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Australian Primary Care Collaboratives Program

  • The Australian Primary Care Collaboratives- Phase 2
    NWQPHC is proud to announce that we have 3 practices involved in the Improvement Foundation’s NSW-QLD-ACT offering of the Australian Primary Care Collaboratives Program (APCC www.apcc.org.au). Two delegates each from Ayr Medical Group, Ingham Family Medical Group, and Hinchinbrook Health Care attended an Orientation seminar in Brisbane in late May, introducing the principles of the collaboratives process. Practices will participate in 3 learning workshops, to be held in Sydney in June, September and December in 2008.
  • APCC- Measuring for improvement
    The APCC (formerly the NPCC- National Primary Care Collaboratives) targets 3 specific areas of general practice for improvement; Diabetes, Coronary Heart Disease (CHD) and Access and Care Redesign. The most recent wave of the program produced some remarkable improvements in health indicators including;
    • 61% improvement in the percentage of patients with CHD whose last recorded blood pressure was below 140/90mmHg
    • 139% improvement in the percentage of patients with Diabetes whose most recent HbA1c in the last 12 months was less than or equal to 7%
    • 199% improvement in the percentage of patients with Diabetes whose measured total cholesterol was less than 4 mmol/l within the previous 12 months
    • 77% increase in the percentage of Diabetes patients who have had a SIP claimed for them within the last 12 months
  • What NWQPHC practices say about the APCC program
    “Our searches and computers run faster now that we have cleaned up our registers, our practice nurses have also commented that the APCC program is having a positive impact on the practice and our patients” Practice Manager
    “We find that our recalls and reminders are easier to do now… it seems as though everyone answers their phone” Administration Assistant
    “ Our practice identified that there are enough potential GPMP's to justify a full time practice nurse dedicated to chronic disease- as a result of this we have claimed 4 times as many GPMP’s compared to this time last year… enough to cover the cost of employing the Chronic disease nurse!” Practice Manager
    “Being involved in the APCC program and having the canning tool has been very positive for our practice, we have wanted to work toward improving what we do for a long time, we’ve always known what we wanted to achieve… because we are involved in the APCC we now put aside time and plan what we will do… it’s been great” Practice Manager
    “I come from a background of practicing in Cuba, where we have a very strong focus on Primary Health Care and the APCC program has helped our practice adopt more of a preventative approach, which makes care so much easier...The tools, data and regular feedback have allowed us to check our progress, identify our weak points, improve patient care, and get the most out of Medicare item numbers to improve our practice income. We have developed a complex understanding of our practice (as a result of the APCC, and a lot of hard work from Sandra, Lyn and our admin staff), we now know exactly how many Diabetes and CHD patients we have, we can quickly access information about their health such as their HbA1c, Cholesterol and blood pressure… The patients are very positive, they have become more involved in their care and understand more about what targets they need to work toward, and the services that are available to them; and because we have become more proactive, our patients feel like we are really looking after them… The APCC program has helped us to plan our services in a smart way for the future. I believe that all the GPs and staff at our practice share the same positive sentiments about the program… we now work better as a care team.” Dr Ricardo Martinez, Ayr Medical Group
  • Results for NWQPHC so far
    After submitting data for 4 months (from May-August 2008) NWQPHC practices have shown an average improvement from baseline:
    • 7.8% improvement in the % of CHD patients on aspirin
    • 10.1% improvement in the % of CHD patients on a statin
    • 91.6% improvement in the % of CHD patients with a recorded blood pressure of <140/90
    • 100% improvement in the % of diabetes patients with a HbA1c of <7%
    • 33% decrease in the % of diabetes patients with no HbA1c recorded
    • 60% increase in the % of diabetes patients with a Blood pressure of <130/80
    • 76.9% increase in the % if diabetes patients with a cholesterol of <4mmol/L
    • 733% improvement in the % of diabetes patients with SIPS claimed in the last 12 months
  • Opportunities for you practice to be involved
    While NWQPHC was only able to offer 3 practices the opportunity to formally be involved in this wave of the APCC program, we would like to invite all other practices that have an interest in participating the chance to reap the benefits of getting involved in this process of Continuous Quality Improvement.
    NWQPHC can supply your practice with access to a free copy of the Canning Data Extraction tool (http://www.canningdivision.com.au/lnk_downloads.html ) which will allow your practice to easily extract data from a variety of clinical software packages. The Canning tool is able to provide your practice with complex information about the health of your patients with Diabetes, CHD and Asthma. The tool also provides information about cervical screening rates and ATSI health screening. An inbuilt Income estimator provides your practice with insight into the income potential of your practice. All data extracted by the Canning Tool stays within your practice.
    Another useful tool on offer by the APCC is access to the Online Reporting Site- your practice will be supplied with a unique site password and login. Once registered, you can enter your results into the site, access graphs that track your practice’s improvement, and compare your progress to the average of that in your division, and nationally. You will also have access to the “Good PDSA database”; a resource that outlines types of changes that have proven effective in other practices, in a variety of settings right across Australia. Data reported online is not shared with any third parties external to the APCC program and any information viewable by other practices or participants is aggregated or de-identified.
  • The Collaboratives Process- small steps
    PDSA stands for Plan, Do, Study, Act. It's a model for testing ideas that you think may create an improvement. It can be used to test ideas for improvement quickly and easily based on existing ideas, research, feedback, theory, review, audit, etc or practical ideas that have been proven to work elsewhere (for more information click here). Some examples of activities that practices have been focusing on include;
    • Cleaning up patient registers by inactivating patients that have not attended the practice for more than 2 years, are deceased, or do not live in local postcodes.
    • Deciding on disease codes that the practice will use consistently
    • Working on identifying all people with Diabetes and Coronary heart disease that have not been correctly coded by conducting medication searches and correlating these with their CHD and Diabetes registers
    • Making sure that Pathology results are being sent in HL7 format (instead of PIT format), which ensures that pathology data automatically populates the appropriate fields in a patients’ medical record, and allows for quick and easy data extraction and benchmarking (for more information on HL7 read e-news
    • Making sure that patient information such as blood pressures are recorded in the appropriate place in medical software.
    • Collecting information about their Access; i.e. their capacity (the number of appointments that they are able to offer in an ordinary week) and their demand (the number of appointment requests that they receive over a week, what these appointments are for, and on which days the practice is most busy).
    While these activities took some time to do, practices have reported that they are now running more efficiently and are saving time on recalling patients now that their patient database is much more accurate. By understanding their demand and capacity, practices have been able to take measures to ensure that procedures or pre-booked appointments are made for days when the practice is not so busy. For example, booking excisions on days when there is less demand for appointments and avoiding pre-booking too many appointments on Monday mornings when demand is high and the practice has many people requesting same day appointments.
  • Other support from your division
    NWPQHC can provide your practice with assistance, through practice support staff and a Collaboratives program manager. We can assist you with more information about using the Canning Tool, Online reporting, Using the Good PDSA database and applying the principals of the APCC program in your practice. Additionally, NWQPHC is currently exploring the possibility of running a workshop to introduce the principals of the APCC and provide your practice with the skills and tools to work toward sustainable improvement. For more information on any of these opportunities please contact Ruth Connors- Collaboratives program manager by phone (07 4725 8868) or email ruthc@nwqphc.com.au.   

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