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Optimal Prescribing Update and Support (OPUS)
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OPUS enters the ‘marketplace of ideas’
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1
Session Lead & Medical Office Asst prepare
4
Patient visit: handout or
key message
5
Follow-up QLS: discuss process lessons & results
2
QLS: Session Lead, GPs, MOAs discuss portraits & actions
3
Action Period GP self-audit of charts
OPUS Steps
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AimsMeasures
Change Ideas
1: Review portraits and
evidence
2: Review patient lists and options
3: Decide your plan for
Action Period4: Review charts,
discuss w patient,
change some Rx
5: Count changes; reflect; discuss
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Preserve confidentiality of individual EQIP portraits
Time for physicians to digest and react to their own prescribing data
Structure of meeting should anticipate GPs’ concerns.
Need for flexible use of tools in Quarterly Learning Sessions and Action Periods.
Tools are needed to facilitate patient conversations
Key issues
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‘EQIP’ -- Education for QI of Patient care
TopicHypertension: thiazidesHigh cholesterol: statins
“Heart burn”: proton pump inhibitorsBlood glucose test stripsUrinary tract infections
Upper respiratory tract infectionsDiabetes oral medications
http://web.his.uvic.ca/eqip/
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Anonymity: ‘Confidential Portraits’
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Aggregate Drug Data on Anonymous GP’s practice
EQIP PORTRAITGP Code
EQIP PORTRAIT
GP Code
Coded MD ID
Rx Portrait for MDGP address
From UVic
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Antihypertensive Portrait, inside
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“Your First-Line Antihypertensive Patients”
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“Your Patients’ First-Line Antihyptensive Costs”
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Statin Portrait, front & back cover
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Statin Portrait, inside
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Statin Price Speedometer
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Proton-Pump Inhibitor Portrait
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Patient List with OPUS Column
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1 Subset of Hypertension Registry
2 ‘Hyperlidemia’ Registry
3 Cardiovascular Registry Subset
4 Cardiovascular / Anticoagulation
5 Osteoarthritis Registry Subset
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906 patient were identified
7 of 18 GPs reporting: How many patients identified?
Statins PPIs
Patient Lists
63 137
EMR 334 372
Total 397 509
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5 GPs reviewed patient charts before visit
4 GPs called in patients to discuss medications
4 GPS flagged charts to identify patients who required medication reviews on next visit
Over half of patients were caught at next regular visit
7 of 18 GPs reporting on Action Period Activities:
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GPs discussed medication changes with 181 patients
…changed medication in over 54 patients
…succeeded in tapering or stopping medications in over 45 patients
What happened?
PPIs Statins156 125
PPIs Statins35+ 19
PPIs Statins26+ 19
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EQIP: Early versus Delayed Towns
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Towns matched by size,
number of physicians,
locations
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Time
Delayed
Early
Non-randomized control group
Rx Change
0
true impact
Unbiased, imprecise
More biased, more precise
Rx of Target Medication
Fig 4a: DDTs vstime-series
Fig 4b: DDTs are less biased, less precise; nonrandomized con-trolled time-series are more precise, biased
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Action Period Report Results
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Urinary Tract Infection Portrait
BackFront
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Detail of UTI Portrait
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Detail of UTI Portrait
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Detail of UTI Portrait
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Detail of UTI Portrait
Over 50% of fluoroquinolone use is not preceded by another antibiotic.
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PLANNERS
DOERS
Healthcare organizations are sometimes compared to factories with Inputs Processes Outcomes
CEO
Mgr Mgr
MD RN MD RN
OutcomesInputs PROCESS HomeHome PATIENT JOURNEY
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$
PAYERS (e.g. PharmaCare)
Prescribers, Community Pharmacists, Patients, Families & Nurses
Conflicts in the Health System (e.g. pharmaceutical policy & programs)
OutcomesInputs Drug Safety & EffectsINNOVATORS, Manufacturers (e.g. Pharma)
OUTCOME EVALUATORS (e.g. Pharmaco- epidemiologists, economists, lawyers)
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STUDY
DODO
PLAN
ACT
The PDSA Cycle with a ‘twist’
STUDY
DODO
Swap ‘Do’ with ‘Study’ Twist O into an 8
CEO
Mgr Mgr
MD RN MD RN
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CONCLUSIONThere is a slow PDSA cycle that takes years and, within it, there are smaller, shorter PDSA cycles that take months.
GPSC’s PLAN
STUDY
ACT
DO
Portraits
Patient Lists
Quarterly Learning Sessions
Action Periods