Teamwork: Enhancing the role of non GP staff in Chronic Disease Management in General Practice

Project Coordinator

Jane Taggart

Chief Investigators

Mark Harris

Associate Investigators

Judy Proudfoot, Justin Beilby, Patrick Crookes, Geoffrey Meredith, Deborah Black, Elizabeth Patterson, David Perkins, Gawaine Powell Davies, Matt Hanrahan, Barbara Booth

Other Team Members

Mahnaz Fanaian, Corinne Opt’ Hoog, Pauline Van Dort, Linda Greer, Jocelyn Tan, Anita Schwartz , Bettina Christl, Shane Pascoe, Sunshine Bustamante (adm), Lucio Naccarello (UniMelb)

Rationale

Chronic disease represents a substantial and increasing portion of health care expenditure and workload. Often the care of patients with these conditions does not meet standards set in evidence-based guidelines. Much of the reason for the gap between evidence and practice is the limited organizational capacity of health services to provide the structured and organised care that is required for these conditions.

Aims

The aim of this study is to examine the extent to which quality of care for patients with cardiovascular disease and diabetes can be increased through a structured intervention involving practice managers, receptionists and nurses.

The specific objectives for this project are to:

• Evaluate the impact of a practice-based intervention involving non-GP staff (practice managers, receptionists and nurses) on the quality of care provided to patients with diabetes, ischaemic heart disease and/or hypertension in general practices.
• Describe the roles, responsibilities and activities of non-GP practice staff in practices receiving the intervention compared with those in the control practices
• Investigate what practice factors (practice characteristics, terms of employment and team management practices, practice location and population characteristics, uptake of Commonwealth incentives etc) are associated with greater or lesser involvement of non-GP practice staff in various aspects of chronic disease management.
• Calculate the cost of the intervention, including the cost of practice support and staff training. (A full cost effectiveness analysis will not be undertaken in this study, in order to protect the rigour and feasibility of the study, but will be carried out as a follow-up to this study).

  Design and Method

  
  This project is a cluster randomised controlled trial, with a total of 60 practices in urban and rural NSW and Victoria Divisions of General Practice being randomised to intervention and control. After baseline data collection has been completed, practices will be stratified according to size (solo, 2-4 GPs or 5+ GPs) and randomised to receive the 6-month teamwork intervention immediately, or after 12 months. In the intervention practices, the 6-month practice-based teamwork program will be facilitated by trained facilitators from the research team. The control practices will receive the teamwork program 12 months later, upon completion of the 12-month follow up data collection.

Intervention practices are being assisted to conduct a needs assessment of their practices’ organisational structures and processes to determine whether they are optimally involving their non-GP staff to support diabetes and cardiovascular management. The needs assessment will focus on 11 systems known to be associated with high quality care (see Intervention below).

Data is being collected from the GPs, practice staff and patients at baseline, 6 months and 12 months, in order to measure and compare the systems and processes being utilised in the general practices, the team climate of practices, the quality of care provided, GP and staff job satisfaction, patients’ satisfaction with their practice, patients’ health status plus the cost of the intervention. The data is being collected through interviews with GPs, administration of questionnaires to GPs, practice staff and patients, audit of patients’ medical notes and review of practices’ Medicare data.

Key Publications

Protocol for Teamwork Project: Enhancing the role of non GP Staff in chronic disease management in general practice. CPHCE UNSW 2006

Perkins D, Harris MF, Tan J, Christl B, Taggart J, Fanaian M. Engaging participants in a complex intervention trial in Australian General Practice. BMC Medical Research Methodology. 2008; 8:55.

Taggart J, Schwartz A, Harris MF, Perkins D, Powell Davies G, Proudfoot J, Fanaian M, Crookes P. Facilitating teamwork in general practice: moving from theory to practice. Australian Journal of Primary Health. 2009; 15: 24-28. Click here to view article.

Teamwork Study Presentations for General Practice Training
Introduction and Background to the Study
The Intervention

Other Presentations
Assessing general practices' capacity to participate in research - presented at the GP & PHC Conference 2008
The Teamwork Study and intervention - presented at the CPHCE 2008 Annual Forum.
An intervention to enhance teamwork-peresnted at the implementing teamwork in PHC workshop, 15th April 2009

For presentations on Teamwork Symposium, Vibe Hotel, 7th July 2009, please click here.