Large-scale RACGP-backed trials of quality and continuity of care about to commence

Doug Hendrie

10/08/2018 2:48:37 PM

Two ground-breaking RACGP-backed trials designed to improve quality and continuity of care are about to commence.

What will improve continuity and quality of care? These trials may find out.
What will improve continuity and quality of care? These trials may find out.

The Flinders-QUEST and EQuIP-GP randomised controlled trials will involve thousands of patients and dozens of GP clinics. They are funded by a $5 million Federal Government grant given to the RACGP to support research into quality care.
The trials come after the RACGP withdrew its support for the Government’s Health Care Home trial.
At last weeks’ Primary Health Care Research Conference in Melbourne, the chief investigators of both projects told the crowd that recruited GP clinics had been very enthusiastic.
The trials, which are expected to begin next month, are focusing on older people, people with chronic or complex disease, and children and adolescents under the age of 17. These three groups are at higher risk of poor health outcomes.  
The University of Wollongong (UOW)-led EQuIP-GP (Effectiveness of Quality Incentive Payments in General Practice) trial will test the efficacy of giving GPs quality incentive payments for an increase in quality indicators, such as longer consultations, rapid follow-up after hospitalisation, reduced prescriptions and same day access. The trial is intended to operate with up to 1800 patients, and will also run through Monash University and the University of Tasmania.
UOW Chief Investigator Professor Andrew Bonney told the conference there is a ‘perverse incentive’ at present, as undertaking longer consultations currently means a drop in income for GPs. He said the trial would ensure that no extra payment would be made without evidence that quality indicators were being met.
The Flinders University QUEST (QUality Enhanced general practice Services Trial) will test whether continuity of care, longer GP consultations, assertive follow-up of patients after hospital discharge, and same-day appointments for children with an acute condition are linked to better health outcomes, such as less use of pathology, imaging and medications, and a lower risk of hospitalisation.
The trial is aiming to recruit 1100 patients across 20 South Australian clinics. 
There is emerging evidence overseas in favour of these four interventions, and the trial will test whether these can be generalised to the Australian context.
QUEST Chief Investigator Professor Richard Reed told the conference the GPs they have been recruiting were strongly positive about the test.

A researcher asked Professor Reed whether longer GP consultations might actually ‘open up a can of worms’ by discovering more and more health concerns.
Professor Reed said that was the point of a two-sided P-value.
‘We’re not sure what we’re going to find – that’s clinical equipoise,’ he said.
The trials are expected to run until December 2019. The RACGP will consolidate the findings and present a final report to the Department of Health. 

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