health:mk

Improving Medical Practice Through CurrenT Evidence IMPACTE groups in Milton Keynes

Anne Gray, Commissioning Librarian, NHS Milton Keynes

12 March 2010

Quality:MK

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health:mk

IMPACTE groups

• What are IMPACTE groups?

• How do they work in Milton Keynes?

• Outcomes

• Have a go

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www.qualitymk.nhs.uk Evidence based, primary care led,

patient centred

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Improving Medical Practice Through CurrenT Evidence

• Primary care initiative

• Started as journal clubs

• Involve clinicians to make evidence based changes to their clinical practice

• Individual and team changes

• Sustainable changes

• Audit changes and followup

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Questions

Clinicians

PCT/ health:mkPatients

Review action plans

Specific answerable question

Track down best evidenceNICE guidelines

Map of Medicine pathwaysCritically appraised articles

Apply the evidence- the

discussion around the impact of the

findings on practice

Action plan

Implement & audit

IMPACTEgroups

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IMPACTE group model– Relaxed, informal sessions

– Regular

– Topics of general interest with possible practical outcome

– Use good evidence eg EBM journal selections, NICE guidelines, Map of Medicine, “experts”

– Follow up actions and report back

– Pragmatic

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IMPACTE groups– People

• Organiser

• Session lead who has prepared a specific paper

• Scribe to record discussion and actions

• Librarian

• Pharmacist or other professionals as appropriate

– Every practice/team is different

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Resources

• Quality MK website www.qualitymk.nhs.uk

• Records of all discussions and analysis by topic

• IMPACTE toolkit /impacte_toolkit includes– Hints and Tips on setting up an IMPACTE group

– Where to find high quality evidence

– Attendance list

– Summary template

– Attendance certificate/reflection

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CEBM approach to critical appraisal

• PICO - is the article relevant to the team?

• Was the research well done?

• What can we learn from the results?

• Are there any actions we could take to improve our practice?

• Action plan

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Light touch statistics

• Basic understanding of statistics eg p value, NNT, OR, funnel plot

• Further statistical concepts (hopefully) explained by session lead if necessary

• In depth statistical understanding is not required by participants

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A few quotes from the IMPACTE leads

• “Any group education is a big positive for the practice”• “identifies learning needs”• “We all want to be there”• “The IMPACTE groups have changed the culture so that we are

learning as a team not individuals”• “Encourages sharing of ideas and consistency of approach”• “We have got into the habit of asking what are the outcomes

and practical actions of evidence we look at”• Provide a rare opportunity to discuss the evidence as a team• Help with keeping up to date• Supports revalidation

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Share and spread good practice

• Improve management of fever in under 5s(NICE guideline -> traffic light flowchart in each room)

• Improvement of patient pathway in Carpal Tunnel Syndrome(Audit reported a change to practice)

• Medication audit of antipsychotics in patients with dementia (Improved safety and reduced costs)

• Improvement of a TIA pro forma now used across MK• Reduction in antibiotic prescribing using delayed

prescribing

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Share and spread good practice -Prescribing Toolkits

• Improve implementation of Lipid management guideline (NICE guideline)– Improve understanding of guidelines

• Improve prescribing of glitazones in diabetic patients – Compilation of evidence around drug selection and

prescribing

• Reduce antibiotic prescribing through delayed prescription – New Read code, prescribing regimen

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Outcomes for the group• Enable discussion of best evidence

• Reduce variation in clinical practice and strengthen team working

• Highlight practical actions which can be taken to act on best evidence

• CPD/appraisal/revalidation points

• Share and spread of good practice

• Improve the quality of patient care

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Outcomes for the service

• Share and spread of good practice

• Reduce waste, overuse, underuse

• Improve compliance of guidelines

• Reduce risk from non-compliance

• Improve the quality of patient care

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Problems/issues

• Initial hurdle

• Sustainability – Time, clinical lead

• Maintaining momentum

• The terror of statistics

• Spreading across practices/teams

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New initiatives

• IMPACTE Online – wiki based online group discussion of NICE

guidelines

• IMPACTE Central– GP trainees plus any others who wish to attend

• Patient and Public IMPACTE– Initial development stages

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Effectiveness of strategies to encourage GPs to accept an offer of free access to online evidence based information: RCT

Buchan et al

Implementation Science 2009: 4: 68