Enhancing prevention in primary health care
Project title: Strengthening the role of Primary Health Networks in the prevention of chronic disease
Start date: August 2018
Estimated end date: December 2021
What is the issue?
Primary health care has an important role in assessing, preventing and managing the most prevalent modifiable risk factors for chronic disease. Australia’s Primary Health Networks (PHNs) can play a role in developing partnerships with key stakeholders to commission and coordinate new preventive services and programs and to integrate clinical and population health approaches to chronic disease prevention. It is not clear, however, what this looks like in practice.
How is the project addressing the issue?
Following the first phase of our research into strengthening the role of PHNs in prevention, this project aims to identify what prevention approaches are feasible, are working well, or could potentially work well, in primary health care.
The project will identify a cardiovascular disease prevention initiative with PHNs and stakeholders, then trial and evaluate this prevention initiative across three to four PHNs to determine feasibility of scaling up such an initiative across all PHNs in Australia. The trial will be implemented in two phases and a number of stages using an adaptive model.
Relevance for practice
Through identifying the barriers to prevention approaches in primary care, such as practice facilitation (which has the potential to play a key role in primary care redesign), there is the potential to improve the coherence of the PHN effort in reducing the burden of chronic disease in Australia and in using resources more effectively to better prevent and manage chronic disease.
Professor Andrew Wilson, The Australian Prevention Partnership Centre, The University of Sydney
Dr Carissa Bonner, The University of Sydney
Professor Lyndal Trevena, The University of Sydney
Associate Professor Kevin McGeechan, The University of Sydney
Samuel Cornell, The University of Sydney
Kristen Pickles, The University of Sydney
Former team members
Dr Melissa Hobbs, The Australian Prevention Partnership Centre
Funding for this research has been provided from the Australian Government’s Medical Research Future Fund (MRFF). The MRFF provides funding to support health and medical research and innovation, with the objective of improving the health and wellbeing of Australians. MRFF funding has been provided to The Australian Prevention Partnership Centre under the MRFF Boosting Preventive Health Research Program. Further information on the MRFF is available at www.health.gov.au/mrff.
First phase 2018-2019
The first step of the project involved conducting a Prevention Workshop in August 2018, attended by representatives of more than 20 PHNs, as well as academics and Department of Health representatives. Stakeholders showcased some examples of prevention approaches in primary care and discussed what works and what doesn’t work when implementing prevention initiatives and the types of prevention approaches that could potentially be implemented by PHNs.
Following the workshop, a Community of Practice (PHN Prevention Network) was established based on feedback from PHNs that there was no information sharing mechanism or support network to advocate for the common interests of PHNs in relation to prevention of chronic disease. The purpose of the CoP is to provide a way for PHN representatives to share and exchange knowledge, tips, and best practices, ask questions of their colleagues, provide support for each other, encourage the free flow of ideas, and provide a forum to identify solutions to common problems.
We are currently in the planning stage for the trial of a practice facilitation model and are seeking stakeholder input.
January – March 2020
The CHAT-GP project aims to develop and test eHealth formats for GP guidelines and patient decision aids to improve cardiovascular disease prevention, with a focus on working with Primary Health Networks (PHNs) to identify and test implementation strategies. In quarter 1 of this project we:
- Reviewed national PHN Needs Assessment and Activity Plans to identify opportunities for CVD prevention activities within strategic priorities; and will expand on this in an interview-based survey of PHN staff in every state
- Engaged with PHNs in every state (including both metropolitan and regional areas) to better understand how CVD prevention is being addressed within their unique contexts, as well as the eHealth solutions they are using for guideline implementation and quality improvement
- Started working with PHNs to test different implementation strategies, including an app that will auto-populate CVD prevention tools in GP consultations (QLD, Vic); improving HealthPathways on CVD risk assessment and management (NSW, Vic); and reviewing different clinical audit tools and how these could be improved using evidence-based behaviour change techniques (Vic).
April – June 2020
- While several tasks in the workplan are on hold due to COVID-19 restrictions, the team completed a review of PHN needs assessment documents relating to CVD prevention
- We are currently interviewing PHN staff about CVD prevention activities including how this may be affected or change during the COVID-19 pandemic response
- We are working with two other Prevention Centre projects to:
- Determine if chronic pain would be suitable as a contrasting case study to the prevention of cardiovascular disease in PHN needs assessment documents
- Explore a health economics approach to make a compelling case for specific prevention interventions.
- Bonner C, Fajardo MA, Doust J, McCaffrey K, Trevena L. Implementing cardiovascular disease prevention guidelines to translate evidence-based medicine and shared decision making into general practice: theory-based intervention development, qualitative piloting and quantitative feasibility. Implementation Sci. 2019;14:86.
- Bonner C. Influencing change: Why when and how. Invited presentation and two-hour workshop hosted by Wiser Healthcare NHMRC program. Melbourne, Australia, 4 March 2020. (Attended by about 50 academic researchers and clinicians from Bond, Sydney and Monash universities and two national consumer representatives.)
- Bonner C. CVD Risk Calculator. Pen CS User Summit hosted by GP clinical audit software company licensed to most PHNs in Australia. Sydney, Australia, 20 March 2020. (Attended by about 50 PHN staff from all states/territories.)
- Bonner C. CHAT-GP project Cardiovascular Risk Assessment Tool. Queensland Statewide GP Liaison Officer Meeting hosted by OUR Primary Health Network. Brisbane, Australia, 25 November 2019. (Attended by Queensland PHN staff from seven regions.)
- Bonner C. What research and activities are currently happening around clinical decision support tools for CVD risk? (Overview of CHAT-GP intervention and research program). National Stakeholder Roundtable hosted by National Heart Foundation and ANU. Canberra, Australia, 29 November 2019. (Attended by 25 stakeholders involved in national clinical guidelines planning, including clinicians, researchers, not for profit and government organisation representatives.