Support Tool for Cardiovascular Disease Management

dr_charlotte_hespe_cardiovascular_disease_managementPresenter: Katherine
Guest: Dr Charlotte Hespe
Guest Bio: Charlotte is one of three principal GPs in a group practice, in the inner city of Glebe in Sydney.  The practice is actively involved in teaching and in research, and provides education and supervision for medical students and GP registrars.
Charlotte was a recent recipient of the Bupa Health Foundation 2014 Health Awards

Segment Overview: 
Dr Charlotte joins us today to talk about a point-of-care electronic decision support tool for cardiovascular disease management.


Health Professional Radio

Katherine: Thank you for listening to Health Professional Radio.  I’m Katherine, and for this segment our guest today is Dr Charlotte Hespe.  Charlotte is one of three principal GPs in a group practice, in the inner city of Glebe in Sydney.  The practice is actively involved in teaching and in research, and provides education and supervision for medical students and GP registrars.

Charlotte was a recent recipient of the Bupa Health Foundation 2014 Health Awards, and joins us today to talk about a point-of-care electronic decision support tool for cardiovascular disease management. Welcome to our show, Charlotte.

Charlotte: Hi, thanks Katherine.

Katherine: Now Charlotte, can you give our listeners a main overview of what exactly is this support tool and how it relates to cardiovascular disease?

Charlotte: Okay.  So, basically we are using a tool called Health Tracker, which has been developed through some research funding at the George Institute at Sydney University. And what it is, is a desktop electronic tool that sits alongside your electronic health record and pulls out data about each patient as you open up each file that is relevant to cardiovascular risk.

So what it’s able to do is pull out patient’s sex, age, what their current weight is, waist, cholesterol, blood pressure, those sorts of data facts, and then is able to actually give the GP at that point-of-care time, an accurate assessment of what their actual cardiovascular risk is.

Katherine: Right.

Charlotte: As well as that it actually then puts into it, other tools that actually enable the GP to be able to be able to a) educate the patient about what that risk means, and also give suggestions about what the best practice guidelines would suggest that patient might benefit from.  For instance, if they’re actually a high cardiovascular risk, that they might, if they aren’t on a statin that they might benefit from a statin, if they aren’t on aspirin that they might benefit from being on aspirin etcetera.

So, it’s a sort of a decision aid tool without really any effort, so I don’t have to go through my file to find all of those things then put them into a calculator.  It does it all for me.

Katherine: Right, right, it sounds very valuable.  And with the Bupa Health Foundation 2014 Health Awards, you have received funding to further this, so congratulations on that.  Can you let us know what this funding will go towards?

Charlotte: Yep I will.  And I’ll just … the other benefit of this tool which I sort of didn’t say is that it also allows me as a whole practice, to be able to pull out all the patients who are identified on my entire database, as being at high risk of cardiovascular disease.  So when I’m not actually seeing the patients, I can actually see, that of my, for instance, 8500 patients there are 280 patients who are high risk for cardiovascular disease.

Katherine: Right.

Charlotte: I can then also do a scroll through and see how many of them are currently already complying with best practice guidelines or those who may actually need to be reassessed to see whether I can better improve what I’m doing by offering them some of those interventions.  So that’s where my research is coming in.

So what this grant is doing is helping the Medicare Local, the Inner West Sydney Medicare Local, to go to a hundred general practices and say, “With the assistance of this Health Tracker tool, we are going to support you in a methodology of what we call “quality improvement”, t look at, as a practice, how we can assist you in improving the cardiovascular risk management of the patients in your practices.”

Katherine: I see.

Charlotte: And by using, yep … and that the idea is can we actually do this big time, so like with 100 practices?  With the support of a Medicare Local, can we actually make some major improvements in what’s actually being done at the coalface?

Katherine: Right, I see.  And can you tell us about the process that will take place and the timeframe that you’ve allowed to do this … that like you said, the 100 inner city primary care practices.  So, I guess my question revolves around, is it a plug-and-play type of … is it something that is already, like you said with the e-record, is it something that plugs into the existing database? And then, do they require special training to … or, do you know what I mean?  What is the process of implementing such a Health Tracker?

Charlotte: Look, the process is a planned approach.  We’re making use of the Improvement Foundation methodology for implementing quality improvements in general practice, which has been proven to make differences in the way that a practice can approach how they can change what they’re doing. But as I said, we are doing it in a very concentrated way in one Medicare Local.

So, the whole program will actually take 18 months.  The funding is for 12 months, and the main amount of … the sort of the main input of all the work is in that 12 months. Where what we do is we approach practices and invite them to participate in the program, and then provide them with support about saying, “Okay, to be involved in this program, what we need you to do is to be able to actually start looking at your electronic health records and understand, to be able to do this sort of work, the data that is sitting in your health record needs to be accurate.”

So it actually starts right back at the, is the data that I’ve got there for the Health Tracker to drag out, accurate?  – Because obviously, if I haven’t put the data in there for it to be able to suck out for me, it’s going to tell me nothing.  So we go to the practices, we teach them about how to actually do that, how to put the data in the right places, how to get the doctors to see the benefit of doing that.  So you do a baseline download of the data and say, “Okay, at this point in time, how much information can I get out and what gaps can you see?”

And then through the quality improvement model, we have a full day workshop where the practices get taught about how, why and what the process is about how you would go about making some changes.  And then every month they do a download of data and the Medicare Local staff will support them in saying, “What’s happening? What improvements can we make? And how can you as a practice actually start doing, you know, more things to actually bring about change, so that you might actually be able to achieve the goals?”

So each practice will have individual goals.  So that’s a big job if you think about we’ve got 100 practices; they are all going to be doing things differently, and they’re all going to have individual goals.  But at the same time, they all come together as a local network and understand they’re all doing this together, and there is lots of sharing that can happen.  So, there is no reinventing of the wheel that needs to happen.  If one practice is doing something really well, another practice can go, “Oh, okay, how could we do that, how would that work for us?” And then change it to adapt to their own practice circumstances.

So it’s about being collaborative, working together as teams, each practice working together as a team, but generally being supported by the Medicare Local, who then gets a much better idea of, what is the size of the problem in our local area?  What are the things that we might be able to do as a local environment to actually help the GPs as well?  For instance, empowering patients to actually understand for themselves, what modifying their lifestyle might mean, and the improvement it might be to actually decreasing their cardiovascular risk.

Katherine: Sure. Well thanks so much for your time today, Charlotte, and I would love to do a follow up interview with you in the future and see how the project goes in about a year’s time.  Congratulations again, on the award.

Charlotte: Thank you very much.  Thank you, Katherine.