Posted: 6 August 2024
In Australia, accessing primary healthcare through general practitioners (GPs) is a cornerstone of the healthcare system. With more than four in five Australians visiting their GP annually and two million attending weekly, general practice serves as the frontline for managing various health conditions 1,2. Among these conditions, type 2 diabetes, chronic kidney disease and cardiovascular disease affect a significant portion of the population, highlighting the pressing need for optimised care delivery strategies.
Chronic diseases represent significant health challenges globally and GPs play a crucial role in managing these conditions. However, as medical knowledge advances at an exponential rate, ensuring its efficient translation into everyday clinical practice is paramount. The translation process is often prolonged, with estimates of an average of 17 years to implement evidence-based practices3. This delay underscores the importance of initiatives aimed at bridging the gap between research findings and clinical application, particularly within the general practice setting.
Furthermore, clinical trials are essential for advancing medical treatments and diagnostic tests, ultimately optimising health outcomes. However, challenges such as poor recruitment contribute to premature trial discontinuation, with over 80 per cent of trials failing to enrol on time4. This significant barrier often results in delays and increased costs, hindering the development of new treatments and the accumulation of critical medical knowledge.
To address the existing gaps in chronic disease management and clinical trial recruitment, a team of University of Melbourne researchers, led by Associate Professor Jo-Anne Manski-Nankervis, an academic general practitioner, initiated an innovative project. The team developed software employing algorithms to analyse electronic medical records in general practices, aiming to improve clinical care and expedite clinical trials. This software introduced two distinct platforms: Future Health Today (FHT) for enhancing clinical care and Torch Recruit for streamlining clinical trial recruitment. Both platforms aim to integrate the latest innovations into general practice, addressing chronic disease management at the frontline.
In 2021, the research team secured a $750,000 grant through the inaugural round of the Targeted Translation Research Accelerator (TTRA) Research Projects supporting new research approaches to improve the prevention, diagnosis, treatment and management of diabetes, cardiovascular disease and their related complications. The opportunity was delivered by MTPConnect, alongside invaluable support from TTRA Partner ANDHealth5.
In partnership with Western Health, the research team dedicated efforts to optimise and implement both platforms within general practice settings. Significant outcomes were achieved by the conclusion of the two-year project duration.
Future Health Today – Enhancing clinical care
FHT is designed to optimise care for individuals with chronic diseases or those at risk by harnessing computerised clinical decision support. FHT streamlines the integration of the latest evidence-based guidelines into clinical practice, providing real-time, patient-specific recommendations directly on the screens of healthcare professionals. This approach holds promise in enhancing the performance of healthcare professionals and ensuring patients receive the most up-to-date and effective care.
Functioning through sophisticated algorithms applied to electronic medical records in primary care settings, FHT identifies individuals either at risk of developing a chronic disease or who are already impacted and stand to benefit from intensified management. The platform’s evolution is propelled by rigorous evaluation, continual refinement and an expansion of its scope to encompass a broader array of conditions. FHT offers modules for recommendations for identifying and managing chronic kidney disease, cardiovascular disease, type 2 diabetes and cancer risk.
Under the TTRA project, a new module dedicated to SGLT2 inhibitors in patients with type 2 diabetes and concurrent chronic kidney diseases, cardiovascular disease or associated risk factors was successfully implemented.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been included in Australian medical guidelines for years as a prescription drug to lower blood sugar in adults with type 2 diabetes. However, their role in therapy has evolved due to recent evidence showing secondary prevention benefits for cardiovascular disease and chronic kidney disease, even in patients with normal blood sugar levels. Despite this, prescription rates for SGLT2 inhibitors remain low, largely due to limited knowledge of these additional benefits and concerns about side effects. Providing appropriate and relevant education may help mitigate these issues, although education alone is unlikely to significantly alter prescribing behaviour.
A qualitative paper was published in JMIR Formative Research6 to explore the module’s use, highlighting its benefits in aiding type 2 diabetes management by improving appropriate prescribing and increasing clinician awareness of SGLT2 inhibitors. If successfully implemented, this tool could identify patients in primary care who would benefit from SGLT2 inhibitors, ultimately helping to reduce overall mortality and illness through guideline-based prescribing.
One GP that participated in the SGLT2 inhibitor study noted, “I can say to people that the reason I’m suggesting the change in medicine or the increase in dose is because there is a little point of care prompt, it’s telling me there are advantages in doing this, in making a change.” Additionally, leveraging strategies such as key opinion leader input and educational sessions further enhances the effectiveness of FHT in facilitating research translation and improving patient outcomes.
Another GP stated, “It [the point of care clinical decision support] comes up automatically every time we enter a patient where it’s relevant and it’s a very good prompt to double check that we’re following the guidelines.”
FHT is now used in more than 100 practices, and the SGLT2 inhibitor module is successfully operational in 33 of these practices and has increased awareness and usage of SGLT2 inhibitors among GP staff. The program is also providing clinical decision support for four MRFF and NHMRC funded trials (Menoprompt, Good4Mums, Primary Breathe, IDEAL).
Associate Professor Manski-Nankervis said: “Future Health Today will change patients’ health outcomes by translating the latest evidence-based guidelines for chronic disease care into practice through the provision of clinical decision support at the point of care.”
Torch Recruit – Streamlining clinical trial recruitment
Torch Recruit addresses the significant barrier of poor recruitment in clinical trials by applying trial criteria to electronic medical records to identify potentially eligible participants within the general practice setting. This innovative approach streamlines recruitment, reducing delays and costs associated with clinical trials. Torch Recruit emerged as a solution to improve trial enrolment efficiency, thereby facilitating the advancement of medical treatments and diagnostic tests.
During the TTRA project, Torch Recruit conducted an implementation study by installing the software in 10 general practices, which has led to the development of several process improvements. Torch Recruit is now operational in 121 practices, with 17 more onboarding, and supports six clinical trials. An implementation study has been submitted to the Australian Journal of Primary Health and further investment opportunities are being explored.
With TTRA funding support, Torch Recruit emerged as a spin-out company from the University of Melbourne, highlighting its innovative edge. For the formation of Torch Recruit Pty Ltd, founder Associate Professor Manski-Nankervis took learnings from the TTRA program reporting process, which compelled the spin out to focus and reflect on progress and future planning. This body of reporting was able to be used to demonstrate progress in terms of engagement, media and the program of work to build Torch Recruit. Further to this, Torch Recruit also drew on MTPConnect’s knowledge and relationships in the clinical trials space.
Associate Professor Manski-Nankervis said: “Torch Recruit aims to accelerate recruitment for clinical trials, providing opportunities to people in the community to participate in studies that may lead to new innovations to benefit health, helping to build the evidence to inform both their care and the care of others globally. The TTRA program, powered by MTPConnect, provided key funding and support to grow our business.”
Both technologies fulfil critical needs: translating guidelines into practice at the point of care and facilitating clinical trial recruitment.
The project established essential infrastructure for clinical trial recruitment in primary care, expanding access to trials for diverse patient populations. The program leveraged support from ANDHealth and the Australian Centre for Accelerating Diabetes Innovations (ACADI)7, presenting at various summits and events, and securing media coverage to enhance visibility and attract interest from potential investors and collaborators.
Future Health Today and Torch Recruit will continue to support clinical decision-making in more than 100 practices around Australia which care for over one million patients. Torch Recruit is seeking further investment to expand its reach, while FHT continues to grow its evidence-based offerings. GPs using the SGLT2 inhibitor study have praised the point-of-care prompts for helping them make informed decisions.
Associate Professor Manski-Nankervis emphasises the transformative potential of these platforms in improving patient outcomes and facilitating clinical trial participation, ultimately advancing global healthcare.
“Primary care is where most Australians receive their medical care. Future Health Today and Torch Recruit aim to optimise the care Australians receive through providing clinical decision support and opportunities to participate in clinical trials to generate evidence for future care,” said Associate Professor Manski-Nankervis.
