Multidisciplinary care in general Practice: The Teamwork Study

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Multidisciplinary care in general Practice The
Teamwork Study

• Mark Harris,
• Centre for Primary Health Care and Equity

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Investigators

• 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/Pro
  fessor Deborah Black1.2 Associate
  Investigators A/Professor Elizabeth
  Patterson Dr David Perkins Mr Gawaine Powell
  Davies Mr Matt Hanrahan Dr Barbara Booth

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Room to improve
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Opportunity and gap in performance
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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.

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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

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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

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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

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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

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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

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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.

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More Information

• If you would like more information
• Email me
• M.f.harris_at_unsw.edu.au
• Visit our website
• http//www.cphce.unsw.edu.au