Primary care improvement program shows benefits of collaboration

By Liam Davenport, medwireNews Reporter

A collaborative primary care program aimed at enhancing provision for chronic diseases, patient self-management, access, and Aboriginal healthcare has shown improvement across the vast majority of measures, Australian study findings indicate.

Noting that the Australian Primary Care Collaborative (APCC) Program is the largest of its kind to be published so far, Andrew Knight, from The Improvement Foundation in Adelaide, and colleagues say: "By creating a small team and a decentralised structure that delivers a series of collaborative waves nationally, expertise in quality improvement, logistics and engagement with clinical teams and their supports has been built."

Nevertheless, they add in BMJ Quality and Safety: "Improvement in APCC measures may in part be due to improved skills in disease register formation, cleaning and data collection, rather than changes in clinical care."

Adapting collaborative strategies used in the UK, the team introduced a large-scale quality improvement collaborative (QIC) program to 1185 general practices and Aboriginal medical services across Australia in 13 waves between 2005 and 2011.

The program, which was delivered at three workshops separated by activity periods and followed by 12 months of further work, focused on diabetes, coronary heart disease (CHD), access to care, chronic obstructive pulmonary disease, patient self-management, Aboriginal health, and diabetes prevention.

Of 111 general practice divisions in Australia, 83% took part in the program, and 262 division staff members have received training in quality improvement and the collaborative method. In addition, 397,111 patients were included on the disease registers of participating health services.

The results of the data analysis revealed notable improvements on all measures apart from access. These included increases in the percentage of patients with diabetes achieving a target glycated hemoglobin level of 7 mmol/l or below, the percentage of patients with CHD achieving target cholesterol levels below 4 mmol/l, and the percentage of patients with chronic diseases who had general practitioner management plans established.

Looking ahead, Patrick O'Connor, from Health Partners Research Foundation in Minneapolis, Minnesota, USA, comments in an accompanying editorial: "In the near future, and especially as we experiment broadly with primary care medical homes, some approaches will prove to be more effective than others.

"QICs can be used to help identify these optimal workflows and systems and to spread them to other clinics and care systems. Indeed, we know that this works."

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