multidisciplinary care in general practice: the teamwork study mark harris, centre for primary...

Multidisciplinary care in general Practice: The Teamwork Study

Mark Harris,

Centre for Primary Health Care and Equity

UNSW Research Centre for Primary Health Care and Equity

Investigators

1. 1.1 Chief InvestigatorsCIA Professor Mark HarrisCIB Dr Judy ProudfootCIC Professor Justin BeilbyCID Professor Patrick CrookesCIE E/Prof Geoffrey MeredithCIF A/Professor Deborah Black

1.2 Associate InvestigatorsA/Professor Elizabeth PattersonDr David PerkinsMr Gawaine Powell DaviesMr Matt HanrahanDr Barbara Booth


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

- 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


Opportunity and gap in performance

Community prevalence

General practice prevalence

GP Interventions

Blood Pressure (in

2000)

30% raised blood pressure.

Estimates vary from 21% to 30% of people attending GPs.

30% of those diagnosed with hypertension were treated to target.

Cholesterol(in 2000)

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.

Both (in 2004/5)

- 15.2% have both hypertension and lipid disorder36.7% 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.


The need for team 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

• GAP in current treatment:– Not everyone who needs it

is getting multidisciplinary care.

General practitioners claims for health assessments, GP management plan, team care arrangements, case conferences from J uly 2005 to October 2006

0

200

400

600

800

1000

1200

1400

J ul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 J an-06 Feb-06 Mar-06 Apr-06 May-06 J un-06 J ul-06 Aug-06 Sep-06 Oct-06

Month-Yr

Health Assessments/100,000 GP Attendances GP Management Plan/100,000 GP Attendances

Team Care Arrangement/100,000 GP Attendances Case Conference/100,000 GP Attendances


Effective teams have:

• 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


Effective teams processes

• 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


Barriers to teamwork

• 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


Facilitators of teamwork

• 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


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


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


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.


More Information

• If you would like more information :

• Email me– [email protected]

• Visit our website– http://www.cphce.unsw.edu.au

mailto:[email protected]

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