| Project Objectives / Summary:
This was a two-year randomised and evaluated trial of a hypertension register, recall, education and clinical support project among GPs throughout the Hume Region. The intended interventions of this project were:
- Audit of GPs medical records with benchmarking by an independent audit nurse;
- Education, utilising GP and specialist doctors;
- Establishment of a hypertension register;
- Establishment of an electronic recall (or reminder) system;
- An independent "watchdog" system (ie reminder to GPs to treat or refer);
- Establishment of clinical care pathways based on peer support and specialist referral when necessary; and
- Availability of a specialist clinical support system (personal visits, telephone and email) and the establishment of a specialist hypertension clinic.
It is unfortunate that this project had to be discontinued. The Division Board made this decision having noted that, while the study had ethical approval from the RACGP, no professional body had been able to provide an unequivocal assurance that the existing arrangement was not a breach of contract between the General Practitioner concerned and his/her patient. It was considered that this had both legal and, arguably, ethical implications, about which a number of general practitioners involved in the trial, had already expressed concern.
The Division's final report outlines the activities undertaken in the project and provides a qualitative assessment. The Division regrets that the project as a whole could not be completed but thinks it is important to note that the clinical activity for the intervention group was. Unfortunately, it is the research aspects that were not.
Project Collaboration:
The project operated in partnership between the Department of Rural Health of the University of Melbourne and the Division.
The project was designed with input from consumers, Rumbalara Aboriginal Health Cooperative, the Goulburn Valley Health Service, Goulburn Valley Health, and the North Eastern Victoria and Border Divisions of General Practice.
Consumer consultation overwhelmingly identified the most important issue for them was that GPs work in consultation with other health professionals to improve their care.
Project Outcomes:
- The audit process was time consuming but successful. The audit had to be curtailed at the end of July 2000 due to the number of active files(28,000).
- The majority of GPs felt that the reminder and recall systems were an excellent intervention strategy to introduce to their practice but that they could be problematic. The recall system was established on computer as well as files being marked with stickers.
- Recruitment of GPs for this project did not pose a problem; 50 from a possible 80 general practitioners were successfully enlisted into the trial.
Recommendations:
- All GP research projects should be appraised (prior to commencement) from a legal as well as an ethical viewpoint, because in General Practice these views may differ.
- ADGP or equivalent should consider the establishment of a Research Advisory Committee for GPs and Divisions that encompasses all aspects of the conduct of research projects.
Lessons / Assessment:
- The Privacy Legislation (effective 21 December 2001) needs to be better understood by health care professionals. The Division states that many project participants were unaware of its specific professional and legal implications. There is, for example, concern for the apparent blurring of the boundary between research / quality activities and audit, and whether the audit process is a system (practice-based) intervention or an individual-based intervention. An understanding of these issues will be a key determinant of the success of future GP research projects.
- The Executive Summary to the Division's final report (pages 4 and 5) details a range of factors that contributed to cessation of this project prior to its completion. They provide an honest assessment by the Division.
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