Research presentation

Introduction
Question prompt lists (QPLs) have been found to support patients to ask questions and improve the information they receive from doctors. However, some QPL tools, which have been available online for over 15 years, have little published data on their impact in real-world settings. This study's aim was to understand patients' attitudes and experiences accessing health information and to assess the impact of introducing two generic QPLs over 3 months.

Methods
A longitudinal qualitative study consisting of three semi-structured interviews over a three-month period was conducted with 31 purposively selected participants, adults ≥18 years, recruited online and through social media. Participants were introduced to two different QPLs currently available online (‘Question Builder’ or the ‘Ask Share Know questions’). Inductive thematic analysis was performed on transcripts of a total of 92 semi-structured telephone interviews which were conducted during May–November 2020.

Results
Three main themes are described. (1) Participants described barriers and facilitators to accessing health information: navigating a complex health system; difficulty asking questions of their healthcare professionals and that they value doctors with good communication skills. (2) QPLs helped some participants recognise the role of question-asking in consultations, made them feel more empowered and helped them prepare and prioritise. (3) Participants wanted QPLs to be easier to use, be accessible when needed and that question-asking and QPLs should be normalised in medical consultations.

Conclusions
Well-designed and easily accessible QPLs can empower people to ask questions and be more involved in decisions about their health care. Endorsement of question-asking in consultations by healthcare professionals and providing QPL tools at the point of contact with health services will be key to realising the potential of QPLs.

1. Question prompt lists can help people to be more involved in decisions about their healthcare.
2. Healthcare professionals can, and should, encourage people to ask questions, you can even link them to appointment reminders
3. QPLs don't increase the length of consultations but do support shared decision making

Research presentation

For over 40 years, Therapeutic Guidelines has supported Australian doctors to prescribe antimicrobials appropriately. Therapeutic Guidelines: Antibiotic provides advice on managing almost 200 unique infections, almost half of which are treated in primary care. Work on an update—the most complex yet—is underway, with the first topics scheduled for publication later this year.

Content
The 2021 Antimicrobial Use and Resistance in Australia (AURA) report identified ongoing high rates of inappropriate antimicrobial prescribing for common infections (eg bronchitis, tonsillitis, otitis media). Multiple factors are suggested to contribute to this problem, including patient expectations, limited time, diagnostic uncertainty, and general practitioner (GP) attitudes and beliefs about antimicrobial resistance (AMR).
To support appropriate prescribing in primary care, the update to Therapeutic Guidelines: Antibiotic includes a dedicated stream of work to address infections treated in primary care. GP-representation on the group has increased 4-fold. In recognition of the broad spectrum of care delivered in general practice, GP representatives will also be involved in other streams of work (eg the stream addressing infections usually treated in hospital). Approximately 100 experts will be involved across the 6 streams of work, which will be staggered over 2 years. Streams with related content will have periods of overlap to support consistency.
These changes are part of broader efforts to move to a living guidelines model, whereby seminal changes in evidence or clinical practice prompt review to update the guidelines between full guideline reviews.
In preparation for the update, almost 500 items of unsolicited feedback were reviewed. Additional feedback (eg usage patterns, potential gaps in guideline content) was solicited from the Therapeutic Guidelines evaluation network, which includes many GP users.

Goals
For GPs to understand the steps being taken to support appropriate antimicrobial prescribing in the update to Therapeutic Guidelines: Antibiotic.

1. An update to Therapeutic Guidelines: Antibiotic is underway, with the first of the updated topics due for publication later this year.
2. The update will involve approximately 100 experts, including many GP representatives.
3. Feedback from users, including GPs, informs the guideline updates.

Research presentation

Background
In China, Community Health Centers (CHCs) provide primary healthcare (PHC); improving the quality of PHC services and patients’ healthcare experience is China’s initiative. We examined potential associations between patients’ PHC experiences and the quality of CHC services in China.

Method
Between September 2021 to October 2021, 847 patients were recruited from four CHCs in China’s Greater Bay Area. We evaluated CHC service quality using the National Committee for Quality Assurance Patient-Centered Medical Home (NCQA-PCMH) questionnaire. We additionally assessed patients’ PHC experiences using the Primary Care Assessment Tools (PCAT). General linear models (GLM) were used to examine associations between patients’ experiences and CHC service quality.

Result
After adjusting for age, sex, education, resident status, annual family income, self-perceived health status, chronic condition, times of visiting doctors and medical insurance, the PCAT total scores of the patients in Level3 CHCs were significantly higher than of Level 1 (β=0.103; 95%CI 0.038 to 0.169). Patients in Level 3 CHCs had significantly better scores than those in Level 1 in first contact utilization (β=0.109; 95%CI 0.021 to 0.195), ongoing care (β=0.118; 95%CI 0.022 to 0.213), coordination of information systems (β=0.127; 95%CI 0.047 to 0.026), family-centeredness (β=0.096; 95%CI 0.015 to 0.177), comprehensiveness of services available (β=0.214; 95%CI 0.120 to 0.307), respectively.

Conclusion
Primary care experiences of patients in Level3 CHC were significantly better than those of Level1, indicating that CHCs could achieve high quality service by improving both institutional health service quality based on NCQA-PCMH assessment and patient experiences based on PCAT scales. These findings can help inform patient-centered primary healthcare policy and management.

1. CHC healthcare service quality is associated with patients’ PHC experiences.
2. CHC “process quality” may impact patients’ PHC experiences (i.e., “outcome quality”).
3. Policymakers should use the NCQA-PCMH to improve CHC healthcare quality.

Background:
The safety and cost-effectiveness of molnupiravir in treating higher-risk COVID patients in the community who are well vaccinated is unknown.

Methods:
Participants in PANORAMIC (the UK COVID antiviral platform RCT) were aged ≥50, or ≥18 years with comorbidities, and unwell ≤5 days with confirmed COVID-19 in the community, randomised to usual care alone or plus molnupiravir (800mg bd for 5 days). Primary outcome measure was all-cause hospitalisation/death within 28 days, analysed using Bayesian models.

Results:
Between 8.12.21and 27.4.22, 25708 participants were eligible and randomised to molnupiravir plus usual care (n=12744) or usual care alone (n=12934). Mean age was 56·6 years; 99% had at least one dose of a SARS-CoV-2 vaccine: and primary outcome available for 97% participants. 105/12529 (0·8%) hospitalisations/deaths occurred in the molnupiravir group versus 98/12525 (0·8%) in usual care alone, with posterior probability of superiority of 0·33 (adjusted odds ratio 1·06 (95% Bayesian credible interval [BCI]) 0·81 to 1·41). The observed median (IQR) time-to-first- recovery from randomisation (a key secondary outcome) was 9 days in molnupiravir and 15 days in usual care. There was an estimated benefit of 4·2 (95% BCI: 3·8–4·6) days in time-to-first-recovery (TTR) giving a posterior probability of superiority of >0·999 (estimated median TTR 10·3 [10·2–10·6] days vs 14·5 [14·2–14·9] days respectively, hazard ratio [95% BCI], 1·36 [1·3–1·4] days), which met the pre-specified superiority threshold. On day 7, SARS-CoV-2 virus was below detection levels in 7/34 (21%) of the molnupiravir group, versus 1/39 (3%) in usual care group (p=0.039), and mean viral load was lower in the molnupiravir group. 50 (0·4%) participants experienced adverse events in the molnupiravir group and 45 (0·4%) in usual care.

Conclusions:
Molnupiravir did not further reduce hospitalisations/deaths among higher risk, vaccinated adults with COVID-19 in the community but resulted in modest improvement in recovery time and reduced viral load.

1. The safety and effectiveness of Molnupiravir in early COVID
2. Whether Molnupiravir has a role in treating COVID in primary care

Rapid impact presentation

The Pegasus Health Clinical Connect Peer Education Programme supports sustainable and ethical use of resources in primary healthcare, minimising variation and promoting best practice. Recently a collaboration with South Tyneside Clinical Commissioning Group demonstrated the effectiveness of this clinical education model in the UK setting. Aims/Goals To outline how the Pegasus peer education model supports improvements in clinical quality To demonstrate how connecting and collaborating internationally supports innovation, and is achievable with benefits to all parties Content Pegasus Health has run a peer education programme to support improvements in clinical quality and best practice for 30 years. Over time, membership of the programme has expanded to include General Practitioners, Nurse Practitioners, Practice Nurses, and Community Pharmacists.

Sessions are peer-developed and intentionally delivered in small groups of 12-15 with interactive discussions informed by evidence and data. They focus on promoting evidence-based practice and supporting change through optimal and ethical use of limited health system resources. Topics look at areas for improvement and of interest to health systems, exploring opportunities and efficiencies for teamwork. Attendees reflect on their own experience and benefit from the group’s collective expertise, respectfully challenging and learning from one another.

Whilst Pegasus Health have partnered within NZ to deliver this programme across the country, the South Tyneside collaboration was the first time testing the model offshore. Two successful pilots with GPs in South Tyneside UK, have demonstrated the effectiveness of the peer group model for both partners. This presentation will outline the approach, benefits, and enablers for our global collaboration, include some topic examples, and highlight improvements seen in engagement, peer support, and clinical quality.

1. Outline how a peer learning model supports clinical quality improvement in primary care;
2. Understand the opportunities and benefits for global collaboration across health systems;
3. Recognise the role of high quality professional development in minimising variation in practice

Rapid impact presentation

In the current debate about the contribution of Australian Primary Care and the value it delivers to patients and to funders, there has been a sharper focus on ways of demonstrating outcomes through analysis of patient records held by a practice. This paper describes an approach using deep data mining to assist a practice and a practice team to better understand how to deliver optimal care. This approach permits a practice or group of connected practices to analyse and interpret changes in outcomes in the context of the practice or group over time, without comparison with other practices which may not be directly comparable. Examples are provided to demonstrate the range of benefits that this approach may provide.

1. Analysising practice data will provide a deeper understanding of the needs of patients
2. A better understanding of the needs of patients and the resource gaps in the practice will assist in planning for the future
3. Measuring patient outcomes will assist doctors and practice teams to focus on ways to improve health outcomes for their patients and to demonstrate this improvement

Aim - to avoid /reduce prolong use of bisphosphonate induced fracture

Content - Ms AC, 73yr old now, ex-district nurse, started to take Fosamax in 2003 when she was 59 years old (but no documented DEXA scan in system), and continuously takes until 2018 for 15 years. Several doctors haven't stop prescribing even when she had a stress fracture of her feet. She visited the same pharmacy for more than a decade and no pharmacist suggested to cease prescribing as well. She had three months ultrasound therapy for her bilateral hip pain which was thought due to greater trochanteric bursitis.
She had bilateral femur fractures in October 2018 after a minor injury and Intramedullary Femoral Nail was inserted both sides. The LEFT side was redo in 2019 due to screw broken She suffers from pain and requires 4WF for mobility since.

Goals:
1- aware of avoid prolong use of bisphosphonate
2- aware of prolong ultrasound therapy may cause bone damage
3- review the GP training program - lack of awareness, lack of training
4- review Osteoporosis follow up guideline for monitor bone health in primary care
5 - state or national incident report system for share experience and warning collogues to avoid similar mistakes
6 - college level cooperative to minimize primary care mistakes - like orthopedic/endochrine research/clinical data share with RACGP for training and clinic guideline

1- aware of avoid prolong use of bisphosphonate
2- aware of prolong ultrasound therapy may cause bone damage
3- cooperate with other colleges to improve primary care safety and quality

Rapid impact presentation

Prescription drug monitoring programs (PDMPs) are computerised decision support systems increasingly being used globally to monitor and mitigate harms from certain high-risk prescription drugs. PDMPs can facilitate improved tracking of data such as prescription or dispensing history, alert health care providers of high- or at-risk patients, and encourage or guide review and revision of prescriptions or dispensing activities or practices. Often, the monitored drugs selected are implicated in prescription shopping, misuse, overdoses and deaths. In New South Wales Australia, a PDMP (SafeScript NSW) has been recently implemented in the primary care sector, giving community prescribers and dispensers access to real- or near-real time information relating to their patients' prescription and/or dispensation history of medicines monitored on this system. This presentation will summarise preliminary findings from a study that aimed to explore the perceptions and experiences of general practitioners (GPs) of SafeScript NSW. In particular, GPs participated in an online survey, and a sample also took part in a semi-structured interview. These instruments were designed with input from a GP clinician, a human factors expert, a pharmacist and a physician, and aimed to understand the impact of the system on GP work, perceived benefits and challenges in using the system. Data collection is currently under way, with results expected mid 2023.

1. To better understand PDMP and its goals,
2. To hear how PDMP has impacted GPs in practice,
3. To become familiar with barriers frequently experienced by GPs when using the system and strategies used to overcome them.