Case studies

A national pilot study using DAVE™ is currently underway among GPs and practice nurses in NSW, VIC and WA. Below is a selection of their experiences:

Dr David Lim, a GP from Newtown in Sydney
Dr Wes Jame, a GP from Berwick in Victoria
Dr Charlotte Hespe, a GP from Glebe in Sydney
Dr Marek Steiner, a GP from Mortlake in Sydney

Dr David Lim

Experiences using DAVE™

I have been using the diabetes tool in my practice since October 2008. Implementing the software is not actually as hard as it may seem – my colleagues were all interested in the concept so I organised a short evening meeting to talk them through the system. My practice nurse and I are now trialling the tool, with plans to implement it across the entire practice within the coming months. Using the tool, my practice nurse now takes responsibility for the diabetes education in our practice whilst I can focus on making the informed clinical decisions.

The tool is well designed and links into the function of our clinical notes and other systems we already use. Fundamentally, it gives me quick access to the latest targets, tells me where the patient is at in terms of their results and medications, and allows me to collect my thoughts before committing to an action plan.

This tool is like a nice ‘guiding hand’. You no longer need to memorise all the targets linked to diabetes – blood pressure, HbA1C, kidney disease, weight – the tool does this for you based on the latest clinical guidelines. You do not need to search through lots of programs, files and correspondence in order to find the latest blood results or eye test referral. The tool is uncluttered, simple to use and supplements your work as much as you need it to.

My patients have been very receptive to the use of the tool during their consultations. I still use the PC at least as much, but now we share the conversation. The patients actually look at the screen and can take a more active interest in the management of their condition. I am able to show them their latest results using graphical representations and use the educational tools to promote self-management. The computer essentially becomes a third person in the consultation.

Overall, the tool has made our diabetes management process more efficient. I am able to save around two to three minutes per consult which I can use to catch up on administration or keep ahead of my appointment schedule if I’m running late. In the longer-term, I would expect the use of the tool to improve the management and outcomes of my diabetic patients.

I would certainly recommend the use of this tool to other GPs. This tool compiles all your thoughts and management decisions into one place and makes sure you actually act on them. This is the only way to make sense of what is essentially an unorganised clinical area and is the way forward in terms of chronic disease management.

Complexity of diabetes management

I have been involved in the development of the diabetes tool since its initial conception. I was very interested in what such a tool could look like and how it could potentially influence patient outcomes.

The current state of affairs in general practice does not lend easily to the management of chronic diseases. GPs sit in the middle of many different guidelines and targets that we must endeavour to achieve for our individual patients. Clinical notes do not help to collect thoughts when dealing with a condition like diabetes, especially under the time constraints of a typical consult.

I believe diabetes is also the most complex disease to manage in primary care. A diabetes consult can be daunting – it’s often difficult to know exactly where to go to monitor all the variants. Patients feel their condition is taking over their lives with the sheer number of targets they need to aim for and the various referrals to specialists.

Timing is also an issue. On average, I need around 20 minutes to consult with a diabetic patient, whereas our typical consults only last 15 minutes. In addition, most patients don’t come to see me specifically for their diabetes – it’s often something I pick up on in their notes about halfway through the consult – but as a chronic condition it’s something I need to discuss with them in addition to any current ailments. The idea of introducing a tool which could potentially save me time and streamline diabetes management was therefore very appealing.

Dr Wes Jame

Diabetes is a very complex area to manage and it is easy to overlook certain factors. As GPs, we need a structure to work within to ensure we are managing our patients as efficiently and effectively as we can.

I’ve worked for over 30 years in a rural practice that is fast becoming part of the Melbourne urban sprawl. Our practice had already started looking at new ways and methodologies to improve the management of diabetes after realising that across our eight doctors, we didn’t have a consistent approach. When we heard about the EDSS tool from The Pharmaceutical Alliance we thought it could be a useful device to ensure consistent standards.

The implementation of the tool is an ongoing process in our practice. When the concept was first introduced, my colleagues were very keen to use the tool but felt a little overwhelmed with the new technology. However, when they actually saw the software they appreciated how user-friendly it was and the potential it had for streamlining diabetes management. It’s certainly one of the easier types of programs we use and is very simple once you have familiarised yourself with the navigation.

We are now using the tool with all our diabetes patients. It’s a standalone system but is well integrated into Locum – when we open the clinical notes for anyone on our diabetes register, the program automatically comes up on the screen.

I find the ‘floating’ page very useful as a reminder of the action plan I’ve committed to for my patients. Whilst I may not necessarily complete all the fields at once, I can build up my thoughts and rectify my clinical decisions at the next consultation. The system can be accessed by all the doctors in the practice in case the patient sees someone else at their next visit. I’m really enthusiastic about the use of this tool; it means that all the GPs are now dancing to the same tune – asking the same questions and adhering to the same standards.

Using the tool has increased engagement and compliance – patients comment it seems well developed, professional and gives them quick access to their latest results in a format they can understand. I find they are most interested in seeing what their current weight, blood pressure and HbA1c readings are, compared to what they should be.

Once we implement the final release version of the tool shortly, we will publicise it amongst the community through our patient newsletter. I feel it’s important that our patients are familiar with the use of the tool and the way the practice is continually aiming to improve patient care.

The tool adds professional rigour to what we do. If you have a set of standards you adhere to, all the GPs in your practice should be trying to pursue the same thing so that ultimately it will lead to better patient outcomes. The tool gives you discipline in the pursuit of targets and brings all the staff into a measurable dimension. I believe that over a three year period we will see evidence of the benefit it will bring to our patients in terms of improved outcomes.

Dr Charlotte Hespe

We have a broad range of patients in our practice with around 230 currently on the diabetic register. As one of the Government’s target health issues, we recently signed up to a local collaborative for diabetes. In addition, we decided to introduce the EDSS tool to streamline our diabetes management process. Each patient has a range of targets they are trying to meet and we wanted to get a grip on exactly where each patient was at, as well as engage them in their own self-management.

The overall system is a fantastic idea and easy to use. When we first implemented the tool a few weeks ago, the main barriers were technical. We were using standard-sized computer screens that made it difficult to view all the different elements at once. We therefore decided to invest in large screens for all the GPs in the practice. Not only has this improved useability of the diabetes tool, it has also meant we get better use out of the other systems we use such as Best Practice.

Everyone in the practice is now using the diabetes tool. We didn’t formally tell our patients that we were using a new system, but instead gradually introduced the patient education to them and involved them in the discussions by showing them the graphs on the screen.

I find the tool provides us with evidence plus education. Having more evidence is important when trying to influence patient behaviour and promote lifestyle modification. The nurses have found the education element very useful, especially with patients who don’t believe they’re not hitting their targets.

This tool is novel in that it is the first standalone piece of software we’ve used in the practice. It’s a really good device, incredibly supportive of what we’re trying to achieve with our diabetic patients. By pulling together all the diabetes management protocols, it introduces best practice for those GPs that are not yet aligned to national targets and guidelines.

Dr Marek Steiner

I became actively involved in the development of DAVE™ back in 2008 and was the very first GP to trial the software in general practice.

I have a keen interest in IT and how computer software can be used to aid clinical practice due to my previous job as a business analyst for an international IT management consultancy. Since becoming a General Practitioner, I have been very interested in how IT solutions can be used to improve patient care and given that diabetes is a very complex disease area to manage – there are many areas to look for and the guidelines change frequently – I was keen to test the software in a real-life setting.

GPs don’t really have any decision support tools in other clinical areas – we have tools for diagnosis and patient education, but we don’t have anything that helps us with the general management of the individual patient or that gathers all the relevant information for us in one place.

There are multiple levels to the DAVE™ application – on the surface, the general taskbar is very user-friendly and previews information about the patient’s progress and areas to be improved upon. Then there are whole other levels beneath that such as decision support tools, patient information and clinical guidelines.

We use Best Practice as our clinical management tool across all our patient records. The DAVE™ software fits in well with the day-to-day clinical practice and complements Best Practice by providing a different view of the patient’s progress in terms of diabetes.

My colleagues were quick to accept the idea of using DAVE™ to improve the way we manage diabetes. There were a few hurdles in terms of computer literacy and finding the time to get everyone together to learn how to use the tool, but these were easy to overcome as using computer software in general practice is second nature to most GPs.

Whilst the software is easy to navigate, using it during a consultation can be a little time-consuming depending on the needs of the individual patient and whether you need to access each level of the software during the consult. I find it’s a very useful aid, so it can sometimes be a trade-off as you can spend more time using the tool but overall you know it is contributing to better patient management.

During the consultation I angle the screen so that it faces both myself and the patient as the software is useful in demonstrating specific targets to them. I find that the spoken word supplemented with visual graphs makes communication with the patient a little easier as they can see their progress over time marked against quantitative measures.

Some patients are a bit more ‘PC savvy’ and they don’t find the use of the screen during the consult threatening. These patients find the software helpful in understanding the targets they are working towards and gain a realisation of their own progress, which in turn motivates them to change their habits. However, it’s important to appreciate that there is a specific segment of patients who are not of the same mindset and in that situation I use the software purely as a support tool for myself.

I think any GP could benefit from using this tool, but each person would use it differently. If you normally run six minute consultations you would find the general overview function particularly useful. If you run longer consultations you can delve into the deeper levels of the system, such as the patient education tools. DAVE™ provides GPs with a new tool to assist them in diabetes management, providing a good understanding of the individual patient’s needs as well as the resources to manage them as required.

The Pharmaceutical Alliance has been an excellent organisation to collaborate with. They are very open to suggestions and comments about the software and easy to work with. I would love to have something like this for other disease areas.