Data-driven quality improvement program to prevent hospitalisation and improve care of people living with coronary heart disease: Protocol for a process evaluation.

BACKGROUND: Practice-level quality improvement initiatives using rapidly advancing technology offers a multidimensional approach to reduce cardiovascular disease burden. For the "QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with heart disease" (QUEL) cluster randomised controlled trial, a 12-month quality improvement intervention was designed for primary care practices to use data and implement progressive changes using "Plan, Do, Study, Act" cycles within their practices with training in a series of interactive workshops. This protocol aims to describe the systematic methods to conduct a process evaluation of the data-driven intervention within the QUEL study. METHODS: A mixed-method approach will be used to conduct the evaluation. Quantitative data collected throughout the intervention period, via surveys and intervention materials, will be used to (1) identify the key elements of the intervention and how, for whom and in what context it was effective; (2) determine if the intervention is delivered as intended; and (3) describe practice engagement, commitment and capacity associated with various intervention components. Qualitative data, collected via semi-structured interviews and open-ended questions, will be used to gather in-depth understanding of the (1) satisfaction, utility, barriers and enablers; (2) acceptability, uptake and feasibility, and (3) effect of the COVID-19 pandemic on the implementation of the intervention. CONCLUSION: Findings from the evaluation will provide new knowledge on the implementation of a complex, multi-component intervention at practice-level using their own electronic patient data to enhance secondary prevention of cardiovascular disease. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134.

Development of a COVID-19 virtual community of practice in New South Wales

ON 30 JANUARY 2020, the Director-General of the World Health Organization announced that the outbreak of a novel coronavirus in China had been declared a Public Health Emergency of International Concern.1 At the time of that announcement, there were 7834 confirmed cases, 98 of those outside China.1 By April 5 2020, there were 1,133,758 cases of COVID-19 globally, with 62,784 deaths.2 At that time, Australia had 5805 COVID-19 notifications and 33 associated deaths.2 In the absence of an available vaccine or effective pharmacotherapy for COVID-19 in Australia during 2020, the mainstay of individual case management was prevention of transmission through identification and isolation of cases and, in severe cases, supportive care, including ventilation.3 Community management was recommended for the approximately 80% of patients with mild disease, provided there was capacity for counselling, isolation, support, monitoring and escalation to hospital-based care in the event of deterioration.3 As the principal providers of continuing healthcare for people living in the community, general practice shared community management and monitoring of Australians with COVID-19, in collaboration with public health units, virtual care clinics and hospital-in-the home teams. Implementation of new evidence, guidelines or procedures into clinical practice is a challenge, especially where the change is complex with limited external support (such as facilitation) or previous applicable experience.6 All of these applied to the early stages of the COVID-19 pandemic. [...]as a contribution to addressing the COVID-19 crisis in Australia, in early April 2020 a group of general practitioner (GP) leaders in NSW established a COVID-19 GP virtual community of practice (VCoP). Communities of practice (CoPs) and VCoPs have been demonstrated to be effective in improving processes and outcomes in education, industry and healthcare.7 CoPs are defined as 'groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly'.8 When a CoP is constructed primarily (although not exclusively) through internetbased interaction, it is termed a VCoP.7 The goal of the COVID-19 GP VCoP was to facilitate rapid implementation of the necessary changes in general practices through widespread sharing of knowledge (know-what) and experience of the application of that knowledge in practice (know-how). Analysis Framework analysis was used to analyse the data, using the VCoP framework developed by Barnett et al. to code the data under the following headings: objectives and goals, champion and support, facilitation, a broad church, supportive environment, technology and community, measurement benchmarking and feedback.7'10 Five members of the research team individually coded two FGD transcripts.

Development of a COVID-19 virtual community of practice in New South Wales: A qualitative study.

BACKGROUND AND OBJECTIVES: In April 2020, a group of general practice leaders in NSW, Australia, established a COVID-19 virtual community of practice (VCoP) to facilitate rapid transfer and implementation of clinical guidance into practice. This research aimed to gain an understanding of the experience and effectiveness of the VCoP from leaders and members. METHOD: The study used a qualitative participatory action research methodology. A framework analysis was applied to focus group discussion, semi-structured interview and open-text written response data. RESULTS: Thirty-six participants contributed data. In addition to a positive evaluation of the effectiveness of information transfer and support, a key finding was the importance of the role of the VCoP in professional advocacy. Areas for improvement included defining measures of success. DISCUSSION: This study has reinforced the potential for VCoPs to aid health crisis responses. In future crisis applications, we recommend purposefully structuring advocacy and success measures at VCoP establishment.

General practitioners' knowledge, preparedness, and experiences of managing COVID-19 in Australia.

BACKGROUND: COVID-19 has brought unprecedented demands to general practitioners (GPs) worldwide. We examined their knowledge, preparedness, and experiences managing COVID-19 in Australia. METHODS: A cross-sectional online survey of GPs members of the Royal Australian College of General Practitioners (RACGP) was conducted between June and September 2020. RESULTS: Out of 244 survey responses, a majority of GPs (76.6%) indicated having good knowledge of COVID-19, relying mostly on state/territory department of health (84.4%) and the RACGP (76.2%) websites to source up-to-date information. Most felt prepared to manage patients with COVID-19 (75.7%), yet over half reported not receiving training in the use of PPE. The majority were concerned about contracting SARS-CoV-2, more stressed than usual, and have heavier workloads. Their greatest challenges included scarcity of PPE, personal distress, and information overload. CONCLUSION: Access to PPE, training, accurate information, and preparedness are fundamental for the successful role of general practices during outbreaks.

Familial hypercholesterolaemia and cascade testing in general practice

THE COVID-19 pandemic highlights the key role of general practice in Australian health service delivery, especially for our most vulnerable patients.1 While terms such as 'index case' (defined as the first identified case in a group of related cases of a particular communicable or heritable disease) and 'cascade testing' (the extension of genetic testing to individuals at risk of inheriting a pathogenic variant previously identified in a biological relative) have long been associated with genetic testing for hereditary conditions among families, the recent increased public awareness of and experience with epidemiological concepts such as contact tracing offers new potential to improve detection and management of familial hypercholesterolaemia (FH) in the community.On 1 May 2020, new Medicare Benefits Schedule (MBS) item numbers relating to genetic testing for FH were introduced in Australia,2 offering a timely opportunity for general practice to collaborate with lipid specialists to facilitate improved detection and management. While an infectious disease such as COVID-19 cannot be directly compared with inherited conditions such as FH, lessons learned from the pandemic and developments in remote consulting can be applied to the management of FH.