Future Health Today: A randomised control trial of pharmacological therapies to reduce cardiovascular risk in people with chronic kidney disease and investigation of people at increased risk of cancer

Patients with undiagnosed cancer can present with non-specific symptoms, and abnormalities in commonly ordered blood tests. Failure to follow up on abnormal blood tests can lead to delays in a cancer diagnosis. This is true for tests such as anaemia, raised platelets, and prostatic specific antigen (PSA) among others. As general practitioners (GPs) have a significant role as gatekeepers to specialist care in Australia, this presents challenges for GPs to make appropriate and timely actions and investigate people with symptoms or abnormal blood tests that may be due to cancer. Clinical Decision Support Systems (CDSS) are tools to help clinicians identify at-risk patients and provide the best available evidence for adequate follow-up at the point of care.

We aim to implement and evaluate a quality improvement (QI) program in general practice, consisting of an innovative technology platform called Future Health Today (FHT). This tool has audit, recall, clinical decision support, and monitoring of QI activity capabilities that, combined with an educational series will help clinicians identify patients at risk of undiagnosed cancer.

We will determine if patients with abnormal blood test results placing them at risk of undiagnosed cancer who attend general practice clinics participating in FHT are more likely to be assessed and investigated than similar patients attending other clinics. The control arm will assess improved management for patients with chronic kidney disease (CKD).

Project co-leads: Herman Prof Jon Emery A/Prof Jo-Anne Manski-Nankervis, and Dr. Craig Nelson

A/Prof Jo-Anne Manski-Nankervis, Academic GP, University of Melbourne

Dr. Craig Nelson, Nephrologist, University of Melbourne, and Western Health

Herman Prof Jon Emery, Academic GP, University of Melbourne, and Western Health

Dr. Megan Prictor, Academic lawyer, University of Melbourne

Prof Mark Taylor, Academic Lawyer, University of Melbourne

Dr. Douglas Boyle, Health informatician and data specialist, University of Melbourne

Dr. An Duy Tran, Health economist, University of Melbourne

A/Prof Shilpa Jesudason, Nephrologist, Kidney Health Australia

A/Prof Patty Chondros, Statistician, University of Melbourne

Dr. Christine Hallinan, Data science and statistics, University of Melbourne

Dr. Barbara Hunter, Qualitative research Fellow, University of Melbourne

Dr. Natalie Lumsden, Practice liaison and clinical coordinator, University of Melbourne, and Western Health

Dr. Javiera Martinez Gutierrez, Academic family physician, University of Melbourne

Dr. Rita McMorrow, Academic GP, University of Melbourne

Dr. Rachel Canaway, VicREN Collaboration and Network Manager – Research

Mr. Timothy Deitz, Data analyst, University of Melbourne

Ms. Sophie Chima, Graduate researcher, University of Melbourne

Dr. Lauren Cussen, Academic GP registrar, University of Melbourne

Ms. Kaleswari Somasundarum, Research Assistant, University of Melbourne

International advisory group:

Dr. Ben Brown, Academic GP, University of Manchester

Dr. Noah Ivers, Academic family physician, University of Toronto

General practice advisory group:

Ms. Julie Duncan, Business Manager, Corio Medical Clinic

Ms. Donna Mannix, Nurse and Practice Manager, Guardian Medical (Highpoint and Showgrounds)

Ms. Melissa Coleman, Practice Nurse, Altona North Medical Group

Ms. Jade Cartwright, Practice Nurse, Gateway Wangaratta

Ms. Linda Holdsworth, Practice Manager, Cohealth Kensington

Dr. John Hodgson, GP, Coolaroo Clinic

Dr. Jane Sklouvsky, GP, Deepdene Surgery

Dr. Richard Smith, GP, Toorak Medical Centre

Dr. Ralph Audehm, GP, Carlton Family Medical

Dr. Kashif Murtaza, GP, DPV Health Mill Park

Dr. Julian Fidge, South Wangaratta Medical Centre

Ms. Valerie Edge, Practice nurse and diabetes educator, Wingrove Medical Centre

Dr. Andrew Cheasley, GP, SIA Medical Moonee Ponds

Ms. Paula Parissi, Practice Nurse, SIA Medical Moonee Ponds

Dr. Ed Skinner, GP, Yarra Medical Centre

Dr. Malay Shah, GP, Gateway Health

Ms. Jane Rinaldi, Practice Nurse, Shepparton Medical Centre

Consumer advisory group:

Kevin Boyce

Deborah Daly

Ian Dennis

Kevin English

Pamela Gilbert

George Jiang

Eileen Lam

Associate personnel (professional staff)

Erin Hunter

Laura van Rooyen

FHT is a collaboration between The University of Melbourne and Western Health (https://futurehealthtoday.com.au). This research is supported by the Medical Research Future Fund’s Rapid Applied Research Translation program in conjunction with the Melbourne Academic Centre for Health and the Paul Ramsay Foundation.

This program of research is funded and supported by CanTest funded by Cancer Research UK.

There is currently an increased focus on quality improvement in general practice, with the implementation of a new quality improvement practice incentive payment (QIPIP) by the Commonwealth Department of Health in August 2019.

Our study will:

a. Provide evidence for the effectiveness of FHT QI program on management of one chronic health condition (CKD) and investigation of people at risk of undiagnosed cancer

b. Improve assessment and investigation of cancer ineligible patients at risk of undiagnosed cancer and improve management of eligible patients with a diagnosis of CKD.

e. Help to understand changes in health service utilisation and perspectives of health professionals on barriers and facilitators of implementation of QI programs.

d. Provide a clinical decision support tool to optimise care for other conditions in primary care.