A framework to support team‐based models of primary care within the Australian health care system

Naccarella, Lucio; Greenstock, Louise; Brooks, Peter

doi:10.5694/mja12.10069

Cited by 13 publications

(10 citation statements)

References 20 publications

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“…General practitioners (GPs) and community pharmacists (CPs) are the most important stewards of antimicrobial use [10,11] in primary care, for which there should be a greater scope for collaboration between these two professions [12,13] to implement effective AMS programs. CPs can act as the gateway practitioners and the sources of antimicrobial information for both patients and GPs.…”

Section: Introductionmentioning

confidence: 99%

Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study

et al. 2021

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Setting up an interprofessional team for antimicrobial stewardship (AMS) to improve the quality and safety of antimicrobial use in primary care is essential but challenging. This study aimed to investigate the convergent and divergent attitudes and views of general practitioners (GPs) and community pharmacists (CPs) about AMS implementation and their perceived challenges of collaboration to design a GP–pharmacist collaborative AMS (GPPAS) model. Nationwide surveys of GPs and CPs across Australia were conducted January-October 2019. Chi square statistics and a theoretical framework were used for comparative analyses of quantitative and qualitative data, respectively. In total, 999 participants responded to the surveys with 15.4% (n = 386) response rates for GPs and 30.7% (n = 613) for CPs. GPs and CPs were aware about AMS however their interprofessional perceptions varied to the benefits of AMS programs. CPs indicated that they would need AMS training; significantly higher than GPs (GP vs. CP; 46.4% vs. 76.5%; p < 0.0001). GPs’ use of the Therapeutic Guideline Antibiotic was much higher than CPs (83.2% vs. 45.5%; p < 0.0001). No interprofessional difference was found in the very-limited use of patient information leaflets (p < 0.1162) and point-of-care tests (p < 0.7848). While CPs were more willing (p < 0.0001) to collaborate with GPs, both groups were convergent in views that policies that support GP–CP collaboration are needed to implement GPPAS strategies. GP–pharmacist collaborative group meetings (54.9% vs. 82.5%) and antimicrobial audit (46.1% vs. 86.5%) models were inter-professionally supported to optimise antimicrobial therapy, but an attitudinal divergence was significant (p < 0.001). The challenges towards GP–CP collaboration in AMS were identified by both at personal, logistical and organisational environment level. There are opportunities for GP–CP collaboration to improve AMS in Australian primary care. However, strengthening GP–pharmacy collaborative system structure and practice agreements is a priority to improve interprofessional trust, competencies, and communications for AMS and to establish a GPPAS model in future.

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Section: Introductionmentioning

confidence: 99%

Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study

et al. 2021

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“…Approximately 40% of Canadians have access to interprofessional collaborative teams and individuals with multiple chronic conditions are most likely to receive team-based primary health care (Zygmunt and Berge, 2014). Internationally there is also a strong move to team-based primary health care, often referred to as medical homes, to enhance integration of services and emphasize health promotion and chronic disease management (Hutchison et al, 2011;Naccarella et al, 2013). The evidence to date suggests that interprofessional collaboration contributes to the structures and processes of primary health care, including patient satisfaction and access to care (Donabedian, 2005;Hogg et al, 2008), however, limited knowledge exists about the impact that interprofessional collaborative teams have on patient health outcomes (Paradis and Whitehead, 2018).…”

Section: Introductionmentioning

confidence: 99%

Measuring the performance of interprofessional primary health care teams: understanding the teams perspective

Donnelly

Ashcroft

Mofina

et al. 2019

Prim Health Care Res Dev

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Aim: The aim of the study was to describe practices that support collaboration in interprofessional primary health care teams, and identify performance indicators perceived to measure the impact of this collaboration from the perspective of interprofessional health providers. Background: Despite the surge of interprofessional primary health care models implemented across Canada, there is little evidence as to whether or not the intended outcomes of primary health care teams have been achieved. Part of the challenge is determining the most appropriate measures that can demonstrate the value of collaborative care. To date, little remains known about performance measurement from the providers contributing to the collaborative care process in interprofessional primary care teams. Having providers from a range of disciplinary backgrounds assist in the development of performance measures can help identify measures most relevant to demonstrate the value of collaborative care on the intended outcomes of interprofessional primary care models. Methods: A qualitative study; part of a larger mixed methods developmental evaluation to examine performance measurement in interprofessional primary health care teams. A stakeholder workshop was conducted at an annual association meeting of interprofessional primary health care teams in the province of Ontario, Canada. Six questions guided the workshop groups and participant responses were documented on worksheets and flip charts. All responses were collected and entered verbatim into a word document. Qualitative analytic strategies were applied to each question. Findings: A total of 283 primary health care providers from 14 health professions working in interprofessional primary health care teams participated. Top three elements of interprofessional collaboration (total n = 628) were communication (n = 146), co-treatment (n = 112) and patient-based conferences (n = 81). Top three performance indicators currently used to demonstrate the value of interprofessional collaboration (total n = 241) were patient experience (n = 71), patient health status (n = 35) and within team referrals (n = 30).

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“…[23] There are calls for studies of longer duration than the one we have undertaken and that more systematic evaluation methodologies on the impact of primary healthcare teams have been called for. [24,25] A limitation of this study is that it followed the changes and development of HealthOne only in the formative stages of the program. Obvious concerns that emerged within the program; such as, staff turnover and, for example, sustainability of the GPLN positions were unable to be conclusively addressed within the remit of the study design.…”

Section: Discussionmentioning

confidence: 99%

Remaking Practices in the Redesign of a Primary Healthcare Program

Rule

Dunston

Solomon

2017

APJHM

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Objective: To develop a detailed account of changed practices in everyday work in the redesign of a primary healthcare program. Design: The research aimed to produce layered and rich descriptions of the complex and multidimensional remaking of health practices. Empirical data was gathered through ethnographic methods including; interviewing, self-reporting, observation and shadowing. The subjects of the research were involved as active participants in the research design, data gathering and analysis. Setting: HealthOne was a New South Wales government attempt to provide a local and responsive model to improve chronic disease management in primary and community healthcare settings. We report specifically on the HealthOne program implemented in a suburb of Western Sydney. Main outcome measures: The research did not aim to evaluate the program but to uncover instances of professional learning though identifying changes in professional practice. These were noted and observed by the researchers and research participants or through reflexive conversations with the program planners, healthcare workers and the research team. Results: Drawing on the work of a number of learning and practice-based theory writers, particularly those using a socio-material approach, we describe how practice change has occurred and how work practiceshave been remade at this site - especially in the role of the General Practice Liaison Nurse (GPLN). Conclusions: The research demonstrated the potential for new categories and practices of health work to emerge; this was especially seen in the work of the GPLN but also extended to new ways of working through General Practitioners and community health networks. Abbreviations: GP – General Practitioner; GPLN – General Practice Liaison Nurse.

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A framework to support team‐based models of primary care within the Australian health care system

Cited by 13 publications

References 20 publications

Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study

Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study

Measuring the performance of interprofessional primary health care teams: understanding the teams perspective

Remaking Practices in the Redesign of a Primary Healthcare Program

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