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Computachem Editor's Note:
We are pleased to announce that we have formed an alliance with Health Communications Network (HCN), an Australian company that is heavily involved in e-health. With permission, we have extracted focus items from their recent newsletter which should prove of interest to pharmacists.
Note that the second item, the top 20 prescriptions written by GP's is provided by the GPRN database noted above.

How many GPs order pathology in MD?

This edition of HCW investigates the GPRN data for pathology requests made through Medical Director.
The previous issue focused on imaging requests.

Pathology requests through Medical Director are made more frequently than imaging requests. Data from the GPRN shows that 73% of users made a pathology request through Medical Director during the last week of June 2001, representing an increase from 43% for the same period in 1999. In June 2001, 62% of users made an imaging request in MD.

Pathology requests included the full range of pathology tests including serology, biochemistry, microbiology, cytology.

Rates of pathology requested in general practice

Rates of pathology request encounters appear to have increased over the study period:

* All diagnostic request encounters – from 100 per 1000 encounters to 200 per 1000 encounters
* Pathology request encounters - from 60 per 1000 encounters to 100 per 1000 encounters * Hb A1c request encounters – from 2-3 per 1000 encounters to 4-6 per 1000 encounters.

However the apparent increase is due to the increased use of the pathology request functionality by users of Medical Director.

GPRN data allows a more detailed picture of pathology requests in Australian general practice than that available in previous studies (1). The data in the GPRN is the full actual request (anonymous – primary source).

1. Britt H, Miller GC, McGeechan K, Sayer GP. Pathology ordering by general practitioners in Australia 1998. AIHW Cat. No. GEP 4. Canberra: Department of Health and Ages Care (General Practice Series No. 4).

Safer pathology requesting in MD

Even with the advances brought by electronic management, a good system is vital.
Prior to the computerisation of general practice, management of tests and investigations was identified as a potentially high risk area for mishaps.
Problems identified include: lost or misfiled test results, patients not informed of follow-up, missing results, no record of actions taken after diagnostics.(2,3)

Margaret Windsor, from DARTA, has been training GPs in MD for the past 4 years.
She emphasises that "MD provides Doctors and support staff with the tools necessary to audit the flow of pathology from the time of request up to the final step of ensuring that all results have been come back in.

"It is important that each practice sets up management systems and protocols for each of these steps."

Margaret uses the flow chart below to demonstrate functions within MD used in the cycle of ordering, reviewing, recording and acting on pathology. The boxes outside the circle highlight issues for practices to consider in their own system.

2. Bhasale A, Miller G, Britt H, Reid S. Aust Fam Physician 1996 Dec;25(12):1861-3 Clinical incidents in general practice. Keeping on track with test results. 3. Bhasale A, Norton KJ, Britt H. Tests and investigations. Indicators for better utilisation. Aust Fam Physician 1996 May;25(5):680-7

The outstanding request window

Main Menu > Files > Outstanding Requests
As an example, lets look at the Outstanding Request window.

The outstanding request screen maintains a list of all requests made in MD. They will remain in the list until they are manually deleted. To maintain a list of requests that have not been received, it could be part of your system to delete requests from this window once they have been received, checked, and acted upon.

To check which results have already been added to the patient’s record, click the search button.

Allergic rhinitis surveillance

The chart below shows the rate of Allergic Rhinitis visits per 1000 up till 28 October 2001.
A visit for Allergic Rhinitis is considered to have taken place if the GP has recorded either Allergic Rhinitis or hay fever as a diagnosis or has prescribed either Mometasone nasal spray or Ipratropium nasal spray. These two products were chosen as their indications are specifically Allergic Rhinitis and not other Allergic conditions. Part of the challenge of attempting surveillance of this condition is that a large proportion of the treatments are available as over-the-counter preparations. Nevertheless it is reasonable to assume that for those patients requiring more aggressive therapy, GPRN data should reflect the seasonal nature of the condition.

Top 20 Medications prescribed in General Practice this week
(weighted by no of repeats)

Editorial Review:
Geoffrey Sayer * Dr Frank Pyefinch
Contributing Authors:
Fiona Horn * Leigh Hendrie * Kevin McGeechan * Geoffrey Sayer
Editor:
Alice Bhasale
Health Communication Network, PO Box 67 St Leonards NSW 1590 ph 02 9906 6633
email: research@hcn.com.au.

PLEASE COMPLETE OUR SURVEY (WHICH HAS A LIFE OF 10 DAYS ONLY), AND WHICH CAN BE FOUND BY FOLLOWING THIS LINK: http://www.zoomerang.com/survey.zgi?9B0V7DDMS0LM6LHD5VQBK6BY

(N.B If the link fails to operate, please copy and paste the link to your browser URL address panel and press return. This will clear any faults.)

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