Innovation

PHASES leverages digital tools, including Primary Sense, to enable general practice, allied health professionals, and Aboriginal health practitioners to deliver smarter, data-driven cardiovascular care. These technologies streamline care, improve outcomes, and support holistic, preventive interventions.

Key features

  • Provides actionable prompts during consultations to flag cardiovascular risks and gaps in care.
  • Alerts GPs to patients eligible for cardiovascular risk assessments or interventions, including social prescribing.
  • Uses evidence-based algorithms to identify patients at high risk of hospitalisation or cardiovascular events.
  • Categorises patients into risk bands for focused care.
  • Generates reports that highlight population-level trends and at-risk cohorts.
  • Enables practices to prioritise quality improvement initiatives and targeted outreach.
  • Primary Sense works with existing GP software systems, including Best Practice and Medical Director, to ensure seamless implementation.
  • Supports over 80% of Queensland’s general practices, increasing accessibility and impact.
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PHASES strengthens the consumer and primary care partnership as the foundation of a healthier community, improving downstream outcomes across the healthcare system. By enabling preventive, multidisciplinary care, PHASES fosters collaboration among primary care providers to achieve sustainable, patient-centred care delivery.

Key benefits

  • Real-time safety nets: Provides in-consult prompts to support clinical decisions and improve patient care.
  • Proactive follow-up: Generates reports to help GPs identify and engage at-risk patients outside of consultations.

Supports practice nurses, managers and Aboriginal health professionals in delivering coordinated, holistic care for their patient populations.

With improved management of CVD risk within general practice, an increased role for allied health professionals in contributing to preventive strategies and lifestyle  interventions.

Offers powerful analytics and tools for health planning and commissioning strategies tailored to local community needs.

Reduces preventable hospitalisations and supports a more sustainable healthcare system by alleviating pressure on acute care services.

Demonstrates the value of leveraging preventive care, including a stronger role for allied health professionals, to reduce healthcare costs through better management of disease in its early stages. PHASES could influence future changes to Medicare and the MBS, ensuring primary care funding better reflects multidisciplinary approaches.

Funded by the Queensland Health Clinical Research Fellowship, the PHASES Linkage project connects general practice cardiovascular disease (CVD) risk data with hospitalisation and mortality data. This study aims to better understand how CVD risk impacts hospitalisation rates and assess the accuracy of the new CVD risk prediction equation in identifying high-risk individuals within Queensland’s population. 

The project will: 

  • Estimate the number of heart attacks and strokes that could be prevented with improved treatment for high CVD risk. 
  • Identify gaps in CVD prevention to inform future care strategies. 

Running in parallel with the PHASES project, PHASES Linkage highlights the power of data-driven insights to improve cardiovascular outcomes and reduce hospitalisations.