Clinical Quality and Education
Pegasus Health's Education Programme was established in 1992. Its character is that it is peer-led, evidence based and independent. It has been evaluated and the concept has been shown to be effective in changing clinician behaviour.1, 2, 3 It is a vital part of ensuring that clinicians working in the community think about and apply evidence as well as clinical judgement. It engages clinicians through an educational approach, providing a link to the analysis of utilisation, and integration across the whole system. Its mission is:
The promotion of best clinical practice with optimal and ethical use of resources.
The approach involves showing clinicians what they are doing in comparison to their peers, presenting summaries of new evidence (including the controversies within it), and allowing peer to peer discussion. In this way, variation is reduced, and under- and over-use are addressed at the same time. Often unclear or controversial evidence is put in front of clinicians for them to explore in discussion. This helps to ensure that there is a proper scepticism about spending scarce resources on tests and treatments that are of uncertain value. Ultimately the patient can be supported in having an informed discussion and be part of the clinical decision making.
The indirect benefits of the programme include: ensuring the optimal use of public money for pharmaceutical prescribing and laboratory testing; promotion of evidence based, peer reviewed quality use of medicines; and reduction in unnecessary testing which can have negative health outcomes of patient anxiety and false positives.
Educational messages are the same for GPs, Practice Nurses and Community Pharmacists, but tailored to their professional needs and context. Practicing professionals work with Education Facilitators in the preparation of topic material. Education topics are independently researched and evidence based. Increasingly the programme is aligned with and supports the transformational system change led by the Canterbury District Health Board.
Education programme services include:
Small Group Meetings
Meetings are generally for 1 1/2 hours, each group comprising approximately 15 members. Concurrent GP, Practice Nurse and Community Pharmacist programmes provide the opportunity to develop and present parallel material which specifically meets the needs of each of these groups and helps facilitate teamwork.
The Small Group Rounds provide a structure for collection and analysis of data on pharmaceutical and laboratory use, and to report this back to professionals, both in an individual feedback report and in a peer group review process. This assists with learning and supports increased professional competency. Small Group Rounds combine a review of the evidence on the topic with discussion of illustrative and stimulating case studies.
Large Group Meetings
These meetings are generally facilitated by secondary care colleagues or outside presenters and the venue and size of these meetings necessitate a more didactic lecture style format. These large group meetings may be topics appropriate for combined sessions for GPs, Practice Nurses, Practice Managers and Community Pharmacists, or sessions specifically appropriate for each group.
Workshops and Skills-Based Training
The format of these meetings and venue is determined by the topic and size of the target audience. For example, these meetings may be used to roll out a new project, or may be offered to those with an area of special interest or expertise. Workshops may be appropriate for either GPs or Practice Nurses or a combined session.
In addition to pre- and post-topic reading, occasional bulletins are produced where appropriate. Bulletins are succinct and cover new medicines, diagnostics and testing, processes of care, updates and changes.
Much of our current product is available on the internet, where clinicians can have ready access to it.
The programme is delivered by peer Small Group Leaders but material is prepared with the support of a small team of GP, Nurse and Pharmacist Clinical Facilitators. The capacity of the team serves the whole system by providing skills and knowledge to respond to threats and concerns in the system. For example, we recently provided evidence-based advice to local professionals in response to a number of controversial hot issues (e.g., 'pre-empt' programme, bowel screening in pharmacy, and infant reflux). This is a vital contribution to ensure that patients are not exposed to costly or poorly-evidenced interventions and speculative new drugs and services.
1 Kerr D, Malcom L, Schousboe J, Pimm F. Successful implementation of laboratory budget holding by Pegasus Medical Group. NZMJ 1996;109:354-7.
2 Richards D. Impact evaluation of pharmaceutical education programme. University of Otago, Christchurch, May 1999.
3 Richards D, Toop L, Graham P. Do clinical practice education groups result in sustained change in GP prescribing? Fam Pract 2003: 20:199-206.