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Urquhart R, Kendell C, Pfaff K, Stajduhar K, Patrick L, Dujela C, Scruton S, Fauteux F, Warner G. How do navigation programs address the needs of those living in the community with advanced, life-limiting Illness? A realist evaluation of programs in Canada. BMC Palliat Care 2023; 22:179. [PMID: 37964238 PMCID: PMC10647106 DOI: 10.1186/s12904-023-01304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND We sought to identify innovative navigation programs across Canadian jurisdictions that target their services to individuals affected by life-limiting illness and their families, and articulate the principal components of these programs that enable them to address the needs of their clients who are living in the community. METHODS This realist evaluation used a two-phased approach. First, we conducted a horizon scan of innovative community-based navigation programs across Canadian jurisdictions to identify innovative community-based navigation programs that aim to address the needs of community-dwelling individuals affected by life-limiting illness. Second, we conducted semi-structured interviews with key informants from each of the selected programs. Informants included individuals responsible for managing and delivering the program and decision-makers with responsibility and/or oversight of the program. Analyses proceeded in an iterative manner, consistent with realist evaluation methods. This included iteratively developing and refining Context-Mechanism-Outcome (CMO) configurations, and developing the final program theory. RESULTS Twenty-seven navigation programs were identified from the horizon scan. Using specific eligibility criteria, 11 programs were selected for subsequent interviews and in-depth examination. Twenty-three participants were interviewed from these programs, which operated in five Canadian provinces. The programs represented a mixture of community (non-profit or volunteer), research-initiated, and health system programs. The final program theory was articulated as: navigation programs can improve client outcomes if they have supported and empowered staff who have the time and flexibility to personalize care to the needs of their clients. CONCLUSIONS The findings highlight key principles (contexts and mechanisms) that enable navigation programs to develop client relationships, personalize care to client needs, and improve client outcomes. These principles include staff (or volunteer) knowledge and experience to coordinate health and social services, having a point of contact after hours, and providing staff (and volunteers) time and flexibility to develop relationships and respond to individualized client needs. These findings may be used by healthcare organizations - outside of navigation programs - to work towards more person-centred care.
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Affiliation(s)
- Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Room 413, Halifax, NS, Canada.
| | - Cynthia Kendell
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kathryn Pfaff
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Linda Patrick
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Carren Dujela
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Sarah Scruton
- Department of Community Health and Epidemiology, Dalhousie University, Room 413, Halifax, NS, Canada
| | - Faith Fauteux
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
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Oliver S, Douglas J, Winkler D, Pearce C, Minter E, Jarman HK, Topping M. The healthcare needs and general practice utilization of people with acquired neurological disability and complex needs: A scoping review. Health Expect 2022; 25:2726-2745. [PMID: 36322481 PMCID: PMC9700155 DOI: 10.1111/hex.13640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/13/2022] [Accepted: 10/16/2022] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND For people with acquired neurological disabilities and complex needs, general practitioners (GPs) play an important role in health management and early intervention for the prevention of comorbidities and health complications. People with disability are a vulnerable group who need and have the right to, quality general practice services. It is therefore important to understand the health needs and service use of this group. The aim of this review was to identify the healthcare needs and general practice utilization of people with acquired neurological disabilities and complex needs. METHODS A scoping review methodological framework was utilized. Six databases (MEDLINE, PsycInfo, CINAHL, Scopus, Embase and the Cochrane Library) were searched. Articles were included if they reported on general practice service utilization of people with acquired neurological disabilities and complex needs aged between 18 and 65. Articles were required to be peer-reviewed, written in English and published between 2010 and 2021. RESULTS Thirty-one articles were included in the review. Studies originated from Canada (9), the United States (8), Australia (4), Switzerland (4), the United Kingdom (2), England (1), Norway (1), France (1) and Denmark (1). For many people, GPs were the main healthcare provider. People with disability consult multiple healthcare providers and navigate complex healthcare systems. Commonly presented healthcare needs were bladder, bowel and skin problems, pain and chronic pain, medication needs and mental health concerns. CONCLUSIONS People with acquired neurological disabilities and complex needs were vulnerable to receiving suboptimal healthcare. The literature highlighted issues regarding the accessibility of services, the fragmentation of health services and inadequate preventative care. GPs were challenged to offer adequate disability-related expertise and to meet the mental health needs of people with disability within time constraints. PATIENT AND PUBLIC INVOLVEMENT This manuscript was prepared in collaboration with a GP, who is one of the authors. A person with lived experience of acquired neurological disability was engaged to check the alignment of the findings with their personal experience and provide feedback.
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Affiliation(s)
- Stacey Oliver
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Jacinta Douglas
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Dianne Winkler
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | | | - Ella‐Rose Minter
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Hannah K. Jarman
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
| | - Megan Topping
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
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Mathews M, Spencer S, Hedden L, Lukewich J, Poitras ME, Marshall EG, Brown JB, Sibbald S, Norful AA. The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada. BMC PRIMARY CARE 2022; 23:290. [PMID: 36402965 PMCID: PMC9675973 DOI: 10.1186/s12875-022-01900-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Family practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care. METHODS This mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses' time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results. DISCUSSION This project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1.
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, BC, Burnaby, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, BC, Burnaby, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St John's, NL, Canada
| | - Marie-Eve Poitras
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1
| | - Shannon Sibbald
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1
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Hor SY, Burns P, Yong FR, Barratt R, Degeling C, Williams Veazey L, Wyer M, Gilbert GL. 'Like building a plane and flying it all in one go': an interview study of infection prevention and control in Australian general practice during the first 2 years of the SARS-CoV-2 pandemic. BMJ Open 2022; 12:e061513. [PMID: 36123071 PMCID: PMC9485647 DOI: 10.1136/bmjopen-2022-061513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES General practitioners (GPs) and their staff have been at the frontline of the SARS-CoV-2 pandemic in Australia. However, their experiences of responding to and managing the risks of viral transmission within their facilities are poorly described. The aim of this study was to describe the experiences, and infection prevention and control (IPC) strategies adopted by general practices, including enablers of and challenges to implementation, to contribute to our understanding of the pandemic response in this critical sector. DESIGN Semistructured interviews were conducted in person, by telephone or online video conferencing software, between November 2020 and August 2021. PARTICIPANTS Twenty general practice personnel working in New South Wales, Australia, including nine GPs, one general practice registrar, four registered nurses, one nurse practitioner, two practice managers and two receptionists. RESULTS Participants described implementing wide-ranging repertoires of IPC strategies-including telehealth, screening of patients and staff, altered clinic layouts and portable outdoor shelters, in addition to appropriate use of personal protective equipment (PPE)-to manage the demands of the SARS-CoV-2 pandemic. Strategies were proactive, influenced by the varied contexts of different practices and the needs and preferences of individual GPs as well as responsive to local, state and national requirements, which changed frequently as the pandemic evolved. CONCLUSIONS Using the 'hierarchy of controls' as a framework for analysis, we found that the different strategies adopted in general practice often functioned in concert with one another. Most strategies, particularly administrative and PPE controls, were subjected to human variability and so were less reliable from a human factors perspective. However, our findings highlight the creativity, resilience and resourcefulness of general practice staff in developing, implementing and adapting their IPC strategies amidst constantly changing pandemic conditions.
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Affiliation(s)
- Su-Yin Hor
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Penelope Burns
- College of Health & Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Faith R Yong
- Safe and Effective Medicine Research Collaborative, School of Pharmacy, Faculty of Health and Behavioural Science, University of Queensland, Saint Lucia, Queensland, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ruth Barratt
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Degeling
- Centre for Health Engagement, Evidence and Values, School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Leah Williams Veazey
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Mary Wyer
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gwendolyn L Gilbert
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Davidson AR, Reidlinger DP. A review of the growth and development of Australian practice nursing: Insights for the dietetic workforce. Nutr Diet 2022; 79:497-548. [PMID: 35989542 PMCID: PMC9545586 DOI: 10.1111/1747-0080.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/09/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
Abstract
Aim The aim of this scoping review was to provide an overview of the development of practice nurses, and the learnings that could be applied to improve the profile of dietetics practice in primary care. Methods A scoping review synthesising peer‐reviewed and other literature relevant to the development of Australian practice nurses was conducted. Structured searches using keywords ‘general practice’, ‘nurse’ and ‘Australia’ were conducted in PubMed and Google Scholar in June 2021. Key government websites, Department of Health and Services Australia, were searched to identify grey literature. One reviewer screened the titles and abstracts against inclusion criteria; two reviewers conducted full‐text screening independently. Data on the evolution of practice nursing were extracted based on its interest and transferability to the dietetics workforce. Results A total of 102 results (82 peer‐reviewed and 20 other literature) were included in the review. Key drivers for practice nurse role development in Australia were government funding, practice nurse practice standards, cost–benefit analyses of practice nurses, career and education opportunities, general practitioner and patient perspectives of practice nurses and, individual, community and local needs. Conclusions The practice nurse role has grown and strengthened and there are three key learnings that could be translated to strengthen the dietetics workforce in primary care. (1) Use and expansion of government funding, (2) furthering post‐tertiary education and career opportunities, including dietetic primary care practice standards and (3) targeting underserviced areas such as those that are rural and remote and building positive relationships with other stakeholders including practice nurses, general practitioners, patients and the broader primary care team.
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Affiliation(s)
- Alexandra R Davidson
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Dianne P Reidlinger
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Pearce C, McLeod A, Supple J, Gardner K, Proposch A, Ferrigi J. Responding to COVID-19 with real-time general practice data in Australia. Int J Med Inform 2022; 157:104624. [PMID: 34741891 PMCID: PMC8564317 DOI: 10.1016/j.ijmedinf.2021.104624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/14/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION As SARS-CoV-2 spread around the world, Australia was no exception. Part of the Australian response was a robust primary care approach, involving changes to care models (including telehealth) and the widespread use of data to inform the changes. This paper outlines how a large primary care database responded to provide real-time data to inform policy and practice. Simply extracting the data is not sufficient. Understanding the data is. The POpulation Level Analysis and Reporting (POLAR) program is designed to use GP data for multiple objectives and is built on a pre-existing engagement framework established over a fifteen-year period. Initially developed to provide QA activities for general practices and population level data for General Practice support organisations, the POLAR platform has demonstrated the critical ability to design and deploy real-time data analytics solutions during the COVID-19 pandemic for a variety of stakeholders including state and federal government agencies. METHODS The system extracts and processes data from over 1,300 general practices daily. Data is de-identified at the point of collection and encrypted before transfer. Data cleaning for analysis uses a variety of techniques, including Natural Language Processing and coding of free text information. The curated dataset is then distilled into several analytic solutions designed to address specific areas of investigation of interest to various stakeholders. One such analytic solution was a model we created that used multiple data inputs to rank patient geographic areas by the likelihood of a COVID-19 outbreak. The model utilised pathology ordering, COVID-19 related diagnoses, indication of COVID-19 related concern (via progress notes) and also incorporated state based actual confirmed case figures. RESULTS Using the methods described, we were able to deliver real-time data feeds to practices, Primary Health Networks (PHN) and other agencies. In addition, we developed a COVID-19 geographic risk stratification based on local government areas (LGAs) to pro-actively inform the primary care response. Providing PHNs with a list of geographic priority hotspots allowed for better targeting and response of Personal Protective Equipment allocation and pop-up clinic placement. CONCLUSIONS The program summarised here demonstrates the ability of a well-designed system underpinned by accurate and reliable data, to respond in real-time to a rapidly evolving public health emergency in a way which supports and enhances the health system response.
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Affiliation(s)
- Christopher Pearce
- Director of Research, Outcome Health, Adjunct Associate Professor in General Practice, Monash University, 1 Chapel Street, Blackburn 3130, Australia.
| | - Adam McLeod
- Chief Executive Officer, Outcome Health, Australia
| | - Jamie Supple
- Director of Business Intelligence, Outcome Health, Australia
| | | | - Amanda Proposch
- Chief Executive Officer, Gippsland Primary Health Network, Australia
| | - Jason Ferrigi
- Chief Information Officer, Outcome Health, Australia
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Mathews M, Ryan D, Buote R, Parsons S, Lukewich J. Family Practice Nursing in Newfoundland and Labrador: Are Reported Roles Reflective of Professional Competencies for Registered Nurses in Primary Care? SAGE Open Nurs 2021; 7:23779608211053496. [PMID: 34734116 PMCID: PMC8559206 DOI: 10.1177/23779608211053496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/31/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Family practice nurses are Registered Nurses who work collaboratively in primary care and deliver a range of services. Professional competency statements have been developed to describe the skills and knowledge of family practice nurses as a distinct field. Purpose We conducted a secondary analysis of qualitative interview data to examine how family practice nurse roles/activities relate to recently developed professional competencies. Methods Family physicians and family practice nurses in Newfoundland and Labrador (NL) participated in semi-structured interviews, during which they discussed roles/activities and scope of practice surrounding family practice nursing. For this secondary analysis, we used competency statements to inform thematic coding of the transcribed interviews. Results For the initial study, a total of 8 participants (5 family practice nurses; 3 family physicians) were interviewed from diverse practices. All transcripts from the original study (n = 8) were included in the secondary analysis and analysed across 47 competencies encompassing 6 domains (Professionalism; Clinical Practice; Communication; Collaboration and Partnership; Quality Assurance, Evaluation and Research; Leadership). Roles/activities reported by participants were reflective of the competencies, but with substantial variation in expression. Conclusions Family practice nursing competency statements reflect the actual activities of family practice nurses in NL. The professional competencies can serve as a framework to examine contributions of family practice nurses and identify areas warranting further training. The use of competencies to explore family practice nurses' roles and activities can assist with optimizing scope of practice.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University, St. John's, NL, Canada
| | - Richard Buote
- Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
| | - Sandra Parsons
- Department of Health and Community Services, Government of Newfoundland and Labrador, St. John's, NL, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, NL, Canada
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Wood A, Braat S, Temple-Smith M, Lorch R, Vaisey A, Guy R, Hocking J. A chlamydia education and training program for general practice nurses: reporting the effect on chlamydia testing uptake. Aust J Prim Health 2021; 27:36-42. [PMID: 33526167 DOI: 10.1071/py20056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022]
Abstract
The long-term health consequences of untreated chlamydia are an increased risk of pelvic inflammatory disease, ectopic pregnancies and infertility among women. To support increased chlamydia testing, and as part of a randomised controlled trial of a chlamydia intervention in general practice, a chlamydia education and training program for general practice nurses (GPN) was developed. The training aimed to increase GPNs' chlamydia knowledge and management skills. We compared the difference in chlamydia testing between general practices where GPNs received training to those who didn't and evaluated acceptability. Testing rates increased in all general practices over time. Where GPNs had training, chlamydia testing rates increased (from 8.3% to 19.9% (difference=11.6%; 95% CI 9.4-13.8)) and where GPNs did not have training (from 7.4% to 18.0% (difference=10.6%; 95% CI 7.6-13.6)). By year 2, significantly higher testing rates were seen in practices where GPNs had training (treatment effect=4.9% (1.1 - 8.7)), but this difference was not maintained in year 3 (treatment effect=1.2% (-2.5 - 4.9)). Results suggest a GPN chlamydia education and training program can increase chlamydia testing up to 2 years; however, further training is required to sustain the increase beyond that time.
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Affiliation(s)
- Anna Wood
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3053, Australia; and Corresponding author.
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic. 3053, Australia
| | - Meredith Temple-Smith
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3053, Australia
| | - Rebecca Lorch
- South Eastern Sydney LHD HIV and Related Programs (HARP) Unit, Sydney, NSW 2010, Australia
| | - Alaina Vaisey
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic. 3053, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic. 3053, Australia
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Dewanto I, Koontongkaew S, Widyanti N. Characteristics of Dental Services in Rural, Suburban, and Urban Areas Upon the Implementation of Indonesia National Health Insurance. Front Public Health 2020; 8:138. [PMID: 32478026 PMCID: PMC7235165 DOI: 10.3389/fpubh.2020.00138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/03/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: The implementation of Indonesia National Health Insurance (NHI) for oral health needs to be evaluated by observing the dental disease patterns and dental therapy patterns from community health centers (CHCs) in the rural area, suburban area, and urban area. The aim of the study is to describe the characteristics of dental services in rural, suburban, and urban areas after the implementation of NHI on CHCs in the Special Region of Yogyakarta in 2014. Materials and methods: This is an observational study with a cross-sectional research design. The study used quantitative data obtained from dental records at selected CHCs. Using a purposive sampling method, 30 CHCs as unit analysis were collected from rural, suburban, and urban areas. The data were collected from January 2014 to December 2014. Results: Data from 26,554 patients were collected from dental records of dental clinics at CHCs. There were 5829 patient dental records from rural areas, 12,327 from suburban areas, and 8938 from urban areas. The primary dentist tends to provide services without clinical intervention on periodontal problems, abscesses, and lesions. Clinical interventions were mostly provided for prolonged retention and deposits on teeth. Primary dentists in suburban areas tend to provide clinical intervention on caries disease compared to those in rural and urban areas. Statistically significant differences (p < 0.05) were observed among locations in the pattern of providing clinical interventions on caries, abscess, lesion, prolonged retention, deposits on teeth, and other problems. No difference was recorded only on periodontal disease. Discussion: This study found that each area has different characteristics of dental disease and dental therapy patterns. Each area has a significant difference in the pattern of the clinical intervention of dental disease except in periodontal problems.
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Affiliation(s)
- Iwan Dewanto
- Faculty of Medical and Health Science, School of Dentistry, University Muhammadiyah Yogyakarta, Bantul, Indonesia
| | | | - Niken Widyanti
- Faculty of Medical and Health Science, School of Dentistry, University Muhammadiyah Yogyakarta, Bantul, Indonesia
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Sørensen M, Groven KS, Gjelsvik B, Almendingen K, Garnweidner-Holme L. The roles of healthcare professionals in diabetes care: a qualitative study in Norwegian general practice. Scand J Prim Health Care 2020; 38:12-23. [PMID: 31960746 PMCID: PMC7054922 DOI: 10.1080/02813432.2020.1714145] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective: To explore the experiences of general practitioners (GPs), nurses and medical secretaries in providing multi-professional diabetes care and their perceptions of professional roles.Design, setting and subjects: Semi-structured interviews were conducted with six GPs, three nurses and two medical secretaries from five purposively sampled diabetes teams. Interviews were analysed thematically.Main outcome measures: Healthcare professionals' (HCPs') experiences of multi-professional diabetes care in general practice.Results: The involvement of nurses and medical secretaries (collaborating health care professionals) was mainly motivated by GPs' time pressure and their perception of diabetes care as easy to standardize. GPs reported that diabetes care had become more structured and continuous after the involvement of collaborating health care professionals (cHCPs). cHCPs defined their role differently from GPs, emphasizing that their approach included acknowledging patients' need for diabetes education, listening to their stories and meeting their need for emotional support. GPs appeared less involved in patients' emotional concerns and more focused on the biomedical aspects of illness. There was little emphasis on teamwork among GPs and cHCPs, and none of the practices used care plans to involve patients in decisions or unify treatment among professionals. Participants stated that institutional structures including a discriminatory remuneration system, lack of role descriptions and missing procedures for collaborative approaches were an obstacle to MPC.Conclusions: cHCPs worked independently under delegated leadership of the GPs. Although cHCPs had a complementary role, HCPs in general practice may not take full advantage of the potential of sharing patient responsibility and learning with, from and about each other. Contextual barriers for team-based care approaches should be addressed in future research.KEY POINTSIt has been suggested that multi-professional approaches improve quality of care in people with long-term conditions.In this study, nurses and medical secretaries perceived to have a complementary role to general practitioners (GPs) in diabetes care, focusing on patient education, building trusting relationships and providing patients with emotional support.As multi-professional collaboration was minimal, GPs, nurses and medical secretaries in the included practices may not take full advantage of the potential of sharing care responsibility and learning with, from and about each other.
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Affiliation(s)
- Monica Sørensen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, Oslo, Norway;
- CONTACT Monica Sørensen Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| | - Karen Synne Groven
- Faculty of Health Sciences, Department of Physiotherapy, OsloMet University, Oslo, Norway;
| | - Bjørn Gjelsvik
- Department of General Practice, Institute for Health and Society, University of Oslo, Oslo, Norway;
| | - Kari Almendingen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, Oslo, Norway
| | - Lisa Garnweidner-Holme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, Oslo, Norway
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Wranik WD, Price S, Haydt SM, Edwards J, Hatfield K, Weir J, Doria N. Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis. Health Policy 2019; 123:550-563. [PMID: 30955711 DOI: 10.1016/j.healthpol.2019.03.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/11/2019] [Accepted: 03/23/2019] [Indexed: 01/19/2023]
Abstract
Interprofessional primary care (IPPC) teams are promoted as an alternative to single profession physician practices in primary care with focus on preventive care and chronic disease management. Characteristics of teams can have an impact on their performance. We synthesized quantitative, qualitative or mixed-methods evidence addressing the design of IPPC teams. We searched Ovid MEDLINE, Embase, CINAHL, and PAIS using search terms focused on IPPC teams. Studies were included if they discussed the influence of team structure, organization, financial arrangements, or policies and procedures, or either health care processes or outputs, health outcomes, or costs, and were conducted in Australia, Canada, the United Kingdom or New Zealand between 2003 and 2016. We screened 11,707 titles, 5366 abstracts, and selected 77 full text articles (38 qualitative, 31 quantitative and 8 mixed-methods). Literature focused on the implications of team characteristics on team processes, such as teamwork, collaboration, or satisfaction of patients or providers. Despite heterogeneity of contexts, some trends are observable: shared space, common vision and goals, clear definitions of roles, and leadership as important to good teamwork. The impacts of these on health care outputs or patient health are not clear. To move the state of knowledge beyond perception of what works well for IPPC teams, researchers should focus on quantitative causal inference about the linkages between team characteristics and patient health.
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Affiliation(s)
- Wiesława Dominika Wranik
- School of Public Administration, Faculty of Management, Dalhousie University, Canada; Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Canada.
| | - Sheri Price
- School of Nursing, Faculty of Health Professions, Dalhousie University, Canada
| | - Susan M Haydt
- School of Public Administration, Faculty of Management, Dalhousie University, Canada
| | | | - Krista Hatfield
- School of Journalism and Communication, Carleton University, Canada
| | - Julie Weir
- Halifax Partnership, Dalhousie University, Canada
| | - Nicole Doria
- Maritime SPOR Support Unit, Dalhousie University, Canada
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Gray J, Hoon EA, Afzali HHA, Spooner C, Harris MF, Karnon J. Is the Counterweight Program a feasible and acceptable option for structured weight management delivered by practice nurses in Australia? A mixed-methods study. Aust J Prim Health 2019; 23:348-363. [PMID: 28490411 DOI: 10.1071/py16105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/05/2017] [Indexed: 11/23/2022]
Abstract
Nurse-led weight management programs, like the Counterweight Program in the United Kingdom, may offer a way for Australian general practices to provide weight management support to adults who are overweight or obese. During Counterweight, nurses provide patients with six fortnightly education sessions and three follow-up sessions to support weight maintenance. This study examined the feasibility, acceptability and perceived value of the Counterweight Program in the Australian primary care setting using a mixed-methods approach. Six practice nurses, from three general practices, were trained and subsidised to deliver the program. Of the 65 patients enrolled, 75% (n=49) completed the six education sessions. General practitioners and practice nurses reported that the training and resource materials were useful, the program fitted into general practices with minimal disruption and the additional workload was manageable. Patients reported that the program created a sense of accountability and provided a safe space to learn about weight management. Overall, Counterweight was perceived as feasible, acceptable and valuable by Australian practice staff and patients. The key challenge for future implementation will be identifying adequate and sustainable funding. An application to publically fund Counterweight under the Medicare Benefits Schedule would require stronger evidence of effectiveness and cost-effectiveness in Australia.
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Affiliation(s)
- Jodi Gray
- School of Public Health, University of Adelaide, Level 7, 178 North Terrace, Adelaide, SA 5005, Australia
| | - Elizabeth A Hoon
- School of Public Health, University of Adelaide, Level 7, 178 North Terrace, Adelaide, SA 5005, Australia
| | - Hossein Haji Ali Afzali
- School of Public Health, University of Adelaide, Level 7, 178 North Terrace, Adelaide, SA 5005, Australia
| | - Catherine Spooner
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), c/o CPHCE, University of NSW, Level 3, AGSM Building, Sydney, NSW 2052, Australia
| | - Mark F Harris
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), c/o CPHCE, University of NSW, Level 3, AGSM Building, Sydney, NSW 2052, Australia
| | - Jonathan Karnon
- School of Public Health, University of Adelaide, Level 7, 178 North Terrace, Adelaide, SA 5005, Australia
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Forsdike K, Murphy TA, Hegarty K. Supporting primary care nurses to work at an advanced level through changing practices' organisational governance. Aust J Prim Health 2019; 24:171-176. [PMID: 29622061 DOI: 10.1071/py17120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/19/2017] [Indexed: 11/23/2022]
Abstract
General practice nurses wishing to develop their careers in general practice are often unsupported, relying on the culture of individual practices. Given the structural diversity of Australian general practice, we qualitatively explored staff experiences of organisational governance, what supports are in place and can be used to assist nurses to advance. Semi-structured interviews with 28 staff (including nurses, GPs, receptions and practice managers) were undertaken across three practices, as part of a case-study approach. It was found that general practice staff know little of organisational governance and how it may be harnessed. Practical and flexible organisational governance were the most important factors in supporting general practice nurses to develop and utilise nursing skills, but advocacy from medical colleagues was necessary to support advancement. Barriers include funding structures, non-supportive cultures and inflexible organisational governance structures. Organisation governance has the potential to assist nurses to work at an advanced level, but significant financial, structural and cultural barriers may be too difficult for organisational governance resources alone to overcome. In addition to utilising resources, it may be useful for general practices to undertake a review of how they function as a team and reflect upon their practice culture.
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Affiliation(s)
- Kirsty Forsdike
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
| | - Tracy Ann Murphy
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
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McInnes S, Peters K, Bonney A, Halcomb E. The influence of funding models on collaboration in Australian general practice. Aust J Prim Health 2019; 23:31-36. [PMID: 27451984 DOI: 10.1071/py16017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/23/2016] [Indexed: 11/23/2022]
Abstract
Despite more nurses working in Australian general practice, there has been limited investigation exploring ways that general practitioners and registered nurses work together to deliver clinical care. However, it has been postulated that the small business structure, common in Australian general practices, might influence collaboration between these two groups of health professionals. This paper presents one theme from a larger qualitative study. Eight general practitioners and fourteen registered nurses working in general practice participated in semistructured face-to-face interviews between February and May 2015. Naturalistic inquiry was adopted to elicit and explore the narrative accounts of participants about working together in general practice. An inductive process of thematic analysis was used to identify, analyse and report patterns and themes. Ancillary costs associated with the employment of registered nurses in general practice and the time registered nurses took to undertake procedural services were a concern for general practitioners. Registered nurses did not always work to their full scope of practice and many felt that their expertise was not appropriately remunerated. Findings suggested that fee for service-funding models can negatively influence collaboration between general practitioners and registered nurses working in general practice.
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Affiliation(s)
- Susan McInnes
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
| | - Kath Peters
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Andrew Bonney
- School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
| | - Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
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Russell GM, Miller WL, Gunn JM, Levesque JF, Harris MF, Hogg WE, Scott CM, Advocat JR, Halma L, Chase SM, Crabtree BF. Contextual levers for team-based primary care: lessons from reform interventions in five jurisdictions in three countries. Fam Pract 2018; 35:276-284. [PMID: 29069376 PMCID: PMC5965082 DOI: 10.1093/fampra/cmx095] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most Western nations have sought primary care (PC) reform due to the rising costs of health care and the need to manage long-term health conditions. A common reform-the introduction of inter-professional teams into traditional PC settings-has been difficult to implement despite financial investment and enthusiasm. OBJECTIVE To synthesize findings across five jurisdictions in three countries to identify common contextual factors influencing the successful implementation of teamwork within PC practices. METHODS An international consortium of researchers met via teleconference and regular face-to-face meetings using a Collaborative Reflexive Deliberative Approach to re-analyse and synthesize their published and unpublished data and their own work experience. Studies were evaluated through reflection and facilitated discussion to identify factors associated with successful teamwork implementation. Matrices were used to summarize interpretations from the studies. RESULTS Seven common levers influence a jurisdiction's ability to implement PC teams. Team-based PC was promoted when funding extended beyond fee-for-service, where care delivery did not require direct physician involvement and where governance was inclusive of non-physician disciplines. Other external drivers included: the health professional organizations' attitude towards team-oriented PC, the degree of external accountability required of practices, and the extent of their links with the community and medical neighbourhood. Programs involving outreach facilitation, leadership training and financial support for team activities had some effect. CONCLUSION The combination of physician dominance and physician aligned fee-for-service payment structures provide a profound barrier to implement team-oriented PC. Policy makers should carefully consider the influence of these and our other identified drivers when implementing team-oriented PC.
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Affiliation(s)
- Grant M Russell
- Southern Academic Primary Care Research Unit, School of Primary and Allied Health Care, Monash University, Clayton, Australia
| | - William L Miller
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Jane M Gunn
- Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Australia
| | - Jean-Frederic Levesque
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, Australia.,Bureau of Health Information, Chatswood, NSW, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, Australia
| | - William E Hogg
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Cathie M Scott
- Alberta Centre for Child, Family and Community Research, Edmonton, Canada
| | - Jenny R Advocat
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Clayton, Australia
| | - Lisa Halma
- Zone Analytics and Reporting Services, Alberta Health Services, Edmonton, Canada
| | - Sabrina M Chase
- Rutgers Biomedical and Health Sciences (RBHS), Rutgers School of Nursing, Rutgers University, New Brunswick, USA
| | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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Desborough J, Phillips C, Mills J, Korda R, Bagheri N, Banfield M. Developing a positive patient experience with nurses in general practice: An integrated model of patient satisfaction and enablement. J Adv Nurs 2017; 74:564-578. [DOI: 10.1111/jan.13461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra, ACT Australia
| | - Christine Phillips
- Australian National University Medical School; Australian National University; Canberra ACT Australia
| | - Jane Mills
- College of Health; Massey University; Palmerston North New Zealand
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health; Research School of Population Health; Australian National University; Canberra ACT Australia
| | - Nasser Bagheri
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra, ACT Australia
| | - Michelle Banfield
- National Institute for Mental Health Research; Research School of Population Health; Australian National University; Canberra ACT Australia
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17
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McInnes S, Peters K, Bonney A, Halcomb E. A qualitative study of collaboration in general practice: understanding the general practice nurse's role. J Clin Nurs 2017; 26:1960-1968. [DOI: 10.1111/jocn.13598] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Susan McInnes
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Kath Peters
- School of Nursing & Midwifery; Western Sydney University; Campbelltown NSW Australia
| | - Andrew Bonney
- School of Medicine; University of Wollongong; Wollongong NSW Australia
| | - Elizabeth Halcomb
- School of Nursing; University of Wollongong; Wollongong NSW Australia
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Karakolias S, Kastanioti C, Theodorou M, Polyzos N. Primary Care Doctors' Assessment of and Preferences on Their Remuneration. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2017; 54:46958017692274. [PMID: 28240040 PMCID: PMC5798707 DOI: 10.1177/0046958017692274] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/06/2016] [Accepted: 01/09/2017] [Indexed: 11/17/2022]
Abstract
Despite numerous studies on primary care doctors' remuneration and their job satisfaction, few of them have quantified their views and preferences on certain types of remuneration. This study aimed at reporting these views and preferences on behalf of Greek doctors employed at public primary care. We applied a 13-item questionnaire to a random sample of 212 doctors at National Health Service health centers and their satellite clinics. The results showed that most doctors deem their salary lower than work produced and lower than that of private sector colleagues. Younger respondents highlighted that salary favors dual employment and claim of informal fees from patients. Older respondents underlined the negative impact of salary on productivity and quality of services. Both incentives to work at border areas and choose general practice were deemed unsatisfactory by the vast majority of doctors. Most participants desire a combination of per capita fee with fee-for-service; however, 3 clusters with distinct preferences were formed: general practitioners (GPs) of higher medical grades, GPs of the lowest medical grade, residents and rural doctors. Across them, a descending tolerance to salary-free schemes was observed. Greek primary care doctors are dissatisfied with the current remuneration scheme, maybe more than in the past, but notably the younger doctors are not intended to leave it. However, Greek policy makers should experiment in capitation for more tolerable to risk GPs and introduce pay-for-performance to achieve enhanced access and quality. These interventions should be combined with others in primary care's new structure in an effort to converge with international standards.
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Desborough J, Bagheri N, Banfield M, Mills J, Phillips C, Korda R. The impact of general practice nursing care on patient satisfaction and enablement in Australia: A mixed methods study. Int J Nurs Stud 2016; 64:108-119. [PMID: 27768985 DOI: 10.1016/j.ijnurstu.2016.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/05/2016] [Accepted: 10/13/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The numbers of nurses in general practice in Australia tripled between 2004 and 2012. However, evidence on whether nursing care in general practice improves patient outcomes is scarce. Although patient satisfaction and enablement have been examined extensively as outcomes of general practitioner care, there is little research into these outcomes from nursing care in general practice. The aim of this study was to examine the relationships between specific general practice characteristics and nurse consultation characteristics, and patient satisfaction and enablement METHODS: A mixed methods study examined a cross-section of patients from 21 general practices in the Australian Capital Territory. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care between September 2013 and March 2014. Grounded theory methods were used to analyse interviews with staff and patients from these same practices. An integrated analysis of data from both components was conducted using multilevel mixed effect models. RESULTS Data from 678 completed patient surveys (response rate=42%) and 48 interviews with 16 nurses, 23 patients and 9 practice managers were analysed. Patients who had longer nurse consultations were more satisfied (OR=2.50, 95% CI: 1.43-4.35) and more enabled (OR=2.55, 95% CI: 1.45-4.50) than those who had shorter consultations. Patients who had continuity of care with the same general practice nurse were more satisfied (OR=2.31, 95% CI: 1.33-4.00) than those who consulted with a nurse they had never met before. Patients who attended practices where nurses worked with broad scopes of practice and high levels of autonomy were more satisfied (OR=1.76, 95% CI: 1.09-2.82) and more enabled (OR=2.56, 95% CI: 1.40-4.68) than patients who attended practices where nurses worked with narrow scopes of practice and low levels of autonomy. Patients who received nursing care for the management of chronic conditions (OR=2.64, 95% CI: 1.32-5.30) were more enabled than those receiving preventive health care. CONCLUSIONS This study provides the first evidence of the importance of continuity of general practice nurse care, adequate time in general practice nurse consultations, and broad scopes of nursing practice and autonomy for patient satisfaction and enablement. The findings of this study provide evidence of the true value of enhanced nursing roles in general practice. They demonstrate that when the vision for improved coordination and multidisciplinary primary health care, including expanded roles of nurses, is implemented, high quality patient outcomes can be achieved.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia.
| | - Nasser Bagheri
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia
| | - Michelle Banfield
- National Institute for Mental Health Research, Research School of Population Health, Australian National University, Australia
| | - Jane Mills
- Nursing, School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Christine Phillips
- Social Foundations of Medicine, Australian National University Medical School, Australia
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia
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20
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Hallinan CM, Hegarty KL. Advanced training for primary care and general practice nurses: enablers and outcomes of postgraduate education. Aust J Prim Health 2016; 22:113-122. [DOI: 10.1071/py14072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/13/2014] [Indexed: 11/23/2022]
Abstract
The aims of the present study were to understand enablers to participation in postgraduate education for primary care nurses (PCNs), and to explore how postgraduate education has advanced their nursing practice. Cross-sectional questionnaires were mailed out in April 2012 to current and past students undertaking postgraduate studies in primary care nursing at The University of Melbourne, Victoria, Australia. Questionnaires were returned by 100 out of 243 nurses (response rate 41%). Ninety-one per cent (91/100) of the respondents were first registered as nurses in Australia. Fifty-seven per cent were hospital trained and 43% were university educated to attain their initial nurse qualification. The respondents reported opportunities to expand scope of practice (99%; 97/98), improve clinical practice (98%; 97/99), increase work satisfaction (93%; 91/98) and increase practice autonomy (92%; 89/97) as factors that most influenced participation in postgraduate education in primary care nursing. Major enablers for postgraduate studies were scholarship access (75%; 71/95) and access to distance education (74%; 72/98). Many respondents reported an increased scope of practice (98%; 95/97) and increased job satisfaction (71%; 70/98) as an education outcome. Only 29% (28/97) cited an increase in pay-rate as an outcome. Of the 73 PCNs currently working in general practice, many anticipated an increase in time spent on the preparation of chronic disease management plans (63%; 45/72), multidisciplinary care plans (56%; 40/72) and adult health checks (56%; 40/72) in the preceding 12 months. Recommendations emerging from findings include: (1) increased access to scholarships for nurses undertaking postgraduate education in primary care nursing is imperative; (2) alternative modes of course delivery need to be embedded in primary care nursing education; (3) the development of Australian primary care policy, including policy on funding models, needs to more accurately reflect the educational level of PCNs, PCN role expansion and the extent of interprofessional collaboration that is evident from research undertaken to date. Nurses with postgraduate education have the potential to increase their scope of practice, take on a greater teaching role and provide more preventive and chronic disease services in primary care. Policies aimed at increasing access to education for nurses working in primary care would strengthen the primary care nursing profession, and enhance the delivery of primary health care services in Australia.
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Turnock A, Morgan S, Henderson K, Tapley A, van Driel M, Oldmeadow C, Ball J, Presser J, Davey A, Scott J, Magin P. Prevalence and associations of general practice nurses' involvement in consultations of general practitioner registrars: a cross-sectional analysis. AUST HEALTH REV 2015; 40:92-99. [PMID: 26117411 DOI: 10.1071/ah15010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/08/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To establish prevalence and associations of general practice nurses' (GPNs) involvement in general practitioner (GP) registrars' consultations. METHODS A cross-sectional analysis from an ongoing cohort study of registrars' clinical consultations in five Australian states. Registrars recorded detailed data from 60 consecutive consultations per 6-month training term. Problems and diagnoses encountered, including chronic disease classification, were coded using the International Classification of Primary Care, second edition duplication system (ICPC-2plus) classification system. The outcome factor in our analysis was GPN involvement in management of individual problems and diagnoses. Independent variables were a range of patient, registrar, practice, consultation and educational factors. RESULTS We analysed 108 759 consultations of 856 registrars including 169 307 problems or diagnoses. Of the problems/diagnoses, 5.1% (95% confidence interval (CI) 5.0-5.2) involved a GPN. Follow-up with a GPN was organised for 1.5% (95% CI 1.4-1.5) of all problems/diagnoses. Significant associations of GPN involvement included patient age, male sex, Aboriginal or Torres Strait Islander status, non-English-speaking background (NESB) and the patient being new to the practice. Larger practice size, the particular training organisation, and the problem/diagnosis being new and not a chronic disease were other associations. CONCLUSIONS Associations with Aboriginal or Torres Strait Islander status and NESB status suggest GPNs are addressing healthcare needs of these under-serviced groups. But GPNs may be underutilised in chronic disease care.
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Affiliation(s)
- Allison Turnock
- Tropical Medical Training, 100 Angus Smith Drive, Townsville, Qld, 4814, Australia.
| | - Simon Morgan
- General Practice Training Valley to Coast, PO Box 573, Hunter Regional Mail Centre, NSW 2310, Australia. , ,
| | - Kim Henderson
- General Practice Training Valley to Coast, PO Box 573, Hunter Regional Mail Centre, NSW 2310, Australia. , ,
| | - Amanda Tapley
- General Practice Training Valley to Coast, PO Box 573, Hunter Regional Mail Centre, NSW 2310, Australia. , ,
| | - Mieke van Driel
- Discipline of General Practice, School of Medicine, The University of Queensland, L8 Health Sciences Building, Royal Brisbane and Women's Hospital, Brisbane, Qld 4029, Australia. Email
| | - Chris Oldmeadow
- University of Newcastle, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Jean Ball
- Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. Email
| | - Jenny Presser
- Tropical Medical Training, 100 Angus Smith Drive, Townsville, Qld, 4814, Australia.
| | - Andrew Davey
- University of Newcastle, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - John Scott
- General Practice Training Valley to Coast, PO Box 573, Hunter Regional Mail Centre, NSW 2310, Australia. , ,
| | - Parker Magin
- General Practice Training Valley to Coast, PO Box 573, Hunter Regional Mail Centre, NSW 2310, Australia. , ,
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Nancarrow SA. Six principles to enhance health workforce flexibility. HUMAN RESOURCES FOR HEALTH 2015; 13:9. [PMID: 26264184 PMCID: PMC4532254 DOI: 10.1186/1478-4491-13-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/22/2015] [Indexed: 05/29/2023]
Abstract
UNLABELLED This paper proposes approaches to break down the boundaries that reduce the ability of the health workforce to respond to population needs, or workforce flexibility. Accessible health services require sufficient numbers and types of skilled workers to meet population needs. However, there are several reasons that the health workforce cannot or does not meet population needs. These primarily stem from workforce shortages. However, the health workforce can also be prevented from responding appropriately and efficiently because of restrictions imposed by professional boundaries, funding models or therapeutic partitions. These boundaries limit the ability of practitioners to effectively diagnose and treat patients by restricting access to specific skills, technologies and services. In some cases, these boundaries not only reduce workforce flexibility, but they introduce inefficiencies in the form of additional clinical transactions and costs, further detracting from workforce responsiveness. Several new models of care are being developed to enhance workforce flexibility by enabling existing staff to work to their full scope of practice, extend their roles or by introducing new workers. Expanding on these concepts, this theoretical paper proposes six principles that have the potential to enhance health workforce flexibility, specifically: 1. Measure health system performance from the perspective of the patient. 2. Minimise training times. 3. Regulate tasks (competencies), not professions. 4. Match rewards and indemnity to the levels of skill and risk required to perform a particular task, not professional title. 5. Ensure that practitioners have all the skills they need to perform the tasks required to work in the environment in which they work 6. Enable practitioners to work to their full scope of practice delegate tasks where required These proposed principles will challenge some of the existing social norms around health-care delivery; however, many of these principles are already being applied, albeit on a small scale. This paper discusses the implications of these reforms. PROPOSED DISCUSSION POINTS 1. Is person-centred care at odds with professional monopolies? 2. Should the state regulate professions and, by doing so, protect professional monopolies or, instead, regulate tasks or competencies? 3. Can health-care efficiency be enhanced by reducing the number of clinical transactions required to meet patient needs?
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Affiliation(s)
- Susan A Nancarrow
- School of Health and Human Sciences, Southern Cross University, East Lismore, NSW, 2480, Australia.
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Lorch R, Hocking J, Guy R, Vaisey A, Wood A, Lewis D, Temple-Smith M. Practice nurse chlamydia testing in Australian general practice: a qualitative study of benefits, barriers and facilitators. BMC FAMILY PRACTICE 2015; 16:36. [PMID: 25880077 PMCID: PMC4371842 DOI: 10.1186/s12875-015-0251-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/27/2015] [Indexed: 11/17/2022]
Abstract
Background Chlamydia infection is a significant public health issue for young people; however, testing rates in Australian general practice are low. Practice nurses (PNs) could have an important role in contributing to increasing chlamydia testing rates. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a large cluster randomised control trial of annual testing for 16 to 29 year olds in general practice, is the first to investigate the role of PNs in maximising testing rates. In order to assess the scope for PN involvement, we aimed to explore PN’s views in relation to involvement in chlamydia testing in general practice. Methods Semi structured interviews were conducted between June 2011 and April 2012 with a purposive sample of 23 PNs participating in ACCEPt. Interview data was thematically analysed using a conventional content analysis approach. Results The participants in our study supported an increased role for PNs in chlamydia testing and identified a number of patient benefits from this involvement, such as an improved service with greater access to testing and patients feeling more comfortable engaging with a nurse rather than a doctor. An alleviation of doctors’ workloads and expansion of the nurse’s role were also identified as benefits at a clinic level. Time and workload constraints were commonly considered barriers to chlamydia testing, along with concerns around privacy in the “small town” rural settings of the general practices. Some felt negative GP attitudes as well as issues with funding for PNs’ work could also be barriers. The provision of training and education, streamlining chlamydia testing pathways in clinics and changes to pathology ordering processes would facilitate nurse involvement in chlamydia testing. Conclusion This study suggests that PNs could take a role in increasing chlamydia testing in general practice and that their involvement may result in possible benefits for patients, doctors, PNs and the community. Strategies to overcome identified barriers and facilitate their involvement must be further explored.
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Affiliation(s)
- Rebecca Lorch
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Anna Wood
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Dyani Lewis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
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Lorch R, Hocking J, Guy R, Vaisey A, Wood A, Donovan B, Fairley C, Gunn J, Kaldor J, Temple-Smith M. Do Australian general practitioners believe practice nurses can take a role in chlamydia testing? A qualitative study of attitudes and opinions. BMC Infect Dis 2015; 15:31. [PMID: 25885341 PMCID: PMC4314754 DOI: 10.1186/s12879-015-0757-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 01/15/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chlamydia notifications continue to rise in young people in many countries and regular chlamydia testing is an important prevention strategy. Although there have been initiatives to increase testing in primary care, none have specifically investigated the role of practice nurses (PNs) in maximising testing rates. PNs have previously expressed a willingness to be involved, but noted lack of support from general practitioners (GPs) as a barrier. We sought GPs' attitudes and opinions on PNs taking an expanded role in chlamydia testing and partner notification. METHODS In the context of a cluster randomised trial in mostly rural towns in 4 Australian states, semi structured interviews were conducted with 44 GPs between March 2011 and July 2012. Data relating to PN involvement in chlamydia testing were thematically analysed using a conventional content analysis approach. RESULTS The majority of GPs interviewed felt that a role for PNs in chlamydia testing was appropriate. GPs felt that PNs had more time for patient education and advice, that patients would find PNs easier to talk to and less intimidating than GPs, and that GPs themselves could benefit through a reduction in their workload. Although GPs felt that PNs could be utilised more effectively for preventative health activities such as chlamydia testing, many raised concerns about how these activities would be renumerated whilst some felt that existing workload pressures for PNs could make it difficult for them to expand their role. Whilst some rural GPs recognised that PNs might be well placed to conduct partner notification, they also recognised that issues of patient privacy and confidentiality related to living in a "small town" was also a concern. CONCLUSION This is the first qualitative study to explore GPs' views around an increased role for PNs in chlamydia testing. Despite the concerns raised by PNs, these findings suggest that GPs support the concept and recognise that PNs are suited to the role. However issues raised, such as funding and remuneration may act as barriers that will need to be addressed before PNs are supported to make a contribution to increasing chlamydia testing rates in general practice.
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Affiliation(s)
- Rebecca Lorch
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia.
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Rebecca Guy
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia.
| | - Alaina Vaisey
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Anna Wood
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Basil Donovan
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia.
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia.
| | - Christopher Fairley
- Central Clinical School, Monash University and Melbourne Sexual Health Centre, Carlton, Victoria, Australia.
| | - Jane Gunn
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia.
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.
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Phillips CB, Dwan K, Hepworth J, Pearce C, Hall S. Using qualitative mixed methods to study small health care organizations while maximising trustworthiness and authenticity. BMC Health Serv Res 2014; 14:559. [PMID: 25407663 PMCID: PMC4245737 DOI: 10.1186/s12913-014-0559-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/24/2014] [Indexed: 11/30/2022] Open
Abstract
Background The primary health care sector delivers the majority of health care in western countries through small, community-based organizations. However, research into these healthcare organizations is limited by the time constraints and pressure facing them, and the concern by staff that research is peripheral to their work. We developed Q-RARA—Qualitative Rapid Appraisal, Rigorous Analysis—to study small, primary health care organizations in a way that is efficient, acceptable to participants and methodologically rigorous. Methods Q-RARA comprises a site visit, semi-structured interviews, structured and unstructured observations, photographs, floor plans, and social scanning data. Data were collected over the course of one day per site and the qualitative analysis was integrated and iterative. Results We found Q-RARA to be acceptable to participants and effective in collecting data on organizational function in multiple sites without disrupting the practice, while maintaining a balance between speed and trustworthiness. Conclusions The Q-RARA approach is capable of providing a richly textured, rigorous understanding of the processes of the primary care practice while also allowing researchers to develop an organizational perspective. For these reasons the approach is recommended for use in small-scale organizations both within and outside the primary health care sector.
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Affiliation(s)
- Christine B Phillips
- Medical School, Peter Baume Building 42A, Australian National University, Canberra, ACT, 2601, Australia.
| | - Kathryn Dwan
- Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia.
| | - Julie Hepworth
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
| | | | - Sally Hall
- Medical School, Australian National University, Canberra, Australia.
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Merrick E, Fry M, Duffield C. Australian practice nursing: collaboration in context. J Clin Nurs 2014; 23:3525-32. [DOI: 10.1111/jocn.12605] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Eamon Merrick
- School of Nursing; University of Sydney; Sydney NSW Australia
- Centre for Health Services Management; Faculty of Nursing, Midwifery and Health; University of Technology; Sydney NSW Australia
| | - Margaret Fry
- School of Nursing; University of Sydney; Sydney NSW Australia
- Research and Practice Development; Nursing and Midwifery Directorate; Royal North Shore Hospital; Sydney NSW Australia
- Faculty of Health; University of Technology; Sydney NSW Australia
| | - Christine Duffield
- University of Technology Sydney and Edith Cowan University; Sydney NSW Australia
- Centre for Health Services Management; University of Technology Sydney; Sydney NSW Australia
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Pearce C, Bainbridge M. A personally controlled electronic health record for Australia. J Am Med Inform Assoc 2014; 21:707-13. [PMID: 24650635 DOI: 10.1136/amiajnl-2013-002068] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE On July 1, 2012 Australia launched a personally controlled electronic health record (PCEHR) designed around the needs of consumers. Using a distributed model and leveraging key component national eHealth infrastructure, the PCEHR is designed to enable sharing of any health information about a patient with them and any other health practitioner involved in their care to whom the patient allows access. This paper discusses the consumer-facing part of the program. METHOD Design of the system was through stakeholder consultation and the development of detailed requirements, followed by clinical design assurance. RESULTS Patients are able to access any posted information through a web-accessible 'consumer portal.' Within the portal they are able to assert access controls on all or part of their record. The portal includes areas for consumers to record their own personal information. DISCUSSION The PCEHR has the potential to transform the ability of patients to actively engage in their own healthcare, and to enable the emerging partnership model of health and healthcare in medicine. The ability to access health information traditionally kept within the closed walls of institutions also raises challenges for the profession, both in the language clinicians choose and the ethical issues raised by the changed roles and responsibilities. CONCLUSIONS The PCEHR is aimed at connecting all participants and their interventions, and is intended to become a system-wide activity.
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Affiliation(s)
- Christopher Pearce
- Inner East Melbourne Medicare Local, Burwood East, Victoria, Australia Monash University Department of General Practice, Clayton, Victoria, Australia
| | - Michael Bainbridge
- School of Health Information Science, University of British Columbia, Victoria, British Columbia, Canada ASE Consulting Pty Ltd., London, UK National E-Health Transition Authority, Sydney, New South Wales, Australia
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Al Sayah F, Szafran O, Robertson S, Bell NR, Williams B. Nursing perspectives on factors influencing interdisciplinary teamwork in the Canadian primary care setting. J Clin Nurs 2014; 23:2968-79. [DOI: 10.1111/jocn.12547] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Fatima Al Sayah
- School of Public Health; University of Alberta; Edmonton AB Canada
| | - Olga Szafran
- Department of Family Medicine; University of Alberta; Edmonton AB Canada
| | | | - Neil R. Bell
- Department of Family Medicine; University of Alberta; Edmonton AB Canada
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Afzali HHA, Karnon J, Beilby J, Gray J, Holton C, Banham D. Practice nurse involvement in general practice clinical care: policy and funding issues need resolution. AUST HEALTH REV 2014; 38:301-5. [DOI: 10.1071/ah13187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/14/2014] [Indexed: 11/23/2022]
Abstract
In Australia, primary care-based funding initiatives have been implemented to encourage general practices to employ practice nurses. The aim of this paper is to discuss limitations of the current funding and policy arrangements in enhancing the clinical role of practice nurses in the management of chronic conditions. This paper draws on the results of a real-world economic evaluation, the Primary Care Services Improvement Project (PCSIP). The PCSIP linked routinely collected clinical and resource use data to undertake a risk-adjusted cost-effectiveness analysis of increased practice nurse involvement in clinical-based activities for the management of diabetes and obesity. The findings of the PCSIP suggested that the active involvement of practice nurses in collaborative clinical-based activities is cost-effective, as well as addressing general practice workforce issues. Although primary healthcare organisations (e.g. Medicare Locals) can play a key role in supporting enhanced practice nurse roles, improvements to practice nurse funding models could further encourage more efficient use of an important resource. What is known about the topic? There is evidence that the increased involvement of practice nurses in clinical-based activities in the management of patients with chronic conditions (e.g. diabetes and obesity) is cost-effective. The Australian Government has implemented financial incentives to encourage general practices to recruit nurses and to expand nursing roles within collaborative models of care. There is currently insufficient engagement of practice nurses in clinical care. What does this paper add? This paper summarises evidence regarding the value of an enhanced practice nurse role in Australian general practice, and discusses refinements to current funding arrangements for practice nurses. What are the implications for practitioners? Delegating clinical role (e.g. patient education and monitoring clinical progress) to practice nurses in the management of patients with chronic conditions can improve clinical outcomes without adversely affecting general practice business models.
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Pearce CM, de Lusignan S, Phillips C, Hall S, Travaglia J. The computerized medical record as a tool for clinical governance in Australian primary care. Interact J Med Res 2013; 2:e26. [PMID: 23939340 PMCID: PMC3744386 DOI: 10.2196/ijmr.2700] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 07/04/2013] [Indexed: 11/13/2022] Open
Abstract
Background Computerized medical records (CMR) are used in most Australian general practices. Although CMRs have the capacity to amalgamate and provide data to the clinician about their standard of care, there is little research on the way in which they may be used to support clinical governance: the process of ensuring quality and accountability that incorporates the obligation that patients are treated according to best evidence. Objective The objective of this study was to explore the capability, capacity, and acceptability of CMRs to support clinical governance. Methods We conducted a realist review of the role of seven CMR systems in implementing clinical governance, developing a four-level maturity model for the CMR. We took Australian primary care as the context, CMR to be the mechanism, and looked at outcomes for individual patients, localities, and for the population in terms of known evidence-based surrogates or true outcome measures. Results The lack of standardization of CMRs makes national and international benchmarking challenging. The use of the CMR was largely at level two of our maturity model, indicating a relatively simple system in which most of the process takes place outside of the CMR, and which has little capacity to support benchmarking, practice comparisons, and population-level activities. Although national standards for coding and projects for record access are proposed, they are not operationalized. Conclusions The current CMR systems can support clinical governance activities; however, unless the standardization and data quality issues are addressed, it will not be possible for current systems to work at higher levels.
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Holmes C, Mills J, Chamberlain-Salaun J. Practice nurses and cervical screening: A two-country review. Int J Nurs Pract 2013; 20:53-9. [DOI: 10.1111/ijn.12121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Colin Holmes
- School of Nursing, Midwifery and Nutrition; James Cook University, Townsville Campus; Townsville Queensland Australia
| | - Jane Mills
- School of Nursing, Midwifery and Nutrition; James Cook University, Cairns Campus; Cairns Queensland Australia
| | - Jennifer Chamberlain-Salaun
- School of Nursing, Midwifery and Nutrition; James Cook University, Cairns Campus; Cairns Queensland Australia
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Pearce C, Hall S, Phillips C, Dwan K, Yates R, Sibbald B. A spatial analysis of the expanding roles of nurses in general practice. BMC Nurs 2012; 11:13. [PMID: 22870933 PMCID: PMC3488547 DOI: 10.1186/1472-6955-11-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 07/09/2012] [Indexed: 11/17/2022] Open
Abstract
Background Changes to the workforce and organisation of general practice are occurring rapidly in response to the Australian health care reform agenda, and the changing nature of the medical profession. In particular, the last five years has seen the rapid introduction and expansion of a nursing workforce in Australian general practices. This potentially creates pressures on current infrastructure in general practice. Method This study used a mixed methods, ‘rapid appraisal’ approach involving observation, photographs, and interviews. Results Nurses utilise space differently to GPs, and this is part of the diversity they bring to the general practice environment. At the same time their roles are partly shaped by the ways space is constructed in general practices. Conclusion The fluidity of nursing roles in general practice suggests that nurses require a versatile space in which to maximize their role and contribution to the general practice team.
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Affiliation(s)
- Christopher Pearce
- Director of Research, Inner Eastern Melbourne Medicare Local and Adjunct Associate Professor, Monash University, Melbourne, Australia.
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Pearce C, Shearer M, Gardner K, Kelly J, Xu TB. GP Networks as enablers of quality of care: implementing a practice engagement framework in a General Practice Network. Aust J Prim Health 2012; 18:101-4. [PMID: 22551830 DOI: 10.1071/py11121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 10/06/2011] [Indexed: 11/23/2022]
Abstract
This paper describes how the Melbourne East General Practice Network supports general practice to enable quality of care, it describes the challenges and enablers of change, and the evidence of practice capacity building and improved quality of care. Primary care is well known as a place where quality, relatively inexpensive medical care occurs. General practice is made up of multiple small sites with fragmented systems and a funding system that challenges a whole-of-practice approach to clinical care. General Practice Networks support GPs to synthesise complexity and crystallise solutions that enhance general practice beyond current capacity. Through a culture of change management, GP Networks create the link between the practice and the big picture of the whole health system and reduce the isolation of general practice. They distribute information (evidence-based learning and resources) and provide individualised support, responding to practice need and capacity.
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Phillips C, Hall S. Nurses and the wise organisation:techneandphronesisin Australian general practice. Nurs Inq 2012; 20:121-32. [DOI: 10.1111/j.1440-1800.2012.00601.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Del Mar C. New investments in primary care in Australia. BMC Health Serv Res 2011; 11:39. [PMID: 21329507 PMCID: PMC3048490 DOI: 10.1186/1472-6963-11-39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 02/17/2011] [Indexed: 12/02/2022] Open
Abstract
There is a crisis in primary care health workforce shortages in Australia. Its government has attempted to fix this by role-substitution (replacing medical work with nursing instead). This was not completely successful. Obstacles included entrenched social roles (leading to doctors 'checking' their nurse role-substituted work) and structures (nurses subservient to doctors) - both exacerbated by primary care doctors' ageing demographic; doctors owning their own practices; doctors feeling themselves to have primary responsibility for the care delivered; and greater attraction towards independence that may have selected doctors into primary care in the first place. Yet there is much to be optimistic about this social experiment. It was conducted, if not ideally, at least in an environment that the Australian government has enriched with capacity for research and evaluation.
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Affiliation(s)
- Chris Del Mar
- Professor of Primary Care Research, Bond University, Australia.
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