Clinical Connect Peer Education Programme Canterbury Impact Report 2024

CLINICAL CONNECT PEER EDUCATION PROGRAMME CANTERBURY IMPACT REPORT 2024

CONTENTS Key Highlights | 3 Introduction | 4 Engagement | 6 2024 Impact Insights | 8 Keeping clinicians up to date with the latest clinical evidence and supporting best practice decision making | 8 Creating a more resilient primary care workforce that feels confident and supported in their clinical practice | 10 Supporting optimal resource use and reducing unhealthy variation | 12 Building a more connected primary care workforce not working in silos | 14

Financial Benefits | 15 Summary | 16 Appendices | 18 References | 21

ACKNOWLEDGEMENT Thank you to Kin Strategy and Research who provided expertise, guidance, and support for the development and implementation of the Clinical Connect Peer Education Programme Measurement Framework and Strategy.

This report was prepared by Pegasus Health. It is not intended to compel or unduly influence independent choices made in developing health care policy or practice. The resource remains the intellectual property of Pegasus Health. This material is not to be redelivered, on sold to any individual or organisation, or made publicly available on any website or in any publication, without written permission from Pegasus Health (Charitable) Ltd © Pegasus Health (Charitable) Ltd. May 2025

KEY HIGHLIGHTS Clinical Connect is well attended across Canterbury and continues to grow with an average of 606 clinicians attending each topic (up from 588 last year) 90% of Canterbury general practices attending at least one session in 2024 Clinical Connect delivers high quality peer education sessions that support quality improvement and improve health outcomes 93% clinicians state that the programme impacted and/or improved their clinical decision-making Clinical Connect sessions are valued highly by the Canterbury primary care workforce Overall quality averaged 4.6 from 5 Clinical Connect increases the resilience of our workforce through peer connection and encourages them to work as teams 98% clinicians state the programme provides a safe space to connect with peers Clinical Connect topics provide positive financial impacts for the health system and our people

INTRODUCTION In this impact report, our second, we are proud to share with you how the Pegasus Clinical Connect Peer Education Programme is improving clinical quality and supporting clinical practice for primary healthcare clinicians across Canterbury.

Five interesting and engaging topics were delivered in 2024: Cardiovascular Disease Risk Assessment, Sleep in Adults, Type 2 Diabetes, Frailty & Legacy Prescribing, and Menopause. The details of each topic, the key messages, shortand long-term impacts are outlined in appendix 1 in detail.

Several of the topics delivered in 2024 support best practice in the long-term management and prevention of chronic diseases, key examples being the topics delivered on cardiovascular risk assessment and type 2 diabetes. Provision of best practice care will reduce the burden on secondary care, for example: better primary prevention of cardiovascular disease or better management of type 2 diabetes will result in fewer hospital admissions and improved quality of life.

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The current NZ health targets are largely focussed on the provision of secondary care, however improving health outcomes in primary care will impact on these targets positively lessening the demand for secondary care services, supporting shorter stays in emergency departments, shorter wait times for first specialist assessment, and shorter wait times for elective treatment.

Our first impact report highlighted the development and details of our impact goals and framework [1]. In this second report we report directly on the Clinical Connect impact goals in relation to the topics and programme delivered in 2024.

Our impact goals are: Keeping clinicians up to date with the latest clinical evidence and supporting best practice decision making Creating a more resilient primary care workforce that feels confident and supported in their clinical practice Building a more connected primary care workforce not working in silos Supporting optimal resource use and reducing unhealthy variation Throughout this impact report, we provide information on the impact indicators for each goal, and we include direct quotes from clinicians who attended our programme in 2024. We also include our first financial impact analysis using the Treasury CBAx tool in relation to one of the intended impacts from a Clinical Connect topic on cardiovascular disease risk assessment.

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ENGAGEMENT Clinical Connect continued to grow in 2024 3028 attendances at Clinical Connect sessions Average of 606 individual clinicians attending each topic (up from 588 in 2023) 955 individual clinicians attended 1 or more session

Clinical Connect is attended by clinicians from most general practices and community pharmacies in Canterbury Clinicians from 90% General Practices and 69% Community Pharmacies attended sessions in 2024 [2] This ensures Canterbury clinicians can provide consistent messaging for patients and whānau across our general practices and community pharmacies

"I often discuss topics with patients - and with med students and other practice staff - trying for that cycle of continuous improvement”

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Clinical Connect sessions continued to rate highly for quality (Average 4.6/5) [3]

Topic

Overall Quality

Facilitation of session

Attendance

Cardiovascular risk

4.5

4.7

644

Sleep

4.7

4.6

623

Type 2 Diabetes

4.7

4.5

618

Frailty & Legacy Prescribing

4.7

4.6

561

Menopause

4.6

4.7

584

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IMPACT INSIGHTS The Clinical Connect Peer Education Programme impact measurements are based on an analytically sound, theory of change impact model, see Appendix 2. By monitoring our predefined impact indicators rigorously throughout the year, we can provide the following evidence-based statistics and insights about the impact of the programme.

IMPACT GOAL - Clinical Connect keeps clinicians up to date with the latest clinical evidence and supports best practice decision making

Indicators 90% clinicians state Clinical Connect addresses their professional development needs "Keeps me up to date, focus on equity and Canterbury data" 93% clinicians state the programme impacted and/or improved their clinical decision-making "Good to know prescribing data to back decisions" "I always take back my learning to my workplace. I share the learnings and updates with others who don’t attend the sessions"

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90% clinicians state they have made changes/improvements to their practice as a result of attending Clinical Connect "More aware of involving wider whānau. Better open dialogue. Improved conversations and supporting the patient to understand and participate in their own decisions.”

"I'm much more culturally aware - aware of pronouns, dealing with transgender issues, barriers that Māori & Pacific people face " 91% clinicians state the programme improved their ability to provide quality care to patients "Increased knowledge in multiple areas & increased confidence after discussing with peers in group meetings e.g. increased confidence & knowledge when not to test (LFTs, repeat lipids, FSH etc.) “ 32% clinicians experienced barriers to applying information from Clinical Connect, most frequently the barrier was a lack of time, and secondly funding.

Understanding the clinicians’ barriers to applying information from sessions contributes to continuous improvement of the programme, such as informing future topic development. It also highlights areas where Pegasus Health and other Canterbury PHOs may be able to support system enablers to improve patient care. [4]

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IMPACT GOAL - Clinical Connect creates a more resilient primary care workforce that feels confident and supported in their clinical practice

Indicators 98% clinicians state programme provides a safe space to connect with peers 87% clinicians state programme has reinforced or improved my confidence in clinical practice Professional isolation is a red flag risk for burn out, which in turn contributes to clinicians leaving the health sector and/or early retirement of health professionals [5-8].

74% clinicians agree being part of the programme minimised their sense of professional isolation (8% stated ‘No’, 16% stated question was ‘Not applicable’)

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Whilst this overall percentage is comparatively lower than other indicators for this goal, it should be noted that 16% respondents stated that this question was ‘not applicable’ to them.

This 16% are those that are potentially already connected through their usual workplace and professional connections.

Key professional differences showed: Nurse Practitioners and Community Pharmacists most identified this benefit of minimising professional isolation Reasons may be that nurse practitioners are a growing workforce and fewer in number; and community pharmacists are often more likely to work in isolation from other regulated health professionals

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IMPACT GOAL - Clinical Connect supports optimal resource use and reduces unhealthy variation

Improving clinical decision-making optimises the use of resources in the health system, reduces unhealthy variation in practice, and ultimately reduces morbidity and associated costs. The statistics below outline specific indicators of improvements in clinical decision making and adoption of best practice in relation to the topics delivered in 2024 (further details of the topics in appendix 1).

Indicators Clinical Connect supports better management of cardiovascular risk: 69% clinicians improved how they support patients at high risk from cardiovascular disease (Noting that the majority of those who did not indicate improvement stated this was because the knowledge was not new, and they were already up to date with their practice in this area). This means that Canterbury clinicians are now more consistent in identifying their high-risk patients, and in using the correct evidence-based tools to inform their calculations and conversations about cardiovascular risk.

Clinical Connect supports evidence-based use of medications for diabetes: Medication management of type 2 diabetes has changed in recent years with funding available for some newer agents. This topic aimed to ensure eligible patients were consistently offered these medications in line with best clinical practice and evidence.

64% GPs and NPs indicated improvement in prescribing of medications for type 2 diabetes

“Good information on new medications that we don't have the time to research - also feels safer to prescribe new medications when you know everyone is doing the same” H. Mohammed 2022. “Hypertension”. Clinical Connect ‘Cardiovascular Risk – look beyond the numbers’. Feb/Mar 2024

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N.Jones. “The Glucose Molecule”. Clinical Connect ‘Type 2 Diabetes – the highs and the lows’. July 2024

Clinical Connect addresses harms from polypharmacy: 65% clinicians (all professions) improved how they review or prevent legacy prescribing for sleep Legacy prescribing occurs when medication is taken longer than recommended.

Sleep medications can often be used much longer than intended, as patients can develop dependence with increasing risk of harms from the side effects, such as falling, as they age.

Clinical Connect improves screening for frailty: 60% GPs and NPs improved screening for frailty for their patients Screening patients for frailty enables clinicians to proactively support them to prevent decline in their daily abilities.

Clinicians commented on better use of Health Coaches, Health Improvement Practitioners, Falls Prevention Services, and Community Sleep services. This wider use of these resources maximises the skillset and capacity of the broader primary care multidisciplinary team. Particularly important, given the shortages of GPs and ongoing challenges for patients to access care. [4]

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IMPACT GOAL - Clinical Connect helps build a connected primary care workforce that is not working in silos The multidisciplinary nature of the Clinical Connect programme strengthens cross discipline connections and working relationships. This enables problem solving, continuous improvement, and teamwork, optimising stretched workforce resource and supporting consistent quality care for patients and whānau.

Indicators 89% clinicians indicated that they are better able to direct patients and whānau to the right people and services in the health system after attending the Clinical Connect sessions 76% increased their understanding of other professional roles in primary care Across the professions, Community Pharmacists and Practice Nurses increased their understanding of other professional roles the most.

“My nursing knowledge is constantly enhanced; I also find the time spent with the GPs and CP valuable with their viewpoint and knowledge sharing”

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FINANCIAL BENEFITS In the 2023 Pegasus Small Group education impact report [1] we outlined in depth the challenges of specifying the financial impacts of the programme.

There were four main areas of challenge: The lack of available data The delayed impact on resource use or costs The difficulty of attribution or causality: it is often not clear how much of a change can be attributed to the programme or other factors, and Best-practice methodologies

Whilst these challenges remain for 2024, we have progressed a costbenefit analysis in relation to one of the five Clinical Connect topics following training of key Pegasus Health Finance team members in the Treasury NZ CBAx methodology.

The NZ Government Treasury encourages all funding decisions to be informed by cost benefit analysis and has used the CBAx tool since 2015 [9]. The Ministry of Health also uses CBAx, with a focus on the impact of health interventions on QALYs (quality of life years). [10].

The ‘Cardiovascular Risk – Look beyond the numbers’ Clinical Connect topic encouraged clinicians to improve their approach to patients at high risk of cardiovascular disease. (for further details on the topic, see Appendix 1)

The CBAx analysis estimated that for every $1 that was invested into the development and delivery of this topic, the Government receives $7.70 in financial benefits across the health system due to improved primary prevention of cardiovascular disease in high-risk Canterbury patients through better management of hypertension (one of the major risk factors for CVD).

When including the non-financial benefits to the wider society, including improving quality of life through primary prevention of cardiovascular disease (avoiding myocardial infarction, stroke, hospitalisation), the total benefit was estimated to value $17.70 per $1 spent.

A link to the full CBAX analysis including the methodology and assumptions is available in Appendix 2.

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SUMMARY This report outlines the value delivered by the 2024 Clinical Connect Peer Education Programme in Canterbury for the participating clinicians, the patients and whānau they care for, and for the health system. Our impact analysis demonstrated that the programme delivered against its’ four impact goals in 2024.

The continued high levels of engagement in the programme, with 90% Canterbury General Practices and 69% Community Pharmacies attending sessions [2], alongside the continued positive feedback with overall quality rating 4.6 from 5 [3], demonstrates the value of the programme to those attending alongside the reach and opportunity of the programme to support best practice patient care.

93% of clinicians stated the 2024 Clinical Connect programme impacted and/or improved their clinical decision-making, and 91% indicated an improved ability to provide quality care to patients showing clearly that Clinical Connect supports clinical quality improvement [4].

The Clinical Connect model also creates safe spaces and provides peer to peer support, indicated by 98% in the annual survey, this demonstrates the programme improves the resilience of individual clinicians alongside encouraging them to work as a team [4].

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Provision of best practice primary care as promoted through the 2024 Clinical Connect topics will reduce the burden on secondary care as evidenced through our indicators: 69% clinicians improved their approach to primary prevention of cardiovascular disease 64% improved prescribing for type 2 diabetes 60% improved screening for Frailty [4] Improving health outcomes in primary care will positively impact on the current NZ health targets lessening the demand for secondary care services, supporting shorter stays in emergency departments, shorter wait times for first specialist assessment, and shorter wait times for elective treatment.

Whilst the impact analysis has been overwhelmingly positive, one third of the clinicians continue to report barriers related to time and funding that prevent implementation of learning from this programme [4].

Future exploration at organisational and system levels of how practice and model changes might mitigate these barriers could optimise the potential impact of the programme and further improve health outcomes.

Our inaugural financial impact analysis on the Cardiovascular risk sessions showcases the potential financial benefits Clinical Connect provides the health system and our people. We will continue to improve our financial reporting as we increase our experience in costbenefit methodology.

Clinical Connect supports a culture of peer connection and clinical quality improvement across Canterbury, strengthening our primary care teams despite ongoing workforce challenges and increasing workload demands.

Expansion of Clinical Connect to other regions of Aotearoa, New Zealand could amplify these benefits to create a wider culture of clinicians who reflect, discuss, and improve their clinical practice to ultimately support better health outcomes.

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APPENDIX 1

Clinical Connect topics delivered in 2024

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APPENDIX 2 Pegasus Small Group Education Impact Report 2023 https://clinicalconnect.nz/impact-report/ Clinical Connect Theory of Change Impact Model https://clinicalconnect.nz/theory-of-change/ Cost-benefit analysis Pegasus Health. Financial impacts of improving cardiovascular disease risk management following Clinical Connect Peer Education – ‘Cardiovascular Risk – look beyond the numbers’ https://clinicalconnect.nz/wp-content/uploads/2025/05/Clinical-Connect-CostBenefit-Analysis-Report-may25.pdf

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REFERENCES 1. Kennedy L; Algera P, Pegasus Small Group Education Programme Impact Report 2023. 2024, Pegasus Health.

2. Clinical Quality & Education Team, Analysis of attendance at 2024 Clinical Connect Peer Education Programme in Canterbury. 2024, Pegasus Health,.

3. Clinical Quality and Education Team, Clinical Connect Attendee & Leader Session Feedback. 2024b, Pegasus Health,.

4. Clinical Quality & Education, Clinical Connect Peer Education Programme Annual Impact Survey. 2024, Pegasus Health,.

5. Christie, C., et al., Self-care of Canterbury general practitioners, nurse practitioners, practice nurses and community pharmacists. Journal of Primary Health Care, 2017. 9(4): p. 286-291.

6. Mandy, A. and P. Tinley, Burnout and occupational stress: comparison between United Kingdom and Australian podiatrists. Journal of the American Podiatric Medical Association, 2004. 94(3): p. 282-291.

7. RNZCGP. Burnout: Let's understand it and find solutions. 2022; Available from: https://www.rnzcgp.org.nz/resources/data-and-statistics/burnout-survey/ 8. Wasoski, R.L., Stress, professional burnout and dentistry. Journal - Oklahoma Dental Association, 1995. 86(2): p. 28-30.

9. The Treasury NZ. The Treasury's CBAx Tool. 2024 23 Dec 2024 [cited 2024; Available from: https://www.treasury.govt.nz/information-and-services/publicsector-leadership/investment-management/investment-planning/treasuryscbax-tool 10. Dr. Bronwyn Crosson; Chief Economist Manatu Hauora Ministry of Health NZ, Social and financial impact of improved health education for primary care professionals, Puck Algera; Louise Kennedy, Editor. 2024.

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CLINICAL CONNECT PEER EDUCATION PROGRAMME IMPACT GOALS Keep clinicians up to date with the latest clinical evidence and support best practice decision making

Create a more resilient primary care workforce that feels confident and supported in their clinical practice

Help build a more connected primary care workforce that is not working in silos

Support optimal resource use and reduces unhealthy variation

N.Jones. 2023. “Sleep Disruptors”. Clinical Connect ‘Sleep In Adults’ Apr/May 2024

H.Mohammed 2022. “Hypertension”.

Clinical Connect ‘Cardiovascular Risk – look beyond the numbers’. Feb/Mar 2024

Placidplace 2023. “Ying Yang Karma Meditation”.

Clinical Connect ‘Sleep In Adults’ Apr/May 2024

N.Jones. “The Glucose Molecule”. Clinical Connect ‘Type 2 Diabetes – the highs and the lows’. July 2024

T.Mossholder. 2019 “Man and child walking on shore”.

Clinical Connect ‘Frailty and Legacy Prescribing: Opportunities for improvement’. Sept/Oct 2024

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