TEAMWORK RESEARCH STUDY Enhancing The Role Of Non-GP Staff In Chronic Disease Management In General Practice

1. TEAMWORK RESEARCH STUDYEnhancing The Role Of Non-GP Staff In Chronic Disease Management In General Practice Jane Taggart Delivery System Design

2. UNSW Research Centre for Primary Health Care & Equity Investigators 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/Professor Deborah Black Associate Investigators A/Professor Elizabeth Patterson Dr David Perkins Mr Gawaine Powell Davies Mr Matt Hanrahan Dr Barbara Booth

3. UNSW Research Centre for Primary Health Care & Equity Rationale Gap in current treatment General practice needs to be well organised to provide effective chronic care (implement elements of the Chronic Care Model) Practice Capacity Study finding: Involving non GP staff in care most strongly associated with evidence-based chronic 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

4. UNSW Research Centre for Primary Health Care & Equity Aim To evaluate the impact of an intervention designed to enhance the role of non GP staff in chronic disease management in general practice The quality of care to patients with diabetes, ischaemic heart disease/hypertension Patient satisfaction Team climate and job satisfaction of staff Compare and describe the roles, responsibilities and activities of non-GP practice staff Our previous research found that building effective teams requires defined roles and responsibilities, having clear protocols, effective communication, leadership, training and linkages with other services. Compare and describe the roles, responsibilities and activities of non-GP practice staff Our previous research found that building effective teams requires defined roles and responsibilities, having clear protocols, effective communication, leadership, training and linkages with other services.

5. UNSW Research Centre for Primary Health Care & Equity Participating practices 60 practices: Baseline and 12 months data collection Randomised into intervention and control groups Control receive delayed intervention

6. UNSW Research Centre for Primary Health Care & Equity Structure of intervention An education session 1-2 hours Ideally PM, PN, principal GP Identify “driver” 3 practice visits over 6 months 1-2 hours each Ideally “driver”, PM, PN, other admin. staff Resources Manual, workbook, CD

7. UNSW Research Centre for Primary Health Care & Equity 11 Systems 1. Structured Appointment System 2. Patient Disease Register 3. Recall & Reminder System 4. Patient Education and Resources 5. Planned Care 6. Practice Based Linkages 7. Roles, Responsibilities & Job Descriptions 8. Communication & Meetings 9. Practice Billing System 10. Record Keeping 11. Quality 80% chose planned care Roles and responsibilities Communication and meetings80% chose planned care Roles and responsibilities Communication and meetings

8. UNSW Research Centre for Primary Health Care & Equity Focused on: Quality care = systems + teamwork Setting goals Task allocation Communication Training needs Review date Written procedures

9. UNSW Research Centre for Primary Health Care & Equity Characteristics of 29 intervention practices 5 had 2000 patients, 2 over 30,0005 had 2000 patients, 2 over 30,000

10. UNSW Research Centre for Primary Health Care & Equity What some practices achieved Expanded roles of non-GP staff, electronic templates, diabetes clinic, group sessions, health assessments Written procedures and pathways to combine GPMP, TCA and SIP, wallet card for patients with appointments, questionnaire to patients for HMR Reviewed roles and responsibilities of PNs, planned and structured meetings for all staff, Friday Facts System to identify diabetes patients at risk, recall for planned care Diabetes clinic coordinator position, structured meetings 3 new manager positions Electronic templates diabetes, IHD, 453 new manager positions Electronic templates diabetes, IHD, 45

11. UNSW Research Centre for Primary Health Care & Equity Observations Facilitators to achieve goals committed driver skilled and motivated staff range of staff involved in intervention meetings structured practice visits by facilitators written goals and timeframes useful resources DRIVER: Most often it was a GP or both a GP and practice manager driving the change. INVOLVED: moved forward quickly as they were able to plan, assign tasks and set timeframes during the meetings DRIVER: Most often it was a GP or both a GP and practice manager driving the change. INVOLVED: moved forward quickly as they were able to plan, assign tasks and set timeframes during the meetings

12. UNSW Research Centre for Primary Health Care & Equity Observations Barriers no leader or lead person did not have skills to be proactive low staff morale staff not ready for change clinical software limitations or lack of knowledge of clinical software lack of space other practice priorities not starting on planned care component

13. UNSW Research Centre for Primary Health Care & Equity Some quotes from practices PM: “having the goals and tasks written with target dates helped to set things in motion.” PN "having a set time arranged with the facilitator meant having time to discuss and consider ideas to take back to the GPs and other staff. If this time was not set then we may not have allocated the time ourselves - there are always other things that get in the way!” PM: “opening up communication in the practice has improved teamwork and has given staff more pride in dealing with patients.”

14. Thankyou J.Taggart@unsw.edu.au (02)9385 8396 www.cphce.unsw.edu.au