impact of essencial recommendations in primary care · impact of essencial recommendations in...

Impact of ESSENCIAL

recommendations in primary care

Johanna Caro Mendivelso1, Cari Almazán1, Cristina Colls1, Manuel Medina2,

Sebastian Calero Muñoz2, Josep Maria Argimon3 1Agency for Health Quality and Assessment (AQuAS, Catalonia, Spain), 2Institut Català de la Salut (ICS) on the behalf of Essencial implementation

pilot, 3Servei Català de la Salut.

Preventing overdiagnosis 2016

Barcelona, 20th-22th September 2016

Background

ESSENCIAL Project is a public

policy initiative to identify

low-value clinical practices

and elaborate

recommendations to avoid

them

Essencial Project: Adding value to clinical practice

Background

Treatment of phimosis in children under three years

Imaging tests in evaluating headache

Antibiotics and asymptomatic bacteriuria

¿What is a low-value clinical practice?

http://www.choosingwiselycanada.org/

Background

Treatment of phimosis in children under three years

Imaging tests in evaluating headache

Antibiotics and asymptomatic bacteriuria

Project

activities

Background

Cari Almazan-How to avoid unnecesary interventions in primary care

Objective

In the context of implementation, the objective is

to evaluate the impact and trends of

recommendations implemented by

primary care teams

Uncontrolled before-after study was designed

18 month follow-up

Methods-Pilot 1

Baseline status

January-March 2015

Intervention

April 2015

8 months post intervention

December 2015

18 month follow-up

Intervention Measurement and monitoring of indicators of each

recommendation

Others interventions in each PCT (training, materials for patients...)

PCTs receive information monthly about evolution

of their indicators (Feedback)

The source of information is the EHR

Methods

Methods

Methods

Poisson regressions models were fitted to study the

comparison rates between baseline status (3 months

previous intervention) and 8 months post

intervention (December 2015).

Statistical analysis

11 PCT

Results-Pilot 1

Primary Care Teams of Institut Català de la Salut (ICS)

323 Healthcare professionals

Results

Recommendations

Results

http://essencialsalut.gencat.cat/ca/implementacio/la-implementacio-al-territori/ http://essencialsalut.gencat.cat/ca/implementacio/la-implementacio-al-territori/

14% (95%CI, 0.77-0.95; P=0.005)

ICS

Team 1

Team 2

Team 3

Results


21% (95%CI, 0.66-0.94; P=0.009)

http://essencialsalut.gencat.cat/ca/implementacio/la-implementacio-al-territori/

ICS

Team 1

Team 2

Team 3

Team 4

Team 5

Results


23% (95%CI, 1.05-1.44; P=0.007)


Team 2

Team 3

ICS

Team 1

Periods between bone densitometry in patients without treatment

Results


Antidepressants Benzodiazepines Statins

ACE and ARA II Vitamin D PPI

The remaining recommendations (5) decreased with no statistically significant changes

• Short follow-up period

• Each team has chosen its own recommendations to be

implemented, which involves a small number of teams for

recommendation

• Heterogeneity of interventions to be carried out by each

PCT, according to the specific characteristics of their

organizations

Limitations

Conclusions /Lessons learned so far…

Results provide information about early impact of

Essencial recommendations.

Professionals are key actors in change of clinical practice,

although there is a need to strengthen interventions in

patients and at organizational level.

It’s not possible to attribute these results only to project.

There are some initiatives at PC aligned with Essencial in

terms of reducing overdiagnosis and overtreatment.

http://www.livescience.com/6414-light-bulbs-spur-bright-ideas-study-reveals.html

With the support of:

Thank you very much!

[email protected]

http://essencialsalut.gencat.cat

mailto:[email protected]



impact of essencial recommendations in primary care · impact of essencial recommendations in...

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