‘Overdiagnosis’ and ‘Difficult Decisions’ tackled in Pegasus Education Programme
‘Overdiagnosis’ and ‘Difficult Decisions’ were both offered as Small Group (SG) topics in Pegasus Health’s education programme in the 2015/16 year. Antibiotic resistance, gout and part one of a two-part series on women’s health were also covered in the SG sessions for General Practitioners, Nurse Practitioners, nurses and community pharmacists.
Clinical Quality and Education (CQE) team leader Andrea Copeland says the ‘Overdiagnosis’ and ‘Difficult Decisions’ topics included some controversial and challenging aspects, which sparked plenty of interest and discussion from participants.
Key points for the ‘Difficult Decisions’ module were illustrated using the case of an elderly man with atrial fibrillation. Issues included balancing management around anticoagulation choices; risk assessment; and patient priorities. Shared decision making and decision aids were also discussed, along with the part they can play in communicating risk and advising on management.
Andrea says nurses worked through the same patient cases as GPs, then discussed a series of nurse-specific examples of difficult decisions made in practice. Community pharmacists covered risk literacy and how to explain risk to patients. They used different cases from the GPs and nurses, focusing on appropriate use of medication; management of patients requesting repeated purchases of ‘over the counter’ codeine-containing preparations; and legal versus ethical dilemmas regarding emergency supply of medicines.
The ‘Overdiagnosis: Too Much Medicine’ topic looked at the cultural belief that more medicine and earlier intervention are better. “There is increasing evidence that this is not necessarily the case,” Andrea says.
In the SG meetings, GPs looked at examples where overdiagnosis can occur including shifting disease thresholds; over-investigation leading to incidental finding of disease that wouldn’t otherwise be of concern; cancer screening; the plays of ‘Big Pharma’; and the effects of ‘Direct to Consumer’ marketing. Practice nurse meetings covered the same issues and followed a similar format.
In their SG meetings, pharmacists were encouraged to reflect on the perils of screening; question the value of health checks; look at the impact of outside influences (such as sales representatives, product promotions and pharmaceutical advertising); and consider the role of complementary medicines and better lifestyle choices.
The 2015/16 year was the first to involve Nurse Practitioners as a distinct group in the Pegasus Health education programme. A pilot study was held from September until March to find out about the continuing education needs of Canterbury’s Nurse Practitioners and how they could be met through the CQE programme.
“They all felt quite strongly that their needs would be best met by attending Small Group meetings alongside GPs, and they are now included in GP groups.” Andrea says.
Three more multi-disciplinary groups have also been established in North Canterbury in the last year – one in Kaikoura led by nurses; one in Hurunui led by a GP; and another in the Waikari area led by a Nurse Practitioner.
The CQE team has continued delivering its diabetes module ‘Starting patients with Type II diabetes on insulin’ to General Practice teams. A Local Community Diabetes Nurse Specialist and a GP teach the module, which is to be expanded later in 2016 to include community pharmacists.
Another significant project for the team has been updating the Preventive Care Manual, which is available on Health Pathways. “There were 147 pages to review on topics as broad as screening, exercise and alcohol, so it was not an easy task,” Andrea says.
The CQE team have recently moved from Shirley Rd back to 160 Bealey Ave in preparation for their eventual shift to 401 Madras St, with the rest of the Pegasus Health team in spring 2016. “We’re delighted to be back with everyone. Bealey Ave offers a great collaborative environment and like everyone else we are looking forward to having a fresh, new space in Madras St,” Andrea says.