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MEDICINEINSIGHT Using health record data to explore the provision of care in primary care Melissa Chapman BPharm MPH(PP) Clinical Product Specialist 14 October 2019 OVERVIEW Aim: To show how health record data can be used to explore general

  1. MEDICINEINSIGHT Using health record data to explore the provision of care in primary care Melissa Chapman BPharm MPH(PP) Clinical Product Specialist 14 October 2019

  2. OVERVIEW Aim: To show how health record data can be used to explore general practitioners’(GPs’) management of patients with certain conditions. Use MedicineInsight data to gain insights about the use of psychological treatments for the management of anxiety by GPs.

  3. WHAT IS MEDICINEINSIGHT? Large-scale Australian primary care data set De-identified patient data routinely extracted from the clinical information software (CIS) of participating practices Data can be used to support quality improvements Data validation in practice

  4. MEDICINEINSIGHT PRACTICES ACROSS AUSTRALIA 722 12 general practices 122 83 21 3.5 M 262 regular patients 11 5,074 50 GPs 144 4 Commercial in confidence

  5. HOW MEDICINEINSIGHT WORKS

  7. MEDICINEINSIGHT REPORT A resource that…  uses practice level data to start a conversation between GPs and educational visitors  enables general practices to review and reflect on clinical activity and plan for areas of improvement  is evidence-based

  8. ANXIETY DISORDERS Affects 2.3 million Australians Second most common mental health presentation in primary care Psychological treatments, including cognitive behavioural therapy (CBT) are first line treatments for mild or moderate and in combination with antidepressants for severe anxiety disorders What data could help GPs understand their use of psychological treatments to manage patients with specific subtypes of anxiety disorders? Mental Health Treatment Plans (MHTP): proxy to explore psychological (non-pharmacological) treatments

  9. WHO HAS ANXIETY SYMPTOMS?

  10. PSYCHOLOGICAL INTERVENTIONS FOR ANXIETY SUBTYPES

  11. CONDITION CODING Coded and free-text condition information were analysed Subtype Related term AGORAPHOBIA Agoraphobia GAD GENERALISED ANXIETY DISORDER Generalised Anxiety Disorder Social Anxiety Disorder SOCIAL ANXIETY DISORDER Social phobia Panic attacks PANIC ATTACKS Panic disorder Obsessive compulsive disorder OBSESSIVE COMPULSIVE DISORDER OCD Post Traumatic Stress Disorder POST TRAUMATIC STRESS DISORDER PTSD

  12. HOW IS THE DATA DISPLAYED? Number of % of patients Number of % of patients patients ≥ 16 patients ≥ 16 years ≥ 16 years with ≥ 16 years 30 years with with anxiety % of patients aged ≥ 16 y ears with anxiety in last 24 months anxiety with anxiety 25 anxiety currently currently 20 prescribed > 1 prescribed > 1 15 antidepressant 10 antidepressant 5 All 0 practices 16-34 35-44 45-54 55-64 65+ 16-34 35-44 45-54 55-64 65+ Your practice Dr 1 Male Female Dr 2 Dr 3 Your practice (n=) Dr 4 Other Doctors Social anxiety disorder General anxiety disorder Agoraphobia Panic disorder Obsessive compulsive disorder [b] Post traumatic stress disorder [b] 0 5 10 15 20 25 30 35 40 % of patients aged ≥ 16 years with anxiety in the last 24 months Your practice (n=) All practices

  13. PSYCHOLOGICAL TREATMENTS

  14. LIMITATIONS Condition coding (coded vs free text) of anxiety symptoms/ anxiety disorder Data can not be extracted from progress notes Tick box for psychological treatments is NOT available for use in the CIS

  15. OUTCOMES/ LEARNINGS Information about non-pharmacological management of patients with anxiety can be extracted even where data appeared to be limited. Data shows that psychological treatments are being used, and recorded in routinely collected data There may be some potential underuse for patients with anxiety:(approx.1/3 patients had a MHTP across the broad cohort of patients with anxiety symptoms) Build upon this data parameter for other condition in future programs

  16. ACKNOWLEDGEMENTS We thank the patients, general practitioners and general practices who allow the use of their de-identified information for MedicineInsight We thank the advisory group (GPs and specialists) and NPS MedicineWise contributors: Rob Mina, Chris Gianacas, Josephine Belcher, Claire Green and Jeannie Yoo Funding was provided by the Department of Health as part of our contract, to deliver quality use of medicines and educational programs in primary care

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