the HANDI* project: evidence and implementation tailored to general practice.

Transcription

1 the HANDI* project: evidence and implementation tailored to general practice. * the RACGP handbook of non-drug interventions Peter Greenberg MD PhD FRACP introduction member of HANDI project team* * chair Prof Paul Glasziou; 5 GP s; 2 Physio T s; 1 OT; 1 consultant physician; 1 medical writer; 2 RACGP senior project officers consultant general physician, Royal Melbourne Hospital appointments in Schools of Medicine & Population and Global Health, University of Melbourne; School of Public Health and Preventive Medicine, Monash University. 1

2 the HANDI project team Paul Glasziou Marie Pirotta John Bennett Tammy Hoffman Jane Gunn Peter Greenberg Sally Green Kim Bennell Dan Ewald Ben Ewald and Raquel Newman (medical writer); Joanna Ong & Gisele Rocha (RACGP senior project officers) the HANDI project a tribute background objectives process HANDI entries examples & discussion improvement opportunities acknowledgements 2

3 a tribute Dr Edward (Ted) Charles Gawthorn (died in 2010*) * the RACGP Iris and Edward Gawthorn Award group general practice in Brunswick, Victoria for ~ 35 years educated at Ely School*, near Cambridge UK * founded by St Etheldreda in 670 AD 1972: Chair, RACGP Victoria Faculty Practice Management Committee 1976: published with Dr Selwyn Carson (Christchurch, NZ) A Manual for General Practice (A Manual for Primary Health Care) background RACGP National Standing Committee - Quality Care* (NSC-QC) * Role 1: to develop and maintain high quality, evidence based tools and resources to improve the delivery of care in general practice and to support preventive care. many publications about treatments report non-drug* interventions * e.g. exercise, psychotherapy, diet, behavioural interventions, rehabilitation.. phamacopeias* date from 77 CE (Pliny s Naturalis Historiae) * an official publication containing a list of medicinal drugs with their effects and directions for their use. (Oxford dictionary) but there is no compendium of non-drug interventions! HANDI project team constituted: 2011 HANDI entries piloted & launched:

4 Number of randomised controlled trials in United Kingdom supported by main non-commercial sources between 1980 and 2002, by type of intervention. Iain Chalmers et al. BMJ 2003;327: by British Medical Journal Publishing Group objective to facilitate the prescription of effective and safe non-drug therapies 4

5 HANDI team reviews updated lists of potential entries* * publications of apparently effective & safe non-drug interventions process individual HANDI members prepare structured* presentations * question defined in PICO(T) format: Patient Intervention Comparison Outcome (Time) * literature search * critical appraisal of relevant publications: for validity, relevance, size of effect HANDI team meets & selects valid & applicable entries * all entries are supported by at least 2 trials or by 1 trial & other supportive evidence individual HANDI members draft entries with the medical writer process (ctd) drafts reviewed* and entries completed * internally by HANDI team and externally by GP s, GP trainees & content-experts entries disseminated * & Australian Family Physician entries updated * additional evidence * GP and other feedback 5

6 HANDI entries format structured evidence-based summaries* of effective and safe non-drug interventions * unlike guidelines, the main focus is on the intervention, not the condition TITLE BACKGROUND INTERVENTION INDICATION CONTRAINDICATIONS ADVERSE EVENTS DESCRIPTION TIPS AND CHALLENGES GRADING ( level of evidence ) REFERENCES ( up to 3) HANDI entries category, number ( ) & example (in mid-september 2015) children (6) e.g. wet combing for head lice musculoskeletal (11) e.g. advice to stay active for acute low-back pain cardiovascular (3) e.g. exercise for intermittent claudication and peripheral arterial disease mental health (5) e.g. brief behavioural therapy for insomnia in adults nutrition (3) e.g. mediterranean diet for reducing cardiovascular disease risk other (5) e.g. the Epley manoeuvre for vertigo 6

7 HANDI entries intervention, number ( ) & example (in mid-september 2015) exercise (12) e.g. pelvic floor muscle training for pelvic organ prolapse behavioural (3) e.g. alarms for bedwetting (enuresis) oral (5) e.g. sweet solutions for procedural pain in infants up to 12 months topical (2) e.g. topical heat for bluebottle and pacific man-o-war stings other (9) e.g. taping for knee osteoarthritis HANDI entries availability & searchability 7

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9 examples & discussion Exercises: falls prevention Low-FODMAP diets: irritable bowel syndrome (IBS) The Epley manoeuvre: vertigo Taping: knee osteoarthritis Mother s kiss: nasal foreign bodies improvement opportunities better search-strategies for publications reporting non-drug interventions better descriptions of non-pharmacological interventions: of 137 non-drug interventions reported in randomised controlled trials in 6 leading general medical journals in 2009, only 53 (39%) were adequately described*. * Hoffmann TC, Erueti C, Glasziou PP. BMJ 2013 Sep 10;347:f3755. doi: /bmj.f

10 acknowledgements the HANDI project team the HANDI sponsors * Jack Brockhoff Foundation * British United Provident Association (BUPA) Health Foundation Mr Tony Parsons - RACGP library Ms Jane Ryan - RACGP archives HANDI content experts 10