Transcript Presentation title here

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
Dr Judy Proudfoot
CIC
Professor Justin Beilby
CID
Professor Patrick Crookes
CIE
E/Prof Geoffrey Meredith
CIF
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
Community
prevalence
General practice
prevalence in 2004/5
GP Interventions per
encounter
Smoking
20% smoke daily
17.2% smoke daily; 4.1%
occas & 27.2% ex-smokers
0.3% smoking cessation
advice
Nutrition
70% low vegetable &
47.5% low fruit
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5.5% nutrition or weight
counselling
Alcohol
10% drink at ‘harmful’
levels
26.2% drink at ‘at risk’ levels
0.4% involve alcohol advice
Physical
Activity
54% insufficiently
active & 15%
sedentary.
65.3% are insufficiently
active
2.1% physical activity
advice
Overweight /
obesity
60% overweight &
20.5% obese
54.7% are overweight or
obese
5.5% nutrition or weight
counselling
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Opportunity and gap in performance
Community
prevalence
Blood Pressure
(in 2000)
Cholesterol
(in 2000)
Both (in 2004/5)
General practice
prevalence
GP Interventions
30% raised blood
pressure.
Estimates vary from 21%
to 30% of people attending
GPs.
30% of those diagnosed
with hypertension were
treated to target.
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.
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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
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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
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GAP in current treatment:
– Not everyone who needs
it is getting
multidisciplinary care.
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Effective teams have:
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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
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Effective teams processes
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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
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Barriers to teamwork
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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
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Facilitators of teamwork
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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
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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
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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.
UNSW Research Centre for Primary Health Care and Equity
More Information
• If you would like more information :
• Email me
– [email protected]
• Visit our website
– http://www.cphce.unsw.edu.au
UNSW Research Centre for Primary Health Care and Equity