Facilitating Multidisciplinary Teamwork in General Practice

1. Facilitating Multidisciplinary Teamwork between General Practice and Allied Health Professionals Dr Bibiana Chan, Team-link Co-ordinator Bettina Christl & Danielle Noorbergen, Data collectors

2. 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

3. 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

4. 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 reports • GPs Feedback • AHPs comments UNSW Research Centre for Primary Health Care & Equity

5. Building effective teams requires Leadership Training Protocol Communication External Linkages Defined roles UNSW Research Centre for Primary Health Care & Equity

6. 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

7. Research Participants RR - Response Rate * Two of the Dieticians were also Ex Physiologist s Average UNSW Research Centre for Primary Health Care & Equity

8. 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 Training UNSW Research Centre for Primary Health Care & Equity

9. Team-link Qual data : Communication New paths Referrals Info from practice Info from AHPs Practices AHPs Why referred? GPs Professional Advice Patients feedback Staff meetings concerns Support Admin stuff & Follow-ups Reports & Visits Prac Nurses & staff 3-way communication via phone between GP, patient and an AHP UNSW Research Centre for Primary Health Care & Equity

10. Team-link Qual data: Partnership GPs Team leaders with decision making POWER GPs acknowledge patient’s control of their own health GPs - delegate jobs PNs - case manager Referrals & Timely reports Patients Patient-centred care provide specialised care & monitor patient progress PNs provide education Patients- Self-manage Prac Nurses and other staff AHPs Follow-ups and other admin stuff Team members provide admin support & clinical care services, Free up GP’s time for patient consultations Team members GPs acknowledge the roles of AHPs; Building up TRUST within the team UNSW Research Centre for Primary Health Care & Equity

11. 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

12. Who holds the POWER? 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).  . GP knows his patients idiosyncrasies and will pick an AH professional  that deals with the individual needs of his patients. (Macathur) 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

13. How to establish PARTNERSHIP? 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).  . GP stated that he is getting feedback from patients saying they are happy with the AHPthey had seen, and this is how he finds out if they have been sent to the right AH person (Macarthur). 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

14. Core concepts of inter-professional collaboration (D’Amour et al 2005) Within the Team-link Intervention Process Power Maintain status quo Interdependency Understand values and roles of Team Members Sharing Need to establish personal relationship and trust UNSW Research Centre for Primary Health Care & Equity

15. GPs’ overall feedback on Team-link Intervention

16. Thank you For more information, contact M.F.Harris@unsw.edu.au or Bibi.chan@unsw.edu.au www.cphce.unsw.edu.au