Brief summary of the proposed research, its aims and significance

The Integrated Care Program Phase 2 (ICP P2) study builds upon previous research into the development and use of a clinical decision support software (CDSS) modules for use by GPs which has shown that in some conditions e.g. Asthma, the use of CDSS has the potential to improve treatment practices in a way that could be expected to result in improved patient outcomes.

Primary aims:

• To further develop CDSS clinically, technically and methodologically, expanding on the experience of Integrated Care Program Phase 1.
• To measure the impact of using evidence based best practice, which includes clinical decision support software, on GP behaviour, patient behaviour and patient outcomes for patients with depression and asthma.

Secondary aims include:

• Assessing the pattern and rate of uptake of the CDSS module by GPs
• Assessing the impact of CDSS on the use of pharmacological and non pharmacological interventions used for the treatment of two chronic disease areas (depression and asthma)
• Measuring any changes in concordance of GPs with best practice associated with the use of the CDSS (as a predictor of likely improved patient outcomes)
• Insights into the practical issues of designing, implementing and evaluating an "e-health" initiative for asthma and depression in primary care
• Collecting information on the uptake and impact of specific government initiatives for asthma and mental health in the primary care sector over the period of the study

Research program

A formal evaluation framework for this study has been prepared by the Department of General Practice, Adelaide University. Approximately 50 GPs will be recruited into the intervention arm and 25 GPs will be recruited as controls. Patients will be enrolled over a 12-month period. The CDSS will be evaluated via a randomised controlled study design with the control group providing information via case notes for comparison against the intervention group. The CDSS module will incorporate input from GPs, experts in the respective clinical fields, consumers and national expert bodies. The study will also utilise data collected from the GPs clinical software package for the evaluation. Data will also be collected from the Medicare Australia (PBS medications and MBS items) and from interviews and focus groups with GPs and patients. A formal external evaluation of the study will be conducted.

Outputs of the Evaluation

The outputs of this study will include a formal evaluation report and a series of discussion papers and protocols in relation to the experiences of conducting this research project.  Other outputs will include a simulation model and business case to demonstrate options for further advancement of the CDSS nationally.

Significance

Depression and asthma both impose a significant burden of ill health on the Australian community. Recent initiatives by Federal and State governments are attempting to improve patient outcomes via a range of policy and funding changes. At the same time General Practice has rapidly adopted practice management software, incorporating electronic patient records, clinical reference material, prescribing software and patient resource material. This project is well positioned to provide valuable insight into the practical implications for future development of "e health" initiatives such as CDSS in the chronic disease areas.

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