Introduction: Pegasus Health is a charitable primary care network Primary Health Organisation) in Canterbury
• Comprehensive healthcare services including accident and acute medical care
• To improve the health of Canterbury people.
• To provide clinical advice to support the delivery of best practice, high quality education services to general practitioners, practice nurses and community pharmacists. This is provided through the Clinical Quality and Education (CQE) programme with oversight by a clinical advisory group.
The Pegasus Health Small Group Education Programme: The programme has been running for 24 years, initially for GPs and now for practice nurses (PNs) and community pharmacists (CPs).
The CQE team consists of experienced health professionals (GPs, nurses, CPs, and a physiotherapist), skilled in literature searching, critical appraisal, and presenting information as evidence informed educational material.
In addition to the CQE experience, we call on the expertise of primary, secondary and tertiary health professionals throughout Canterbury. The team also includes a Qualitative Analyst who helps with survey design and reporting, and documents how the CQE programme influences behavioural change. A skilled Knowledge Management team regularly scrutinize prescribing data, laboratory test ordering, and other relevant datasets to provide quantitative analyses for incorporation into the education programme.
Aim and theory of change: The philosophy underpinning the Small Group education programme is consistent with the triple aim of promoting best clinical practice with optimal and ethical use of finite resources, with a particular focus on improving equity of outcomes.
Themes threaded through the clinical topics include: polypharmacy, understanding and managing variation in practice, cultural competency, encouraging shared decision making, health literacy, overdiagnosis and overtreatment, collaborative working across professions to optimise patient outcomes and collaboration with the local DHB
Examples from the Small Group Education Programme:
• Reduction in prescription of proton pump inhibitors to infants:
- Education delivered to GPs, PNs, CP and Plunket nurses on the potential harms of PPI use in infants
• Reduction in the numbers of patients who are prescribed the “Triple Whammy” combination of a diuretic, angiotensin converting enzyme inhibitor and non-steroidal anti-inflammatory – this combination can result in acute kidney injury:
- Identification that this combination of medications was being prescribed fairly frequently
- Education delivered to GPs, PNs and CPs in several topics (Renal disease, heart failure, polypharmacy) over several years to reinforce the message
- Development of a patient information hand out
• Improved communication between members of the primary care team
- Annotation of “back pocket” antibiotic prescriptions
• Integration of messages across HealthPathways (the local interface between primary and secondary care) and HealthInfo (the local patient information website)
- Practitioner and patient advice easily available
Conclusion and lessons learned:
• The Pegasus Health Small Group Education Programme supports the delivery of integrated care and promotes a team approach to benefit population health.
• The SG programme is sustainable - the inclusion of PNs and CPs has also supported consistent messaging to patients. The approach is now being adopted by other Primary Care groups outside the Canterbury region.