Multidisciplinary care in general Practice: The Teamwork Study Mark Harris, Centre for Primary Health Care and Equity

Investigators

1.

1.1 Chief Investigators CIA Professor Mark Harris CIB CIC Dr Judy Proudfoot Professor Justin Beilby CID CIE CIF Professor Patrick Crookes E/Prof Geoffrey Meredith A/Professor Deborah Black 1.2 Associate Investigators A/Professor Elizabeth Patterson Dr David Perkins Mr Gawaine Powell Davies Mr Matt Hanrahan Dr Barbara Booth UNSW Research Centre for Primary Health Care and Equity

Room to improve

Smoking Community prevalence

20% smoke daily

General practice prevalence in 2004/5

17.2% smoke daily; 4.1% occas & 27.2% ex-smokers

GP Interventions per encounter

0.3% smoking cessation advice

Nutrition

70% low vegetable & 47.5% low fruit 5.5% nutrition or weight counselling

Alcohol Physical Activity Overweight / obesity

10% drink at ‘harmful’ levels 54% insufficiently active & 15% sedentary.

26.2% drink at ‘at risk’ levels 65.3% are insufficiently active 60% overweight & 20.5% obese 54.7% are overweight or obese 0.4% involve alcohol advice 2.1% physical activity advice 5.5% nutrition or weight counselling UNSW Research Centre for Primary Health Care and Equity

Opportunity and gap in performance

General practice prevalence Blood Pressure (in 2000) Community prevalence

30% raised blood pressure.

GP Interventions

Estimates vary from 21% to 30% of people attending GPs. 30% of those diagnosed with hypertension were treated to target.

Cholesterol (in 2000)

51% have raised cholesterol (46% with raised LDL 11.9% with reduced HDL, and 20.5% with raised triglycerides. 22% of audit population was diagnosed with lipid disorder.

<20% treated to target.

12.7% attending GPs were currently using lipid lowering medications.

Both (in 2004/5)

15.2% have both hypertension and lipid disorder 36.7% had either hypertension and/or lipid disorder. Of those with either HT or lipid disorder, 39.9% took 1 medication and 31.3% took 2 medications. 12.2% were not taking any medication.

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• The need for team care Good evidence that team care: – Improves patient adherence to management – Helps patient to achieve and sustain lifestyle change especially diet, physical activity, and weight control and monitoring of their chronic condition – Helps to save GP time • GAP in current treatment: – Not everyone who needs it is getting multidisciplinary care. UNSW Research Centre for Primary Health Care and Equity

Effective teams have: • • • • • • • • Small, manageable number of members Appropriate mix of skills and expertise Measurable performance goals and specific tasks Clear roles Suitable leadership (person with most expertise) Good communication structures Collective responsibility for achieving goals Adequate resources – financial, training, admin, technical UNSW Research Centre for Primary Health Care and Equity

Effective teams processes

• • • • • • Shared, clear purpose and objectives* Regular communication, problem-solving High level of participation in team Emphasis on quality Support for innovation Clear leadership (incl. lack of conflict about leadership) * Strongest predictor of team effectiveness UNSW Research Centre for Primary Health Care and Equity

Barriers to teamwork • • • • • • • • • • GP attitudes/lack of knowledge of benefits Patient attitudes re: nurse care Lack of knowledge/training of individual staff (eg.PN) Lack of time Volume of paperwork Funding structures (i.e. not enough reimbursement to GP or nurse for nurse tasks) Lack of support systems (IT etc) Small business (need for financial viability) Lack of policies & procedures Lack of structured communication systems UNSW Research Centre for Primary Health Care and Equity

Facilitators of teamwork • • • • • • • • • • • Greater understanding of benefits (patient outcomes) Systemic changes (IT, protocols & processes, communication) Item numbers for CDM (including nurse care) Greater role clarity Clinical benchmarking A designated leader in the practice Different models GP champions & case studies of success Support from Divisions & Colleges Involvement of Divisions with smaller practices (e.g. contract PN) More physical space UNSW Research Centre for Primary Health Care and Equity

Aims NHMRC study

• Evaluate the impact of a practice-based intervention involving non-GP staff (practice managers, receptionists and nurses) • Describe the roles, responsibilities and activities of non-GP practice staff • Investigate what practice factors are associated with greater or lesser involvement of non-GP practice staff • Calculate the cost of the intervention UNSW Research Centre for Primary Health Care and Equity

Intervention

Practice based intervention designed to enhance the role of non-GP staff in chronic disease management. Intervention facilitated by research team. Components – Education session – 3 structured practice visits to support practices to put in place systems to create team care – Resources including directories, referral aids, care plan templates, – Telephone support UNSW Research Centre for Primary Health Care and Equity

3. Evaluation

• Interviews with GPs and GP staff, and other providers before and after the study • Patient information (following patient consent) – Survey at 0 and 12 months including SF12 and PACIC – Data from patient records for the past 2 years (HbA1c; cholesterol – HDL, LDL; blood pressure, body mass index, etc.), as well as any referrals they have received for their condition.

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More Information

• If you would like more information : • Email me – [email protected]

• Visit our website – http://www.cphce.unsw.edu.au

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