Transcript Presentation title here

UNSW research centre for primary health care and equity
An intervention to enhance
teamwork within general practice
Jane Taggart
Investigators
Chief Investigators
CIA
Professor Mark Harris
CIB
Dr Judy Proudfoot
CIC
Professor Justin Beilby
CID
Professor Patrick Crookes
CIE
E/Prof Geoffrey Meredith
CIF
A/Professor Deborah Black
Associate Investigators
A/Professor Elizabeth Patterson
Dr David Perkins
Mr Gawaine Powell Davies
Mr Matt Hanrahan
Dr Barbara Booth
Team: Bettina Christl, Jocelyn Tan, Anita Schwartz, Corinne Opt’ Hoog,
Pauline Van Dort, Linda Greer, Mahnaz Fanaian, Shane Pascoe, Sue
Kirby, Leigh Cantero, Peta Sharrock, Oshana Hermiz
UNSW Research Centre for Primary Health Care & Equity
• Taggart J, Schwartz A, Harris MF, Perkins D, Powell Davies
G, Proudfoot J, Fanaian M, Crookes P. Facilitating
teamwork in general practice: moving from theory to
practice. Australian Journal of Primary Health. 2009; 15:
24-28.
www.publish.csiro.au/journals/py
• Perkins D, Harris MF, Tan J, Christl B, Taggart J, Fanaian
M. Engaging participants in a complex intervention trial in
Australian General Practice. BMC Medical Research
Methodology. 2008; 8:55.
UNSW Research Centre for Primary Health Care & Equity
Aim
To describe:
• The Teamwork Study and intervention
• What helped / limited practices to achieve goals?
• What worked with the facilitation?
UNSW Research Centre for Primary Health Care & Equity
The Teamwork Study
To evaluate the impact of an intervention designed
to enhance the role of non GP staff in chronic
disease management in general practice
The quality of care to patients with diabetes, ischaemic
heart disease/hypertension
Patient satisfaction
Team climate, staff roles, readiness for change and job
satisfaction of staff
Clinical linkages
UNSW Research Centre for Primary Health Care & Equity
Our previous research
Building effective teams requires:
• defined roles and responsibilities
• clear protocols
• effective communication
• leadership
• training
• linkages with other services
Aspect of teamwork most associated
with quality chronic care was
utilising administrative staff in
systems
UNSW Research Centre for Primary Health Care & Equity
11 Systems
1. Structured Appointment System
2. Patient Disease Register
3. Recall & Reminder System
4. Patient Education and Resources
5. Planned Care
6. Practice Based Linkages
7. Roles, Responsibilities & Job Descriptions
8. Communication & Meetings
9. Practice Billing System
10. Record Keeping
11. Quality
UNSW Research Centre for Primary Health Care & Equity
Characteristics of practices
Intervention (n=30)
Control (n=30)
Metro / region
Rural / remote
12
18
19
11
1-3 GPs
 4 GPs
Mean FTE GPs (SD)
12
18
3.07 (1.70)
13
17
3.49 (2.39)
0 PN
1 PN
 2 PNs
Mean FTE PNs (SD)
2
9
19
1.09 (0.77)
3
14
13
1.12 (1.01)
Mean FTE PMs (SD)
0.69 (0.33)
0.92 (0.51)
Mean FTE Admin (SD) 2.55 (1.87)
2.92 (1.96)
Mean FTE Allied
Health (SD)
0.12 (0.38)
0.13 (0.38)
UNSW Research Centre for Primary Health Care & Equity
Structure of intervention
 Education session – 1 to 2 hours
– Background, evidence, clinical guidelines, teamwork and systems
– Practices identify driver / practice lead
 3 practice visits over 3 to 6 months – 1 to 1.5 hours each
– Worked on priority system chosen by practice
– Set goals, tasks and timeframes
– Roles of non-GP staff
 Resources
– Manuals and workbooks for each system
UNSW Research Centre for Primary Health Care & Equity
Priorities chosen (29 practices)
Planned care
23 (80%)
Communications 4 (14%)
and meetings
Roles and
responsibilities
3 (10%)
Patient disease
registers
2 (6%)
Recall and
reminder
systems
1 (3%)
Clinical linkages
1 (3%)
UNSW Research Centre for Primary Health Care & Equity
Observations
What helped practices achieve goals
committed driver
skilled and motivated staff
range of staff involved in intervention meetings
structured practice visits by facilitators
writing goals and timeframes
useful resources
UNSW Research Centre for Primary Health Care & Equity
Observations
What limited practices achieving goals
 no leader or lead person did not have skills to be proactive
 low staff morale
 staff not ready for change
 clinical software limitations or lack of knowledge of clinical
software
 lack of space
 other practice priorities
 not starting on planned care component
UNSW Research Centre for Primary Health Care & Equity
What worked with the facilitation
"it made us sit down
and look at what we do,
what we want to do and
how we go about doing
it”. (GP)
“having the goals and
tasks written with
target dates helped to
set things in motion”.
(PM)
UNSW Research Centre for Primary Health Care & Equity
“liked having someone from
outside the practice
providing advice and
resources and time to discuss
ways to improve the care of
chronic disease patients”.
(PN)
What worked with the facilitation
•
•
•
•
•
•
Practices in control
Range of staff participating in visits
Flexibility – cater for differences
Setting follow-up visit in 4 to 6 weeks time
Facilitators with practice support experience
Walking through resources / tools
UNSW Research Centre for Primary Health Care & Equity
UNSW Research Centre for Primary Health Care & Equity
What practices achieved
 Expanded roles of non-GP staff, electronic templates, diabetes clinic,
group sessions, health assessments
 Written procedures and pathways to combine GPMP, TCA and SIP,
wallet card for patients with appointments, questionnaire to patients for
HMR
 Reviewed roles and responsibilities of PNs, planned and structured
meetings for all staff, Friday Facts
 System to identify diabetes patients at risk, recall for planned care
 Diabetes clinic coordinator position, structured meetings
UNSW Research Centre for Primary Health Care & Equity
A case study
Group practice – regional NSW
5 GPs, 2 PNs, Full Time PM
11 staff attended education session
Visits 1, 2 & 3 with PM and PN
Audit showed
60% were on
GPMPs
Worked on goal: All diabetes patients
onto GPMPs and annual cycle of care
1. Developed a
care pathway and
billing charts for
GPMPs, TCAs
and the Diabetes
SIP
2. Designed
flexible working
model for diabetes
clinic in
consultation with
DGP
3. Took to clinical meeting for input
and commitment
•Whole practice commitment
•Leadership from PM and PN
•All staff informed and involved
UNSW Research Centre for Primary Health Care & Equity
4. Whole practice meeting to plan
implementation in more detail
5. Started with 1 GP, modified and
extended to all GPs
UNSW research centre for primary health care and equity
Thankyou
For more information
[email protected]
or
[email protected]
www.cphce.unsw.edu.au