Battling the blight with benzos in primary care with big data and small steps

Initiative Type
Clinical Guideline
Status
Deliver
Added
18 December 2019
Last updated
30 January 2020

Summary

The Gold Coast PHN developed and recently validated Primary SenseTM, a data extraction, analysis and management tool for general practice. Primary SenseTM generates simple reports from confidential data with only three clicks about individual patients at a practice level who may benefit from specific interventions. At a regional level, data from practices are aggregated and displayed in real-time as dashboards and maps. A specific report and dashboard were developed to identify those patients who may inappropriately be prescribed benzodiazepines. The reports are used as an essential component of the Continuous Quality Improvement (CQI) projects practices undertake. At the PHN level, the prevalence of potentially inappropriate benzodiazepine prescribing is addressed through educational activities, targeted practice support and commissioning of related services.

The challenges included: Adequate funding to further develop Primary SenseTM reports and dashboards; The capacity and capability of general practice teams to undertake CQI projects; Incorporating real-time data in commissioning local services.

Key dates
Aug 2019
Aug 2020

Aim

The project addresses three problems: the prevalence of low-value care in general practice has not (yet) reliably been quantified; Choosing Wisely recommendations are not widely implemented; and many patients are inappropriately prescribed benzodiazepines in primary care settings.
 

Benefits

Low value care can be reduced by implementing Choosing Wisely recommendations in general practice. The exemplar of inappropriate benzodiazepine prescribing identifies three important facilitators: Linking interventions to existing initiatives (PIP QI) and processes (CQI); quick access to accurate, real-time data; and allocating adequate and appropriate resources.

Background

Public healthcare services worldwide, including in Queensland, face unprecedented challenges from an ageing population, increasing multimorbidity and constrained resources. Consequently, initiatives like Choosing Wisely are increasingly important to help improve the efficiency of health care and ensure a high-quality, safe and sustainable service. The Royal Australian College of General Practitioners (RACGP) made 10 recommendations in 2015/16 about tests, treatments and procedures clinicians and consumers should question. However, the prevalence of low-value care associated with the recommendations are unknown, and the recommendations have not been systematically considered or implemented in primary care settings. 

Solutions Implemented

Providing clinicians with a sample of named patients who may benefit from a simple intervention is an acceptable and feasible strategy to increase their participation in CQI. Increased awareness of the Choosing Wisely recommendations provide a strong rationale for addressing the issue of inappropriate benzodiazepine prescribing.

Evaluation and Results

General practices in the Gold Coast that registered for the Practice Incentive Payment Quality Improvement (PIP QI) initiative that was launched in August 2019 (n=>150) now routinely undertake CQI projects. 33 Practices with a combined patient population of approximately 250,000 patients are currently using Primary SenseTM , with more are added every week from a large wait list. The PHN developed a standardized CQI process, templates, ‘recipes’ and resources for practices that is widely used and supported by PHN Practice Support Officers and educational events. One of the ‘recipes’ is for reviewing and reducing inappropriate prescribing of benzodiazepines. There is now preliminary evidence that practice teams are willing, able and ready to plan, undertake and complete CQI projects. The PHN Commissioning Team has access to Primary SenseTM data and it informs strategic planning.

The ‘blight of benzos’ has been extensively chronicled in the international literature. Efforts to reduce inappropriate benzodiazepine prescribing may therefore help improve patient safety.

Lessons Learnt

Choosing Wisely recommendations can feasibly be implemented as CQI projects; Quick access to accurate data in real time is essential to achieve measurable improvements in primary care; GPs and practice teams are willing, able and ready to undertake CQI projects.

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Key contact

Dr Carl de Wet
GP Liaison Officer
Gold Coast University Hospital
0756876432
Carl.deWet@health.qld.gov.au