Spreading journal clubs across primary care The Quality: MK experience LfN 28 November 2008

health:mk 28 November 2008

Spreading journal clubs across primary care

The Quality: MK experience LfN 28 November 2008

Anne GrayOutreach Librarian, MK PCT

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Milton Keynes

• Unitary authority• Relatively small geographic footprint• One general hospital • One PCT (Commissioning and Provider arms)• 28 General practices, all with a number of GPs

and nursing staff


Quality: MK programme

“A whole system approach to improving health care in Milton Keynes driven by primary care,

patient engagement and evidence-based practice.”


Quality:MK programme


Introducing Journal Clubs

• Held in 4 GP practices • First meeting led by GP from Centre Evidence Based

Medicine (CEBM), Oxford University • Rapid critical appraisal methodology examining

published controlled trials• Written record of meeting to document appraisal,

discussion, clinical impact• Discussion around next meeting Aim to use the evidence to improve patient care (not

education)


Evidence based clinical discussion cycle

Questions

Clinicians

PCT/ health:mkPatients

Review action plans

Specific answerable question

Track down best evidence

Critically appraised articlesNICE guidelines

Map of Medicine pathwaysExpert opinion

Apply the evidence

Action plan

Implement & audit

Evidence based discussion groups



“Track down best evidence”• Primary literature (RCT)• Evidence synopses (Evidence Based Medicine journal

or OTSeeker)• Secondary literature (Cochrane review)• NICE guidance• Map of Medicine• Expert opinionJournal clubs Evidence based discussion groups

Quality:MK



• So what – what are the implications of the evidence?

• Different forms of evidence add variety and maintain interest


The Librarian’s role• Searches to find a suitable publication• Get the articles and distribute them• Prepare ourselves by reading the articles• Participate in the meeting in the practice• Guide the discussions• Write up a draft report of the meeting• Check actions carried out• Be in touch with the feelings of the group• Cajole and persuade to maintain momentum

Quality:MK


Toolkit

• Journal club Leaflet• Core resources for evidence based medicine • Critically appraised topic templates• Search request forms• Search result forms• Attendance record

20/5/2008 Taunton

Quality:MK

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Critically Appraised Topics (CATs)

• Record of the meeting• Bibliographic details• Study methodology• Brief study appraisal • Results• Record of discussion, clinical impact• Follow up actions (if any)• Drafted by librarian, signed off by clinician


EBDGs across MK

4 journal clubs in April 2007As of November 2008• 5 GPs• Public health staff• 4 provider teams (OT, Learning disabilities, CAMH,

diabetes specialist nurses)

• GP VTS trainees


Successes so far

• Clarification of procedures / protocols within and across practices

• Highlighting differences in prescribing practice within surgery and move towards consistency

• Increase in knowledge• Changes in practice • Audits of drug use

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Quality:MK


Questions?

• For further information contact

– Anne Gray, Outreach Librarian, MKPCT• [email protected]

Quality: MK websitehttp://www.miltonkeynes.nhs.uk/default.asp?ContentID=1359

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Documents

Spreading journal clubs across primary care The Quality: MK experience LfN 28 November 2008