UNSW research centre for primary health care and equity

TEAMWORK RESEARCH STUDYEnhancing The Role Of Non-GP Staff In Chronic Disease Management In General PracticeJane Taggart

Delivery System Design

UNSW Research Centre for Primary Health Care & Equity

Investigators

Chief InvestigatorsCIA Professor Mark HarrisCIB Dr Judy ProudfootCIC Professor Justin BeilbyCID Professor Patrick CrookesCIE E/Prof Geoffrey MeredithCIF A/Professor Deborah Black

Associate InvestigatorsA/Professor Elizabeth PattersonDr David PerkinsMr Gawaine Powell DaviesMr Matt HanrahanDr 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 satisfactionTeam 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

Location NSW: 44

ACT: 1

Victoria: 15

RRMA Metro: 32

Rural: 26

Remote: 2

Withdrawn 3

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 System2. Patient Disease Register3. Recall & Reminder System4. Patient Education and Resources5. Planned Care6. Practice Based Linkages7. Roles, Responsibilities & Job Descriptions8. Communication & Meetings9. Practice Billing System10. Record Keeping11. 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 practicesRRMA 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 and equity

Thankyou

J.Taggart@unsw.edu.au

(02)9385 8396www.cphce.unsw.edu.au