Volume 215 - Issue 4
Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed
Authors: Charlotte M Hespe, Mark F Harris and David P Peiris
Med J Aust 2021; 215 (4): 189-189.e1. || doi: 10.5694/mja2.51190
Published online: 16 August 2021
Published online: 16 August 2021
In reply
In reply: We thank Sturmberg and Martin1 for their thoughtful comments on our MJA research letter,2 which highlight the potential for an overly reductionist approach when using big data to examine the implementation of guidelines in real world general practice. As they note, there are many nuances and assumptions inherent in using general practitioner electronic medical record data and we agree that this does not provide a holistic account of the complex care practices that are jointly negotiated between care provider and patient.
In terms of setting performance benchmarks, we are not advocating that best practice should be defined as 100% adherence to guidelines. There are often well considered, important reasons why GPs and patients may choose not to follow guideline recommendations.3 However, the gaps we measured in our study are large and this is unlikely to offer a complete explanation for what we observed.
While an individualised approach is entirely appropriate, we must also be cautious that this is not used to justify an ad hoc approach to clinical care. Audits against guideline recommendations and feedback should focus on known gaps and provide an opportunity for reflection and continuous improvement.4,5,6
We agree that assessing performance in health care is complex and that traditional performance measurement may not acknowledge interdependence between different parts of the health care system and could restrict its focus to measurable outcomes rather than processes.7 Our study demonstrates a need to improve cardiovascular disease risk identification and management, but it should be considered as only one part of a multidimensional approach to understanding and improving performance. We support the need for a more comprehensive understanding about what occurs at multiple levels of the primary health care and hospital sectors, utilising a range of quantitative and qualitative data sources to shed more light on this multifaceted issue.
Competing interests
No relevant disclosures.
References
- Sturmberg JP, Martin CM. Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed [letter]. Med J Aust 2021; 215: 189.
- Hespe CM, Campain A, Webster R, et al. Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed. Med J Aust 2020; 213: 327–328. https://www.mja.com.au/journal/2020/213/7/implementing-cardiovascular-disease-preventive-care-guidelines-general-practice
- Harris MF, Lloyd J, Krastev Y, et al. Routine use of clinical management guidelines in Australian general practice. Aust J Primary Health 2014; 20: 41–46.
- Ivers N, Jamtvedt G, Flottorp S, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012; (6): CD000259.
- Ivers NM, Sales A, Colquhoun H, et al. No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci 2014; 9: 14.
- Gachau S, Ayieko P, Gathara D, et al. Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya. BMJ Global Health 2017; 2: e000468.
- Levesque J‐F, Sutherland K. Combining patient, clinical and system perspectives in assessing performance in healthcare: an integrated measurement framework. BMC Health Serv Res 2020; 20: 23.
Linked content
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MJA Research Letter: Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed
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MJA Letter: Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed