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

UNSW Research Centre for Primary Health Care & Equity Investigators Chief Investigators CIAProfessor Mark Harris CIBDr Judy Proudfoot CICProfessor Justin Beilby CIDProfessor Patrick Crookes CIEE/Prof Geoffrey Meredith CIFA/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:  Baseline and 12 months data collection  Randomised into intervention and control groups Control receive delayed intervention LocationNSW: 44 ACT: 1 Victoria: 15 RRMAMetro: 32 Rural: 26 Remote: 2 Withdrawn3

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 RRMAMetropolitan: 10 (38%) Rural: 18 (62%) No. GPs1 GP: 4 practices(14%) 2 to 3 GPs: 7 practices (25%) 4+GPs: 17 practices (61%) At least 1 practice nurse28 (96%) Patient populationRange 2,000 to over 30,000 % Patients low income disadvantaged5 practices: 70% or more 17 practices: 40% or less Registered for Chronic Disease Initiatives17 (59%) Disease specific registers19 (65%) Get support from their Division26 (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.”

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