The Veterans’ MATES programme
The initiative reported here was developed as part of the Veterans’ Medicines Advice and Therapeutics Education Services (Veterans’ MATES) programme. Veterans’ MATES is funded by the DVA and aims to improve medicine and health services use and health outcomes for all persons in the veteran community across Australia. The programme drives professional behaviour change via a multifaceted intervention, composed of an educational component and an audit and feedback component delivered to GPs; these are supported by educational components delivered to pharmacists, other relevant health professionals, and veterans. Veterans’ MATES is informed by social cognitive theory,Interventions are created in three sequential steps:
Step one — an epidemiological inquiry is conducted to identify trends and potential issues in healthcare access and use. Examples include the long-term prescription of medicines recommended for acute issues, doses above guideline recommendations, and lack of screening tests for an eligible population. The programme has access to the DVA’s health claims database, which is updated monthly and includes all dispensed medicines requiring prescription, along with claimed healthcare services and laboratory services, home care, and aged care;Step two — educational material, along with audit and feedback documents, are developed. This is a collaborative process with heavy stakeholder involvement, including multiple health professionals and behaviour-change specialists;Step three — the identification and delivery of the intervention to veterans and their main healthcare provider. This step requires the use of patient-level information contained in the database to print personalised audit and feedback documents at scale, reaching tens of thousands of veterans and GPs per intervention.The programme has been extensively described elsewhere,Veterans’ MATES ran the first intervention in 2004 and, since then, has delivered four interventions each year. In 2019, a digital precision public-health initiative was implemented, which used digital technology infrastructure available at healthcare provider practices. The goal of this initiative was to use the large longitudinal claims database to create risk profiles, and use data to tailor interventions for GPs. Each digital document sent to GPs is dynamic, and may contain different elements (prompts, goal setting, chartsThe digital solution developed takes advantage of Australia’s secure-messaging infrastructure, which is commonly used to communicate electronically laboratory results and referral letters from the source directly to the GP’s desktop computer. Electronic documents are visualised in the clinical software, and a GP can request actions from the clinic nurse or reception on the same screen. The paper-based intervention documents were developed as HTML pages, converted to portable document format (PDF), encrypted, and embedded in a Health Level 7 (version 2) file using internally developed software.