Medicine & Health
Medicine & Health
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(2007) Amoroso, Cheryl; Proudfoot, Judy; Bubner, Tanya; Swan, Edward; Espinel, Paola; Barton, Christopher; Beilby, Justin; Harris, MarkJournal ArticleBACKGROUND: Clinical audit is recognised worldwide as a useful tool for quality improvement. METHODS: A feedback report profiling capacity for chronic disease care was sent to 97 general practices. These practices were invited to complete a clinical audit activity based on that feedback. Data were analysed quantitatively and case studies were developed based on the free text responses. RESULTS: Eighty-two (33%) of 247 general practitioners participated in the clinical audit process, representing 57 (59%) of 97 general practices. From the data in their feedback report, 37 (65%) of the 57 practices recognised the area most in need of improvement. This was most likely where the need related to clinical practice or teamwork, and least likely where the need related to linkages with other services, and business and finance. Only 25 practices (46%) developed an action plan related to their recognised area for improvement, and 22 (39%) practices implemented their chosen activity. Participating GPs judged that change activity focused on teamwork was most successful. DISCUSSION: The clinical audit process offered participating GPs and practices an opportunity to reflect on their performance across a number of key areas and to implement change to enhance the practice’s capacity for quality chronic disease care. The relationship between need and action was weak, suggesting a need for greater support to overcome barriers.
(2008) Dennis, Sarah; Zwar, N; Griffiths, Rhonda; Roland, Martin; Hasan, I; Davies, Gawaine Powell; Harris, MichaelJournal ArticleObjectives: To review the effectiveness of chronic disease management interventions for physical health problems in the primary care setting, and to identify policy options for implementing successful interventions in Australian primary care. Methods: We conducted a systematic review with qualitative data synthesis, using the Chronic Care Model as a framework for analysis between January 1990 and February 2006. Interventions were classified according to which elements were addressed: community resources, health care organisation, self-management support, delivery system design, decision support and/or clinical information systems. Our major findings were discussed with policymakers and key stakeholders in relation to current and emerging health policy in Australia. Results: The interventions most likely to be effective in the context of Australian primary care were engaging primary care in self-management support through education and training for general practitioners and practice nurses, and including self-management support in care plans linked to multidisciplinary team support. The current Practice Incentives Payment and Service Incentives Payment programs could be improved and simplified to encourage guideline-based chronic disease management, integrating incentives so that individual patients are not managed as if they had a series of separate chronic diseases. The use of chronic disease registers should be extended across a range of chronic illnesses and used to facilitate audit for quality improvement. Training should focus on clear roles and responsibilities of the team members. Conclusion: The Chronic Care Model provides a useful framework for understanding the impact of chronic disease management interventions and highlights the gaps in evidence. Consultation with stakeholders and policymakers is valuable in shaping policy options to support the implementation of the National Chronic Disease Strategy in primary care.
(2002) Fisher, Karen; Kemp, Lynn; Tudball, JacquelineReportThis document is the Final Draft of the Families First Outcomes Evaluation Framework, concerned with evaluating child, family and community outcomes. It is one of the evaluation activities for Families First. Others include process evaluation through Area Reviews of three Families First Areas in 2002-03, local Area evaluations and program evaluation of the projects funded through Families First. This outcome evaluation activity will inform the other evaluation activities. Overall the evaluation considers whether Families First has been effective in supporting families and communities in NSW to care for children using an early intervention approach and in developing linkages between specialised health, education, community and other policies. The Framework includes suggestions for minimum data collection and foundations for extending studies beyond the budget of the evaluation. A general aim in choosing the outcome indicators is to maintain compatibility with simultaneous program evaluation of similar NSW, Commonwealth and international programs.