UNSW research centre for primary health care and equity

Facilitating Multidisciplinary Teamwork between General Practice and Allied Health Professionals

Dr Bibiana Chan, Team-link Co-ordinator Bettina Christl & Danielle Noorbergen, Data collectors

UNSW Research Centre for Primary Health Care & Equity

InvestigatorsChief Investigators

CIA Professor Mark HarrisCIB Professor Nick ZwarCIC Professor Patrick CrookesCID A/Professor David PerkinsCIE A/Professor Judy ProudfootCIF A/Professor Gawaine Powell-Davies

Associate InvestigatorsA/Professor Stephen LilliojaDr Jeff FlackMrs Elizabeth HarrisDr Teressa AndersonDr Andrew BoydenDr Upali Jayasinghe

UNSW Research Centre for Primary Health Care & Equity

Aims

The specific objectives of the study are:

• To design a practice-based intervention to improve multidisciplinary teamwork within general practices and between practices and other services ( by allied health professionals)

• To evaluate the impact of this intervention on the quality of care for patients with diabetes, ischaemic heart disease and hypertension

UNSW Research Centre for Primary Health Care & Equity

The Team-link Study

To evaluate the outcomes of multidisciplinary care in General Practice in chronic disease management

QUAN Data

The quality of care to patients with diabetes, ischaemic heart disease/hypertension (Clinical audits, SF12, Clinical Care Interviews, Practice Profile Interviews)

Patient satisfaction (PACIC) Measures of Multidisciplinary

Linkages (MoML_GP, MoML_RS)

QUAL Data Facilitator’s Practice-

visit reportsGPs FeedbackAHPs comments

UNSW Research Centre for Primary Health Care & Equity

Defined roles

Protocol

External Linkages

Training

Leadership

Communication

Building effective teams requires

UNSW Research Centre for Primary Health Care & Equity

Structure of intervention Education session for GPs and referral services (2 hrs)

– Focus on roles and responsibilities, effective teamwork, and communication

– element of shared learning - allow for building personal links e.g. Case Conferences involving GPs, AHPs and patients

• 3 Structured practice visits over 6 months (1 - 1.5 hr each)

– Conducting needs analysis, – helping practices formulate PDSA cycles– linkages with AHPs (visits by AHPs, small group learning

sessions at DGPs, referrals and electronic record download)

• Ongoing support– IT Support, troubleshooting & guidance – Provide info on evidence based care of diabetes, CVD,

and hypertension.

UNSW Research Centre for Primary Health Care & Equity

Research ParticipantsDivision Central SE Sydney SW Sydney Macarthur Total

GP 13 5 6 10 34

Nurse 1 0 1 7 9

Receptionist 10 7 9 8 34

Practice Manager 5 1 1 3 10Diabetes Educator 2 1 3 (8%)

Dietician 2 3 1 4* 10 (26%)

Ex Physiologist 2 1 0 2 5 (13%)

Incontinence Nurse 1 1(3%)

Physiotherapist 2 2 4 (10%)

Podiatrist 2 4 1 6 13 (33%)

Psychologist 1 3 4 (10%)

Occupation Rx 1 1 (3%)

AHPs Sub-total 8 (RR 31%) 10(RR 40%) 3 (RR 23%) 18 (RR 30%) 39/41*RR = 31%

RR - Response Rate * Two of the Dieticians were also Ex Physiologist s Average

UNSW Research Centre for Primary Health Care & Equity

QUAL Data: Organisational Collaboration

Local DGPs

Board Members, Program managers,

project officers, IT officers

AHPs

In-house AHPs , AHPs based at DGPs,

private practices and

public services

Practices

GPs, Practice Nurses, Non-Clinical staff

Support and T

raining

UNSW Research Centre for Primary Health Care & Equity

GPs AHPs

Prac Nurses& staff

Patients

Why referred?

Practices

Referrals

Reports & Visits

feedback

Supportco

ncer

ns

Staff meetings

Professional

Advice

Admin stuff & Follow-ups

New paths

Team-link Qual data : Communication

Info from practice

Info from AHPs

3-way communication via phone between GP, patient and an

AHP

GPsTeam-link Qual data: Partnership

UNSW Research Centre for Primary Health Care & Equity

AHPsPrac Nurses

and other staff

GPs - d

eleg

ate

jobs

PNs - c

ase

man

ager

Follow-ups and other admin stuff

Team leaders with decision making

POWER

Team members GPs acknowledge the

roles of AHPs; Building up TRUST

within the team

Patients

PNs pr

ovid

e ed

ucat

ion

Patie

nts-

Sel

f-man

age

GPs acknowledge patient’s control of their own health

Team members provide admin support &

clinical care services, Free up GP’s time for patient consultations

provide specialised care &

monitor patient progress

Patient-centred

care

Referrals & Timely reports

UNSW Research Centre for Primary Health Care & Equity

Most benefit was opportunity to interact with AHPs and

find out what they need from us and what they can do for

us and our patients to improve patient health.

(Small Group Learning Central)

The more contact with the referring Dr the more they (GPs) realise that AHPs play an integral role in the management of their patients in a positive way. The professional relationship takes time to build up, usually relies on the GPs to initiate the process. (AHP Survey). 

At the beginning GP did not entirely trust allied health professionals

(dieticians) to treat the patient as he wanted them treated, so he was doing all the work himself. Now he is using Division’s dieticians and can see the

value of their participation.   (Macathur)

Where does TRUSTTRUST (sharing) start?

UNSW Research Centre for Primary Health Care & Equity

Developing educational strategies for patients in self- management. GP is keen in

supplying education on lifestyle changes for his

patients  in relation to their chronic conditions (SW Syd).

 .

I think it is more important to have a relationship with the doctor than the practice nurse as it is the Dr who has the decision making power regarding treatment

(AHP Survey).  

GP knows his patients idiosyncrasies and will pick an AH professional  that deals with the individual needs of his patients.

(Macathur)

Who holds the POWERPOWER?

UNSW Research Centre for Primary Health Care & Equity

GP suggested regular internal group meetings in the future will be helpful for them to

strengthen the exchange of ideas within the internal

team (SW Syd).  .

The management of chronic disease depends on the patient moving in and out of the various

layers of the health system easily (AHP Survey). 

GP stated that he is getting feedback from patients saying they are happy with the AHP they had seen, and this is how he finds out if they have been sent to the right AH

person (Macarthur).

How to establish PARTNERSHIPPARTNERSHIP?

UNSW Research Centre for Primary Health Care & Equity

Power Maintain status quo

SharingNeed to establish personal

relationship and trust

InterdependencyUnderstand values and roles of Team Members

Core concepts of inter-professional collaboration (D’Amour et al 2005) Within the Team-link Intervention Process

GPs’ overall feedback on Team-link Intervention… prior to the study, communication within the practice was disjointed and now he is happy to delegate to others which reduces his workload. Mac

PN stated that the structure had made it easier to work with the patients. The patients are encouraged by the interest taken in their care, which makes the patient more compliant.

Mac

Overall there is better understanding than a year ago. The study has highlighted the importance of better communication and understanding of each others roles.

Mac

To give the patient a role to play e.g. to measure their waist circumference on a regular basis. This makes it interesting for both the patient and the GP. …

Mac

there has not been enough passage of time to come to a conclusion as to whether there is better communications with AHPs at this time.

Mac

Dr said, “I have a low opinion of 'teamwork' .” SES

UNSW research centre for primary health care and equity

Thank youFor more information, contact

M.F.Harris@unsw.edu.au

or

Bibi.chan@unsw.edu.au

www.cphce.unsw.edu.au