RESUMO
PROBLEM: Effective and affordable health systems have good primary care. Access, equity, care of chronic conditions and quality are key priorities in primary care in Australia. DESIGN: A large-scale quality improvement collaborative addressing diabetes, coronary heart disease (CHD), access, chronic obstructive pulmonary disease (COPD), patient self-management, Aboriginal health and diabetes prevention. SETTING: General practices and Aboriginal medical services across Australia. KEY MEASURES FOR IMPROVEMENT: Sample measures are reported. STRATEGY FOR CHANGE: The Improvement Foundation (Australia) adapted collaborative strategies used in the UK. Health service teams attended three workshops, separated by activity periods and followed by 12 months of further work. Teams were supported by local collaborative program managers to make changes and report measures. Services received feedback about improvement compared with their wave. EFFECTS OF CHANGE: 1185 health services participated in 13 waves between 2005 and 2011. 83% of Australian divisions of general practice participated, and 262 support staff received quality improvement training. Key measures show improvement in all topics except access. 397,111 patients were on the disease registers of participating health services. LESSONS LEARNT: The collaborative methodology is transferable to primary care in Australia. Results may reflect improved data recording and disease coding, as well as changes in clinical care. Team dynamics and local support are important success factors. Collaboratives are a useful tool in a program of clinical quality improvement. The APCC will work with the new primary healthcare organisations which are part of health reforms in Australia to improve data reporting, improve diabetes care and entrench quality improvement in the emerging environment.