrolled to participate in the clinical audit “Improving GP access to and use of retrospective and current pathology data to increase detection of pre- diabetes (IGT and IFG) in general practice”. Sixteen GPs completed data collection for Steps 1-4. Eight GPs enrolled in Step 5 of the clinical audit and five completed the data collection. The attrition rate was due to several reasons including competing time commitments, involvement in other Divisional projects and 2004 being the final year of the RACGP QA&CPD triennium.
One of the aims of this project was to develop communication systems between general practices and pathology laboratories through trialling a format for feedback to GPs. Due to the time delay between project planning and project implementation, General Pathology Laboratories (GPL) had already put this initiative into operation and it was not included as an intervention in this project. The use of retrospective pathology reports provided by the pathology laboratory to the general practice as the intervention to improve communication systems became the focus instead.
A multifaceted approach to improving the detection and management of pre-diabetes proved to be an effective strategy that targeted all the stakeholders in general practice. This approach included the development of linked education and resources for GPs, PNs and patients.
The pathology laboratories and information management systems in general practice were also targeted to ensure the infrastructure was in place to support GPs and PNs to improve the management of pre-diabetes. This strategy also ensured that all care providers and patients were provided with consistent information.
Combining educational outreach for GPs, PNs and patients, audit and feedback, along with provision of resources and information management support was effective in promoting behaviour change among health professionals.
Involving PNs in all aspects of this project was a successful strategy. The role of the PN in general practice is relatively new and their roles and duties are continually evolving. By providing education for PNs and linking it to GP education, GPs could understand and utilise the potential of the PN to provide education, distribute resources and assess lifestyle risk factors in patients.
The strategy of providing continuing medical education linked to the workplace, planned to meet GPs needs and based on self-assessment and peer review proved to be effective in this project. The baseline data provided by the clinical audit informed the development of the educational activities and resulted in participant GPs taking part in education designed to meet needs identified through the clinical audit.
The varying educational activities, ranging from clinical audit to education workshops, were effective in addressing the broad educational needs of GPs. It also allowed the knowledge gained from this education to lead to sustainable changes in practice through the incorporation of information management strategies and provision of resources for patients, GPs and PNs.
Undertaking a range of activities enabled a detailed picture of current practice to be developed. This helped in the development and implementation of a comprehensive education plan that addressed all aspects of general practice. As a result, all planned educational activities were well attended and received and resulted in real changes in practice by GPs and PNs.
The involvement of local pathology laboratories at both a steering committee and project implementation level enabled general practice and pathology laboratories to further their knowledge about the services each provides, and how to improve the linkages between them.
Areas for Future Consideration
Investigate the areas Practice Nurses can assist with information regarding pathology testing and patient education.
