1
|
Taylor R, Acharya S, Parsons M, Ranasinghe U, Fleming K, Harris ML, Kuzulugil D, Byles J, Philcox A, Tavener M, Attia J, Kuehn J, Hure A. Australian general practitioners' perspectives on integrating specialist diabetes care with primary care: qualitative study. BMC Health Serv Res 2023; 23:1264. [PMID: 37974197 PMCID: PMC10652609 DOI: 10.1186/s12913-023-10131-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Improving the coordination and integration of health services is recognised nationally and internationally as a key strategy for improving the quality of diabetes care. The Australian Diabetes Alliance Program (DAP) is an integrated care model implemented in the Hunter New England Local Health District (HNELHD), New South Wales (NSW), in which endocrinologists and diabetes educators collaborate with primary care teams via case-conferencing, practice performance review, and education sessions. The objective of this study was to report on general practitioners' (GPs) perspectives on DAP and whether the program impacts on their skills, knowledge, and approach in delivering care to adult patients with type 2 diabetes. METHODS Four primary care practices with high rates of monitoring haemoglobin A1c (HbA1c) levels (> 90% of patients annually) and five practices with low rates of monitoring HbA1c levels (< 80% of patients annually) from HNELHD, NSW provided the sampling frame. A total of nine GPs were interviewed. The transcripts from the interviews were reviewed and analysed to identify emergent patterns and themes. RESULTS Overall, GPs were supportive of DAP. They considered that DAP resulted in significant changes in their knowledge, skills, and approach and improved the quality of diabetes care. Taking a more holistic approach to care, including assessing patients with diabetes for co-morbidities and risk factors that may impact on their future health was also noted. DAP was noted to increase the confidence levels of GPs, which enabled active involvement in the provision of diabetes care rather than referring patients for tertiary specialist care. However, some indicated the program could be time consuming and greater flexibility was needed. CONCLUSIONS GPs reported DAP to benefit their knowledge, skills and approach for managing diabetes. Future research will need to investigate how to improve the intensity and flexibility of the program based on the workload of GPs to ensure long-term acceptability of the program.
Collapse
Affiliation(s)
- Rachael Taylor
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| | - Shamasunder Acharya
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia.
| | - Martha Parsons
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Ushank Ranasinghe
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Kerry Fleming
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Melissa L Harris
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| | - Deniz Kuzulugil
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Julie Byles
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| | - Annalise Philcox
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Meredith Tavener
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| | - Johanna Kuehn
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Alexis Hure
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| |
Collapse
|
2
|
Blackberry ID, Furler JS, Young D, Best JD. What does it cost to establish a practice‐nurses‐led clinical trial in general practice? Med J Aust 2009; 191:492-5. [DOI: 10.5694/j.1326-5377.2009.tb02911.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 07/14/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Irene D Blackberry
- Department of General Practice, University of Melbourne, Melbourne, VIC
- NHMRC Centre for Clinical Research Excellence in Clinical Science in Diabetes, Melbourne, VIC
| | - John S Furler
- Department of General Practice, University of Melbourne, Melbourne, VIC
- NHMRC Centre for Clinical Research Excellence in Clinical Science in Diabetes, Melbourne, VIC
| | - Doris Young
- Department of General Practice, University of Melbourne, Melbourne, VIC
- NHMRC Centre for Clinical Research Excellence in Clinical Science in Diabetes, Melbourne, VIC
| | - James D Best
- NHMRC Centre for Clinical Research Excellence in Clinical Science in Diabetes, Melbourne, VIC
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC
| |
Collapse
|