May 2019 Practice visits: Flagstaff Hill Medical Centre

On 6 May, the Flinders QUEST team of Leigh Roeger, Toni Chappel and Heilie Kwok visited Flagstaff Hill Medical Centre. The practice has 4 GPs and 33 participants taking part in the trial. Flagstaff Hill Medical Centre has been operating for over 40 years in the area.

We had a great turn out at the meeting with 9 representatives from the practice. Flagstaff Hill has focused on providing nursing engagement in the study and Amanda (Practice Nurse) reviews QUEST participants one day a week. This provides a great opportunity to keep track of all QUEST participants and ensures that phone calls after a hospitalisation are made.

Flagstaff Hill has also blocked out reserve QUEST appointments but if participants do not inform reception staff that they are QUEST participants when making appointments these reserved slots may not always be taken up. To address this we are contacting Flagstaff’s participants to remind them that when making appointments it is important to mention to reception staff at the start of the phone call that they are QUEST participants.

Our visit to Flagstaff Hill Medical Centre completes our round of Intervention group practice visits. It has been great for the team to get out of the office and meet with Intervention group practice staff.

The main job for the Flinders QUEST team currently is the 6-month participant survey. A big thank you to practice staff in both the Intervention and Control groups for checking through your participant lists before we sent out around 1000 surveys last week. In addition to the mail-out we will schedule around 60 home visits for participants who have difficulties completing the questionnaire without assistance.

As the surveys are returned, the data is entered into our systems here and then exported for analysis. The results from the 6-month participant survey will be presented to Intervention group practices at the Intervention group workshop at Flinders in June.  The results will be very interesting with hopefully some early signs of participants reporting benefits from the enhanced general practice services they have been receiving.

For those interested in where Flinders QUEST fits into the bigger political picture, the RACGP’s 2019 election statement is worthwhile reading. The statement emphasises the value of continuity of care through formalising the relationship between patients and their GPs. Secondly, the RACGP advocates for a better Medicare rebate structure to support longer consultations for complex care.  Both these initiatives are at the core of Flinders QUEST ensuring that the findings of the trial will have important policy implications.

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Left to right (standing): Dr Heilie Kwok (QUEST Coordinator), Dr Natalia Zygocki (GP), Dr Cate Price (GP), Dr Leigh Roeger (QUEST Manager), Ms Nickie Bungey (Site Manager), Dr Andrew Southcott (GP)
Left to right (seated): Dr Jade Lee (GP), Dr Brada Shimmin (GP), Ms Jessica Burford (Practice Nurse), Ms Amanda Pearce (Practice Nurse), Ms Anne Patron (Practice Nurse)

Six month survey: What to expect at the end of April

At Flinders we are gearing up for the 6-month follow-up survey with QUEST participants in both the intervention and control groups.

We are aiming to mail the survey on Monday 29th and Tuesday 30th April. We will do a final check with practices (to ensure correct participant lists) just prior to sending the survey.calendar-

The survey responses will be entered into our study databases and from there we export the data to statistical packages for analysis.

The intervention group results will be presented to intervention practices at our planned June workshop to be held at Flinders. We look forward to seeing as many intervention group practice staff in attendance as possible!

Control group practices will receive the results from the participant surveys at the end of the trial scheduled for December 2019.

 

April 2019 Practice visits: Belair Medical

Belair Medical is located in the foothills of Adelaide and home to koalas and a nearby bakery with delicious bee sting cakes. Belair is one of our medium sized practices with 4 GPs and 64 participants taking part in the trial.

We had a great turnout at the meeting with 7 representatives from the practice (unfortunately Kym and Wendy had to attend another meeting so had to leave before our favourite part, photo time!).

Belair Medical is offering all QUEST participants 15-minute consultations with the practice nurse prior to the longer appointments (30 mins) with the participants’ preferred doctors. During the nurse consult, nurses have focussed on educating participants on how to better manage their health as well as keeping immunisations, care plans and past history information up-to-date.

Belair Medical has blocked out reserve appointments for each participating QUEST doctor so if a QUEST participant needs an appointment, they will be able to see their doctor on the same day. Doctors have found the spare appointments to be helpful as they are able to slot in participants very easily.

Kirsty (Practice Manager) has been keeping a very good track record of QUEST participants and informed us that 8 patients have had hospitalisations since the beginning of the trial – each of whom received prompt follow-up.

Belair Medical raised the point that not all their QUEST participants are availing themselves of the enhanced services on offer. This is to be expected given the specific criteria for entry to Flinders QUEST. Participants were identified on the basis that they could “potentially” benefit from the enhanced services. We didn’t expect that every participant would benefit in reality, despite the best efforts of practices to engage with participants.

Toni (our Flinders QUEST practice nurse) plans to visit with Belair Medical nurses in the near future to share some ideas for how practice nurses can contribute to the delivery of better care for QUEST participants. We encourage all intervention group practices with practice nurses to take advantage of Toni’s services.

Belair
Left to right: Prof Richard Reed (Chief Investigator), Dr Helen Roxburgh (GP), Ms Kirsty Tippett (Practice Manager), Ms Barbara Smith (Practice Nurse), Dr Leigh Roeger (QUEST Manager), Dr Serafim Dafillis (GP), Dr Lizzy Harvey (GP)

April 2019 Practice visits: Seacombe Medical Centre

Seacombe Medical Centre has a mixed socio-economic patient population and has been providing comprehensive medical care to patients for over 40 years. The practice is one of our medium size practices with 63 participants and 6 GPs taking part in the trial.

Seacombe routinely offers same day, double appointments without any additional co-payments to QUEST participants. Most participants joining QUEST were already on a care plan and these are being regularly reviewed during the trial. Like other QUEST practices Seacombe are gearing up for the flu season with clinics planned in late April.

In the 12 months prior to Flinders QUEST our Medicare data showed that Seacombe participants had high levels of both continuity of care (seeing their preferred GP) and longer appointments. Practice staff have targeted providing more nursing contacts for the QUEST participants with nurse visits scheduled prior to the GP seeing the patient.

With only a limited number of Medicare item numbers to bill for nurses, Seacombe staff made the good point that this ‘extra’ work was not going to be reflected in our Medicare statistics. During the design of Flinders QUEST we were very conscious of not creating additional paperwork burden and so we haven’t asked practices to record these additional workload statistics. The extra nurse work will, however, be picked up qualitatively when we interview practice staff about their experiences.

Seacombe are also considering taking part in the Department of Veterans’ Affairs (DVA) Coordinated Veterans’ Care (CVC) Program. Flinders QUEST was modelled on several aspects of this program, based on our experiences working with the DVA on the CVC program design and evaluation. Interestingly the CVC program also appears to be guiding the Government’s latest thinking for the next iteration of the Health Care Home model with details about this released in the latest budget. The results from Flinders QUEST therefore will be highly influential in informing future national primary health care policy.

A nice touch at Seacombe was learning that the QUEST initial practice payment had been directed to purchasing new adjustable height beds for their consulting rooms. These can be very beneficial for older patients or those with multiple chronic illnesses (many of whom will be QUEST participants). So well done Seacombe!

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Left to right (standing): Ms Toni Chappel (QUEST Research Nurse), Prof Richard Reed (Chief Investigator), Dr Leigh Roeger (QUEST Manager), Dr Tim Slimming (GP)
Left to right (seated): Ms Terrie Coombe (Practice Nurse), Ms Kerry Bruce (Practice Manager)

March 2019 Practice visits: Russell Clinic

On Thursday 28 March the full Flinders QUEST team visited our 7th intervention practice, Russell Clinic for a progress meeting. The meeting was well attended with four representatives from the practice.

Russell Clinic is located in Blackwood (very close to Flinders University) and is one of our medium sized practices with 6 GPs and 51 participants taking part in the trial.

Russell Clinic is implementing the four enhanced service components in a straightforward manner. The practice is also focused on providing additional preventative activity to QUEST participants. For example, Robyn (Practice Manager) is going through the list of all QUEST participants to check they are up-to-date with their flu vaccinations and care plans.

Practice staff at Russell Clinic are also receiving calls from Flinders Medical Centre to make appointments for patients when they are discharged. We are on the job to track down who is leading this good idea so that we can understand the procedure a little bit better.

During the meeting we discussed the 6-month survey which is scheduled to go out to participants at the end of April. Getting a good response rate to this is very important and we will be offering participants the option for completing the survey by mail, online or with a home visit.

We look forward to our next practice visit next week on Tuesday 2 April at Seacombe.

Russell
Left to right (standing): Dr Haydn Bunton (GP), Ms Robyn Hicks (Practice Manager), Ms Marcelle Woodman (Practice Nurse), Dr Leigh Roeger (QUEST Manager), Dr Heilie Kwok (QUEST Coordinator), Prof Richard Reed (Chief Investigator)
Seated: Ms Claudia Lumsden (Receptionist)

March 2019 Practice visits: Medical HQ

The full Flinders QUEST team visited our 6th intervention practice, Medical HQ GP Family Practice, which is the only practice located in the Eastern suburbs. Medical HQ were first established in 1919 which must be a record for our QUEST practices.

Medical HQ has 39 participants (mainly older people) in Flinders QUEST. During the meeting we met with the majority of practice staff participating in the trial.

Medical HQ are confident they are implementing the enhanced services to a high standard. Participants are offered longer appointments with their preferred doctors by reception staff, and are followed up by a phone call if they experience a hospitalisation. Medical HQ are also offering personalised plans to participants by way of fortnightly or monthly advanced bookings.

Medical HQ have created a ‘tracking grid’ for the QUEST participants so that the services they are receiving can be monitored. Instances when participants did not see their preferred doctors were found to be related to participants wanting a repeat script or for an UTI (i.e., not for the management of chronic illnesses).

Discussion about our continuity of care measure was raised at the meeting. There are definitely advantages to patients seeing a GP at their usual practice if their preferred GP is unavailable. For example, the patient’s medical records will be available for ‘informational continuity of care’. Based on these conversations we will be including a measure of ‘practice continuity of care’ in our analyses.

Medical HQ’s GPs believe that patients get sufficient time for their problems to be addressed. Longer appointment times however have been useful for the ‘extra’ tasks when appropriate (such as reviewing medication lists). Having these positive perceptions confirmed by patients’ responses to the 6-monthly survey which will ask directly about patients’ time with GPs, will provide an extra layer of ‘quality assurance’.

Thanks to Lindsey and the team at Medical HQ for an enjoyable visit. Our next practice visit will be on 28 March 2019 at Russell Clinic.

M2Left to right (back row): Ms Toni Chappel (QUEST Research Nurse), Dr Heilie Kwok (QUEST Coordinator), Dr Leigh Roeger (QUEST Manager), Ms Pauline Pankhurst (Practice Manager), Dr Don Cameron (GP), Prof Richard Reed (Chief Investigator)
Left to right (front row): Dr Rod Pearce (GP), Ms Lynda Matthews (Practice Nurse), Ms Lindsey Gilkes (Practice Manager), Ms Donna Costanzo (Receptionist)

March 2019 Practice visits: Hallett Cove Family Practice

We have now visited half of our Intervention practices and this post will be covering our 5th intervention practice: Hallett Cove Family Practice.

On Thursday 21 March the full Flinders QUEST team of Richard Reed, Leigh Roeger, Toni Chappel and Heilie Kwok visited the practice and met with the Practice Managers (Lynne Jarrad and Kathy Lovell) and Drs Gerry Healy and Justin Choong.

Hallett Cove Family Practice is one of our smaller practices with 21 participants in the trial (adults aged 18 to 64: 7 and adults aged over 65: 14).

Hallett Cove will be undergoing some major changes this coming month, as Lynne will be retiring (after having worked at the practice for 18 years) and Dr Paul Hyam will be relocating to Western Australia (he will continue to be the owner of the practice). We would like to welcome Kathy Lovell, the new Practice Manager, and Dr Justin Choong to Flinders QUEST.

When a GP in Flinders QUEST leaves the practice, we ask the practice staff to contact that doctor’s participants to discuss a new “preferred GP” with them and then let us know so we can make the changes to our data systems. We can also issue another trial ID card if participants would like this.

QUEST participants are flagged in Hallett Cove’s clinical and appointment systems. Staff felt that participants were able to gain appointments with their preferred GP on the same or next day. High levels of continuity of care (seeing the preferred GP) were evident in Hallett Cove’s data in the 12 months prior to the trial so we are confident that this will continue.

Participants are offered double appointments when they call but these have not been taken up. A possible deterrent to patients taking a double appointment is if they are charged a high gap fee. We recommend to practices not to charge a higher gap fee for longer appointments as this could be seen as inconsistent with the information provided to participants that there would not be any additional costs for them taking part in Flinders QUEST. If anyone has any questions regarding the gap payment, please give us a ring on 7221 8538 or email to quest@flinders.edu.au.

In terms of follow up after hospitalisation, practice staff forward the discharge summary to the doctor to review whether the participant should be contacted to make an appointment. Where an appointment is clinically indicated administrative staff from the practice will contact the participant.

We were pleased to hear that Hallett Cove staff found the Intervention practice workshop held at Flinders valuable – although it is not clear whether it was the fine food, the company of other practices or our presentations they found most enjoyable! We are planning another workshop in late May/early June where we hope as many staff as possible from all our Intervention practices can attend.

Last but not least the Flinders team would like to send Lynne and Dr Paul Hyam our very best wishes for the future. You have both been great to collaborate with, not just with Flinders QUEST, but other projects in the past. Good luck for the next chapters in your lives.

IMG-2644Left to right: Dr Leigh Roeger (QUEST Manager), Dr Heilie Kwok (QUEST Coordinator), Ms Kathy Lovell (Practice Manager), Prof Richard Reed (Chief Investigator), Dr Gerry Healy (GP), Dr Justin Choong (GP), Ms Lynne Jarrad (Practice Manager)

March 2019 Practice visits: Chandlers Hill Surgery

On Tuesday 19 March the Flinders QUEST team comprising of Richard Reed, Leigh Roeger and Toni Chappel visited Chandlers Hill Surgery for a progress meeting. The meeting was very well attended with the majority of practice staff present.

Chandlers Hill Surgery is situated in Happy Valley and has been providing care for patients in this catchment area since 1985. Chandlers is our largest QUEST practice with 9 GPs and 100 patients taking part. This means that Chandlers has approximately 20% of our Intervention participants.

Being a larger practice meant that the first key task for Chandlers’ indomitable Practice Manager (Jacky Genesin) was to get a very large group of staff working together “on the same page” for Flinders QUEST, to ensure that there was consistent delivery of the enhanced services across the team.

Jacky has flagged participants in their Best Practice software system by recording them as Health Care Homes (HCH) trial participants. She is currently experimenting with using the HCH reports programmed within the software, for our participants.

At Chandlers each QUEST participant is allocated into a ‘Pod’ which contains his or her preferred GP, a Practice Nurse and an Administration staff member. Each participant was informed (by letter) explaining how Chandlers was going to implement the trial. In the introductory letter participants were also encouraged to phone the practice to advise their ‘Pod’ of any Emergency Department presentation or hospital admission. As we all know, the discharge summary is not 100% reliable and so this will help prevent participants from falling through the cracks.

As in other practices GPs are blocking out reserved appointment slots for QUEST participants. It is thought that this will significantly improve the ability of participants to see their preferred GP (continuity of care). Longer appointments are being offered but Chandlers also reviewed the appointment frequency of participants and used this information to schedule a ‘course’ of planned longer appointments for the 12 months of the trial.

In addition (and we don’t know how they found the time to do this!) they ran a focus group for participants where they gathered lots of useful feedback not just about the trial but also the services they provide generally.

With a real ‘Pod’ team approach, Chandlers has been able to ensure that nearly all QUEST participants have a Care Plan and have been screened (where appropriate) for preventative health requirements e.g., BMD and Home Medicine Reviews.

Chandlers staff always ask very good questions and GPs had two curly ones for us. The first question was whether GP participation in Flinders QUEST could be used for CPD purposes. The answer is yes and we will post a blog next week on the specific details.

The second question (which was also raised at WOWS) was around our measure of continuity of care when GPs have a ‘buddy’ GP. We will do some investigations into this and present the data at our planned 6 month workshop for Intervention practices.

An interesting question raised by seeing all the ‘extra’ activities being undertaken by Chandlers is how does this fit into the idea of our clinical trial which is designed to test the impact of specific enhanced services. Flinders QUEST is a pragmatic trial. This means it is being conducted in the real world of practices and not a laboratory or university setting. Taking part in Flinders QUEST did not mean that practices (either Intervention/Control group) had to stand still with their quality improvement efforts. Chandlers (like all the practices in QUEST who self-selected to join our trial) were engaging in quality improvement activities long before we came along and will do so after the trial is complete. According to Jacky, Flinders QUEST enabled Chandlers to put additional focused effort into quality improvement areas that they had wanted to do for some time.

From our perspective, better quality general practice services have the potential to produce better patient outcomes. And that’s something that everyone involved in Flinders QUEST can be on the same page about.

So well done to Jacky, Meera, Casey and the whole team at Chandlers for their very proactive approach to implementing Flinders QUEST.

Next practice visit we are looking forward to is Hallett Cove.

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Left to right (standing): Dr Natasha Alexandrides (GP), Dr Moira Gallagher (GP), Dr Dan Nolan (GP), Dr Laura Turnbull (GP), Dr Paul Muffet (GP/Partner), Dr Leigh Roeger (QUEST Manager), Ms Jacky Genesin (Business Manager), Dr Kerry Hancock (GP/Partner), Ms Stacey Jennings (Practice Nurse)
Left to right (seated): Prof Richard Reed (Chief Investigator), Dr Daniel Byrne (GP/Partner), Ms Casey Franchi (Practice Nurse)

 

March 2019 Practice visits: Wirreanda on Wheatsheaf Surgery

On Thursday 14 March the Flinders QUEST team of Richard Reed, Leigh Roeger and Heilie Kwok visited Wirreanda on Wheatsheaf Surgery (WOWS) for our first on-site progress meeting.

Since the trial has begun, WOWS has grown in size and has welcomed two additional doctors on board. WOWS is located in Morphett Vale and is one of our medium size practices with 38 participants (child/young people: 4; adults aged 18-64: 18; adults aged over 65: 16).

At the progress meeting representing WOWS were the Practice Manager (Ms Kerrie Payten), Practice Nurse (Ms Marta Zan), Medical Receptionist (Ms Donna Kammermann) and Drs Lou Christodoulou, Charmaine Sargent and Michael Ludlow.

So that was the first highlight of our visit to WOWS. Meeting with the full team (Reception, PM, PNs and GPs) at the practice and seeing how well everyone has got on the same page about Flinders QUEST.

Like the other Intervention practices we have visited, WOWS haven’t experienced any difficulties incorporating the enhanced services into their routine system of care for QUEST participants.

We did learn a couple of things we hadn’t been aware of previously.

Apparently, on occasions, Flinders Medical Centre staff ring through to WOWS and make appointments for patients being discharged who require a follow-up GP appointment. This is a great service which could really make a difference to the critical transition from secondary to primary care. We will try and dig further into this to better understand how it is being implemented.

The other thing we learned was the difficulty that practices can experience achieving very high levels of appointments with preferred GPs when GPs in the clinic may work part-time. As a result of the discussion with WOWS we will tweak our measures to also look at proportion of appointments made to GPs in the practice.

We enjoyed an interesting discussion with practice staff about the potential benefits of the longer appointments and the follow-up appointments after discharge from hospital. The GPs gave us some food for thought about providing guidance materials for how we think these enhanced services could best be maximised for patient benefit.

The final highlight for us was the group photo. This was taken with a background of several paintings in the WOWS waiting room which had been painted by their GPs. We were subjected to a tough guessing game where we had to try and match the painting to the GP – naturally we got this entirely wrong!

Thanks to WOWS for a very enjoyable visit. Next visit (Tuesday 19 March) is to Chandlers Hill – we know that many of our Intervention group practices have been very interested to learn about how Chandlers have gone about implementing Flinders QUEST so look forward to providing an update next week.

WOW
Left to right: Dr Heilie Kwok (QUEST Coordinator), Prof Richard Reed (Chief Investigator), Ms Donna Kammermann (Medical Receptionist), Dr Lou Christodoulou (GP), Ms Kerrie Payten (Practice Manager), Dr Charmaine Sargent (GP), Ms Marta Zan (Practice Nurse), Dr Leigh Roeger (QUEST Manager), Dr Michael Ludlow (GP)

March 2019 Practice visits: Hackham Medical Centre

On Wednesday 13 March the Flinders QUEST team of Leigh Roeger and Heilie Kwok visited Hackham Medical Centre for our first on-site progress meeting.

Hackham Medical Centre is in Huntfield Heights and is one of the largest practices in the trial. Hackham has 83 participants (child/young people: 7; adults aged 18-64: 32; adults aged over 65: 44). It is primarily a bulk billing practice serving a patient population in a disadvantaged area.

At the progress meeting representing Hackham were the Practice Managers (Mr Zeeshan Khan and Ms Sue Daglish), Practice Nurse (Ms Belinda Blackstock) and Drs Navtej Pal Singh Sandhu, Edwin Lapidario, Muhammad Durani, Mahbubul Alam and Blaceline Costelo-Sayo.

QUEST participants have been relatively healthy since the beginning of the trial but Hackham doctors are gearing for a difficult flu season during the winter months.

Hackham are implementing the enhanced services for Flinders QUEST participants with a direct approach. All QUEST participants have been flagged in the practice system and are routinely offered double appointments with their preferred GPs.

Anecdotally we heard that patients are very positive about the trial and are feeling that they are receiving “better” services. Participants are not using their QUEST ID card as much as when the trial started but do remind practice staff verbally that they are QUEST participants.

Since the start of the trial, it is estimated around 20 participants have experienced hospitalisations. In these cases, discharge summaries were forwarded to each participant’s preferred GP who conducted the follow-up phone call.

It was great for us to catch up with the team at Hackham Medical Centre and to see the interventions getting implemented. The next practice visit will be at Wirreanda on Wheatsheaf Surgery on Thursday 14 March.

Hackham