1. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros The impact of new health professionals on patients’ satisfaction and health outcomes: evidence from the MUNROS European Project M. Ruggeri*, S. Coretti*, E. Di Brino*, Moramarco* *Università Cattolica del Sacro Cuore, School of Economics.

2. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros The Munros Project: Background and objectives European countries are reforming their health systems to improve health care delivery. One of the ways they are doing this is by changing skill mix within teams delivering health services: extending the roles of existing health professions and introducing new ones. Munros project will undertake a systematic evaluation of the impact of these ‘new professional roles’ on practice, outcomes and costs in a range of different health care settings within European Union and Associate Countries. It will detail the nature, scope and contribution of the new professional roles, evaluate their impact on clinical practice and outcomes, and identify their scope to improve the integration of care. It will conduct economic evaluation to identify the cost effectiveness of the new professional roles, identify optimal models for delivery of health care and the consequences of these for management of human resources and workforce planning. Partners: University of Aberdeen, Technische Universitat Berlin, Erasmus University Rotterdam, Universita Cattolica Del Sacro Cuore, Uniwersytet Warszawski, Univerzita Karlova V Praze, Economic Policy Research Foundation of Turkey, Uni Research Norway, University of Manchester.

3. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros WP6 specific objectives The aim of this study is to investigate to which extent the changes occurred in the workforce composition in recent years affect patients’ satisfaction and health outcomes, within clinical pathways for the management of three conditions, namely heart disease, diabetes and breast cancer.

4. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Methods 1/2 A structured is being administered to patients suffering from: – Coronary Heart Disease – Type2 diabetes – Breast cancer Patients are being recruited in both primary and secondary care settings. More in detail, 12 hospital along with their respective primary care centers will be selected in each country, six employing new professional (case group) and six employing only traditional roles (control Group). Approximately 30 patients for each center recruited will be enrolled.

5. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Methods 2/2 The questionnaire for patients’ data collection is made up of five sections investigating: 1. the patient’s health state; 2.the care she received for her condition; 3.her experience of care received; 4.her use of healthcare services; 5.some general questions. Aggregate data is being be analyzed through descriptive statistics. Here we present preliminary findings from Scotland focusing on patient’s experience of care and satisfaction.

6. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Results for CHD Data refer to 39 patients 66% male; age 61 years (28-88) 2 post acute event, 10 in rehab and 25 in long term follow up Most 30/39 are being regularly monitored Most see a regular GP Average visit lasts 14.47 mins (5-30) WTP for an ideal visit £110

7. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros

8. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Patients’ perception of organization of care Patients feel that GP is the main responsible for care they receive, even though many professionals intervene in the pathway.

9. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Patients’ degree of satisfaction Despite patients are rarely actively involved in the choice of ther treatment (they are closely monitored for side effects, though), they report high degree of satisfaction for all the aspects of care ranging from waiting time to information provided. Only few patients exhibit a low level of satisfaction with respect to continuity of care and duration and frequency of visit.

10. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Demography T2D Data refer to 12 patients. 92% male; age 57 years (47-79) Only one is at the early stage of treatment Most 10/12 are being regularly monitored Most see a regular GP Average visit lasts 27.5 mins (15-60) WTP for an ideal visit £19

11. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Care received for T2D

12. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Patients’ perception of organization of care Similar trend as CHD: single doctor with overall responsibility of care, but at the same time well coordinated group of professionals.

13. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Patients’ degree of satisfaction

14. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Demography BC Data refer to 34 patients Age 61 years (36-87) All the respondents are currently receiving ongoing treatment Most 30/39 are being regularly monitored Average visit lasts 16.25 mins (10-35) WTP for an ideal visit £73

15. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Care received for BC

16. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Patients’ perception of organization of care Similar trend as CHD and T2D: single doctor with overall responsibility of care, but at the same time well coordinated group of professionals.

17. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Low involvement in care? About half say they never or rarely: Contribute to treatment plans (8/34); or given choices (9/34) Are asked about problems (1/34); or are asked about goals (10/34) Are asked about lifestyle (7/34) Low involvement but more than in the other two pathways. This maybe justified by the greater burden of the condition Patient’s experience of care

18. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Patients’ degree of satisfaction Most of patients state to be satisfied of care received.

19. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Discussion Most of the patient received education and information to manage their condition. At this stage the main role players were GPs and specialized nurses. It is worth to point out that these professional roles were mentioned with the same frequency as those providing advice on medicines, except for diabetes pathway. Nineteen out of 23 patients received monitoring for HD, which was most often provided by GPs. From the analysis of patients’ experience of care we found that the patients are scarcely involved in the choice of treatments, but are provided with information and other tools, such as written plan of care, to be empowered in the management of their condition. Apparently, patients did not observe any kind of task substitution within their pathway but they most often state that care is provided by a range of professionals, well organized and coordinated by a single doctor (the GP). Respondents expresses a high degree of satisfaction on all the aspects of care. Next steps: 1.extend the analysis to data from other countries 2.test some hypotheses on the association between organization of care and patients’ satisfaction.