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
Investigators
Chief Investigators
CIA Professor Mark Harris
CIB Professor Nick Zwar
CIC Professor Patrick Crookes
CID A/Professor David Perkins
CIE A/Professor Judy Proudfoot
CIF A/Professor Gawaine Powell-Davies
Associate Investigators
A/Professor Stephen Lillioja
Dr Jeff Flack
Mrs Elizabeth Harris
Dr Teressa Anderson
Dr Andrew Boyden
Dr 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
QUAL 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)
UNSW Research Centre for Primary Health Care & Equity
Facilitator’s Practicevisit reports
GPs Feedback
AHPs comments
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 Participants
Division
GP
Central
SE Sydney SW Sydney
Macarthur
Total
13
5
6
10
34
1
0
1
7
9
10
7
9
8
34
Practice Manager
5
1
1
3
10
Diabetes Educator
2
1
3 (8%)
Dietician
2
3
1
4*
10 (26%)
Ex Physiologist
2
1
0
2
5 (13%)
1
1(3%)
2
4 (10%)
1
6
13 (33%)
1
3
4 (10%)
1
1 (3%)
18 (RR 30%)
39/41*
Nurse
Receptionist
Incontinence Nurse
Physiotherapist
Podiatrist
2
2
4
Psychologist
Occupation Rx
AHPs Sub-total
8 (RR 31%)
10(RR 40%)
3 (RR 23%)
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
GPs,
Practice Nurses,
Non-Clinical staff
Support and
Training
Practices
UNSW Research Centre for Primary Health Care & Equity
AHPs
In-house AHPs ,
AHPs based at DGPs,
private practices and
public services
Team-link Qual data : Communication
New paths
Referrals
Info from practice
Info from AHPs
Practices
GPs
Reports &
Visits
Patients
Prac Nurses
& staff
3-way communication
via phone between
GP, patient and an
AHP
UNSW Research Centre for Primary Health Care & Equity
AHPs
Team-link Qual data:
Partnership
GPs
Team leaders
with decision making
POWER
GPs acknowledge
patient’s control of
their own health
Patients
Patientcentred
care
Prac Nurses
and other staff
Follow-ups and other admin stuff
Team members
Team members
provide admin support &
clinical care services,
Free up GP’s time for
patient consultations
GPs acknowledge the
roles of AHPs;
Building up TRUST
within the team
UNSW Research Centre for Primary Health Care & Equity
AHPs
Where does TRUST (sharing) start?
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)
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).
UNSW Research Centre for Primary Health Care & Equity
Who holds the POWER?
GP knows his patients idiosyncrasies
and will pick an AH professional that
deals with the individual needs of his
patients.
(Macathur)
Developing educational
strategies for patients in selfmanagement. 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).
UNSW Research Centre for Primary Health Care & Equity
How to establish PARTNERSHIP?
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).
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).
UNSW Research Centre for Primary Health Care & Equity
Core concepts of inter-professional collaboration
(D’Amour et al 2005) Within
the Team-link Intervention Process
Power
Maintain status quo
Sharing
Interdependency
Need to establish personal
relationship and trust
Understand values and
roles of Team Members
UNSW Research Centre for Primary Health Care & Equity
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 you
For more information, contact
[email protected]
or
[email protected]
www.cphce.unsw.edu.au