UNSW research centre for primary health care and

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 q The quality of care to patients with diabetes, ischaemic heart disease/hypertension (Clinical audits, SF 12, Clinical Care Interviews, Practice Profile Interviews) q Patient satisfaction (PACIC) q Measures of Multidisciplinary Linkages (Mo. ML_GP, Mo. ML_RS) UNSW Research Centre for Primary Health Care & Equity q. Facilitator’s Practicevisit reports q. GPs Feedback q. AHPs comments

Building effective teams requires Lead ershi p Prot Traini ocol ng Communica tion External Linkages UNSW Research Centre for Primary Health Care & Equity Defin ed ro les

Structure of intervention q 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 Central GP 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 feedb a ck 3 -way communication via phone between GP, patient and an AHP UNSW Research Centre for Primary Health Care & Equity AHPs s llo ort Prac Nurses & staff nal ssio e Prof vice Ad Supp gs tin ee fm af St Reports & Visits Patients concerns GPs Why re ferred? i dm A ff stu n o &F up w-

with decision making POWER ls GPs acknowledge patient’s control of their own health ra er & pr o m vid on e ito sp r p ec at iali ie se nt d pr ca og re re & ss y el Patients m Ti Follow-ups and other admin stuff 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 ts Patientcentred care or na p re ge n GPs ef Prac Nurses and other staff Team leaders R G PN Ps s -d PN - c el Pa s p as eg tie ro e at nt vid m e s- e an jo Se ed ag bs lf- uc er m at a io Team-link Qual data: Partnership 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? 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 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). UNSW Research Centre for Primary Health Care & Equity

How to establish PARTNERSHIP? 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 Need to establish personal relationship and trust UNSW Research Centre for Primary Health Care & Equity Interdependency Understand values and roles of Team Members

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 Mac basis. This makes it interesting for both the patient and the GP. … there has not been enough passage of time to come to a conclusion as to whethere 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 M. F. Harris@unsw. edu. au or Bibi. chan@unsw. edu. au www. cphce. unsw. edu. au