PDF(Pubmed)
Abstract：
Australian cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk assessment, but less than half of eligible patients have the required risk factors recorded due to fragmented implementation over the last decade. Co-designed decision aids for general practitioners (GPs) and consumers have been developed that improve knowledge barriers to guideline-recommended CVD risk assessment and management. This study used a stakeholder consultation process to identify and pilot test the feasibility of implementation strategies for these decision aids in Australian primary care.
This mixed methods study included: (1) stakeholder consultation to map existing implementation strategies (2018-20); (2) interviews with 29 Primary Health Network (PHN) staff from all Australian states and territories to identify new implementation opportunities (2021); (3) pilot testing the feasibility of low, medium, and high resource implementation strategies (2019-21). Framework Analysis was used for qualitative data and Google analytics provided decision support usage data over time.
Informal stakeholder discussions indicated a need to partner with existing programs delivered by the Heart Foundation and PHNs. PHN interviews identified the importance of linking decision aids with GP education resources, quality improvement activities, and consumer-focused prevention programs. Participants highlighted the importance of integration with general practice processes, such as business models, workflows, medical records and clinical audit software. Specific implementation strategies were identified as feasible to pilot during COVID-19: (1) low resource: adding website links to local health area guidelines for clinicians and a Heart Foundation toolkit for primary care providers; (2) medium resource: presenting at GP education conferences and integrating the resources into audit and feedback reports; (3) high resource: auto-populate the risk assessment and decision aids from patient records via clinical audit software.
This research identified a wide range of feasible strategies to implement decision aids for CVD risk assessment and management. The findings will inform the translation of new CVD guidelines in primary care. Future research will use economic evaluation to explore the added value of higher versus lower resource implementation strategies.
This mixed methods study included: (1) stakeholder consultation to map existing implementation strategies (2018-20); (2) interviews with 29 Primary Health Network (PHN) staff from all Australian states and territories to identify new implementation opportunities (2021); (3) pilot testing the feasibility of low, medium, and high resource implementation strategies (2019-21). Framework Analysis was used for qualitative data and Google analytics provided decision support usage data over time.
Informal stakeholder discussions indicated a need to partner with existing programs delivered by the Heart Foundation and PHNs. PHN interviews identified the importance of linking decision aids with GP education resources, quality improvement activities, and consumer-focused prevention programs. Participants highlighted the importance of integration with general practice processes, such as business models, workflows, medical records and clinical audit software. Specific implementation strategies were identified as feasible to pilot during COVID-19: (1) low resource: adding website links to local health area guidelines for clinicians and a Heart Foundation toolkit for primary care providers; (2) medium resource: presenting at GP education conferences and integrating the resources into audit and feedback reports; (3) high resource: auto-populate the risk assessment and decision aids from patient records via clinical audit software.
This research identified a wide range of feasible strategies to implement decision aids for CVD risk assessment and management. The findings will inform the translation of new CVD guidelines in primary care. Future research will use economic evaluation to explore the added value of higher versus lower resource implementation strategies.
摘要：
背景：澳大利亚心血管疾病（CVD）预防指南建议进行绝对CVD风险评估，但在过去10年中,只有不到一半的合格患者记录了所需的危险因素,原因是实施过程分散.已经开发了针对全科医生（GP）和消费者的共同设计的决策辅助工具，以改善指南推荐的CVD风险评估和管理的知识障碍。这项研究使用了利益相关者的咨询过程来确定和试点测试这些决策辅助在澳大利亚初级保健中实施策略的可行性。
方法：这项混合方法研究包括：（1）利益相关者咨询，以绘制现有的实施策略（2018-20年）；（2）采访来自澳大利亚所有州和地区的29名初级卫生网络（PHN）工作人员，以确定新的实施机会（2021年）；（3）试点测试低，中等,和高资源实施战略（2019-21年）。框架分析用于定性数据，Google分析提供了一段时间内的决策支持使用数据。
结果：非正式利益相关方讨论表明需要与心脏基金会和PHN提供的现有项目合作。PHN访谈确定了将决策辅助工具与GP教育资源联系起来的重要性，质量改进活动，和以消费者为中心的预防计划。与会者强调了与一般实践过程相结合的重要性，比如商业模式，工作流,病历和临床审核软件。在COVID-19期间，具体的实施策略被确定为可行的：（1）低资源：为临床医生添加指向当地卫生领域指南的网站链接和初级保健提供者的心脏基金会工具包；（2）中等资源：在全科医生教育会议上介绍并将资源整合到审核和反馈报告中；（3）高资源：通过临床审核软件从患者记录中自动填充风险评估和决策辅助工具。
结论：本研究确定了实施心血管疾病风险评估和管理辅助决策的多种可行策略。这些发现将为初级保健中新的CVD指南的翻译提供信息。未来的研究将使用经济评估来探索较高和较低资源实施策略的附加值。
方法：这项混合方法研究包括：（1）利益相关者咨询，以绘制现有的实施策略（2018-20年）；（2）采访来自澳大利亚所有州和地区的29名初级卫生网络（PHN）工作人员，以确定新的实施机会（2021年）；（3）试点测试低，中等,和高资源实施战略（2019-21年）。框架分析用于定性数据，Google分析提供了一段时间内的决策支持使用数据。
结果：非正式利益相关方讨论表明需要与心脏基金会和PHN提供的现有项目合作。PHN访谈确定了将决策辅助工具与GP教育资源联系起来的重要性，质量改进活动，和以消费者为中心的预防计划。与会者强调了与一般实践过程相结合的重要性，比如商业模式，工作流,病历和临床审核软件。在COVID-19期间，具体的实施策略被确定为可行的：（1）低资源：为临床医生添加指向当地卫生领域指南的网站链接和初级保健提供者的心脏基金会工具包；（2）中等资源：在全科医生教育会议上介绍并将资源整合到审核和反馈报告中；（3）高资源：通过临床审核软件从患者记录中自动填充风险评估和决策辅助工具。
结论：本研究确定了实施心血管疾病风险评估和管理辅助决策的多种可行策略。这些发现将为初级保健中新的CVD指南的翻译提供信息。未来的研究将使用经济评估来探索较高和较低资源实施策略的附加值。
