Grant: Operating Grant: Knowledge to Action

When evidence about drug effects is complex, general practitioners (GPs) are less likely to be influenced by one-way advice from researchers and authorities than by two-way conversations with peers and researchers together. A challenge for our health system is to enable two-way conversations with thousands of GPs at low cost, timed when GPs are receptive to rethinking their prescribing. An opportunity to test a new approach has arisen in British Columbia (BC) through the Practice Support Program (PSP), co-sponsored by the Ministry of Health and BC Medical Association. Since 2007, PSP has helped GPs and their Medical Office Assistants (MOAs) to improve clinical practices and office management by paying them to participate in 'Modules' comprising 3 half-day Learning Sessions and 2 half-day 'Action Periods.' In Action Periods, they review medical charts of a list of targeted patients and consider changes in care. In 2012, PSP will launch a scaled-down module called Optimum Prescribing Updates and Support (OPUS) comprising 2 Learning Sessions and 1 Action Period. The scaling down includes restrictions on new materials. OPUS will use only existing ONE-WAY knowledge-transfer tools: confidential 'Portraits' of individual GPs' prescribing plus 'Patient Lists' for targeting prescribing improvements. We propose to divide OPUS into 2 streams, each with about 250 GP-MOA pairs: one stream will get OPUS with ONE-WAY tools only; the other will participate in co-producing TWO-WAY Action-Period Tools: local modifications to Portraits, Lists and patient handouts; self-training videos; and an ongoing phone-in conversation among GPs, researchers and program decision-makers modeled on CBC Radio's Cross Country Checkup. GPs and MOAs will listen to and 'phone in' to 'OPUS Check-up' during Action Periods. We will compare prescribing changes in the 2 streams using PharmaNet data from all community pharmacies in BC.