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UNSW research centre for primary health care and equity
TEAMWORK RESEARCH STUDY
Enhancing The Role Of Non-GP Staff In Chronic
Disease Management In General Practice
Jane Taggart
Delivery System Design
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
UNSW Research Centre for Primary Health Care & Equity
Rationale
• Gap in current treatment
• General practice needs to be well organised to provide
effective chronic care (implement elements of the Chronic
Care Model)
• Practice Capacity Study finding: Involving non GP staff in
care most strongly associated with evidence-based chronic
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
UNSW Research Centre for Primary Health Care & Equity
Aim
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 and job satisfaction of staff
UNSW Research Centre for Primary Health Care & Equity
Participating practices
 60 practices:
Location
NSW: 44
ACT: 1
Victoria: 15
RRMA
Metro: 32
Rural: 26
Remote: 2
Withdrawn
3
 Baseline and 12 months data collection
 Randomised into intervention and control groups
Control receive delayed intervention
UNSW Research Centre for Primary Health Care & Equity
Structure of intervention
 An education session
– 1-2 hours
– Ideally PM, PN, principal GP
– Identify “driver”
 3 practice visits over 6 months
– 1-2 hours each
– Ideally “driver”, PM, PN, other admin. staff
 Resources
– Manual, workbook, CD
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
Focused on:
 Quality care = systems + teamwork
 Setting goals
 Task allocation
 Communication
 Training needs
 Review date
 Written procedures
UNSW Research Centre for Primary Health Care & Equity
Characteristics of 29 intervention
practices
RRMA
Metropolitan: 10 (38%)
Rural: 18 (62%)
No. GPs
1 GP: 4 practices(14%)
2 to 3 GPs: 7 practices (25%)
4+GPs: 17 practices (61%)
At least 1 practice nurse
28 (96%)
Patient population
Range 2,000 to over 30,000
% Patients low income disadvantaged
5 practices: 70% or more
17 practices: 40% or less
Registered for Chronic Disease Initiatives
17 (59%)
Disease specific registers
19 (65%)
Get support from their Division
26 (90%)
UNSW Research Centre for Primary Health Care & Equity
What some 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
Observations
Facilitators to achieve goals
 committed driver
 skilled and motivated staff
 range of staff involved in intervention meetings
 structured practice visits by facilitators
 written goals and timeframes
 useful resources
UNSW Research Centre for Primary Health Care & Equity
Observations
Barriers
 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
Some quotes from practices
• PM: “having the goals and tasks written with target dates
helped to set things in motion.”
• PN "having a set time arranged with the facilitator meant
having time to discuss and consider ideas to take back to
the GPs and other staff. If this time was not set then we
may not have allocated the time ourselves - there are
always other things that get in the way!”
• PM: “opening up communication in the practice has
improved teamwork and has given staff more pride in
dealing with patients.”
UNSW Research Centre for Primary Health Care & Equity
UNSW research centre for primary health care and equity
Thankyou
[email protected]
(02)9385 8396
www.cphce.unsw.edu.au