The role of practice nurses in coordinated care of people with chronic and complex conditions

Abstract

General practice in Australia must cope with growing numbers of individuals with chronic and complex needs. The Australian Government has recognised the need to reform the primary health care sector to address this issue, with recent initiatives, such as coordinated care. The overall goal of coordinated care at a national level is to facilitate integrated care for people with chronic and complex conditions, by enhancing collaborative partnerships among general practitioners, primary health care providers, community service providers and clients. Interestingly, practice nurses (PNs) have not been identified as key stakeholders in the coordinated care service delivery model in Australia. In contrast, an expanded role for PNs has been in place in the United Kingdom and New Zealand for some time. This paper is based on focus group discussions with Australian PNs who have had a range of experiences in coordinated care models. The study identifies an important role for PNs, suggesting trial of a variety of models of coordinated care that include PNs in chronic disease man- THE MANAGEMENT of chronic and complex conditions is a major issue for health systems in the developed world today. The Australian health care system has responded to this problem by introducing a number of initiatives; one of which has been coordinated health care. The overall goal of coordinated care is to facilitate integrated care for people with chronic and complex conditions, by enhancing collaborative partnerships among general practitioners (GPs) and non-medical primary and community services providers. Coordinated care is also based on the development of disease management approaches and evidence-based protocols for multidisciplinary care that maximise the likelihood of effective care within existing resources and enhance the coordination of care across acute and primary care sectors. Key stakeholders of coordinated care include: GPs, who act as care coordinators; community and domiciliary nurses from both public and private sectors, whose role is service coordination; service providers from public, private and institutional health care settings; and the target populations (elderly people with chronic conditions).

Health service use in the older person with complex health needs

“…This finding is somewhat unexpected given the relative volume of services used by people with complex health needs, the emphasis on primary care as the main point of contact with the health system and in the management of people with chronic and complex conditions, and the fact that the Australian Government has introduced several funding programs to support and encourage GP management of people with chronic and complex disease. [15][16][17] It should be noted that crude attendance rates indicate that GPs do indeed have significant contact with people with complex needs; it is just that after adjustment for confounders, this contact is no greater than for people without a complex condition. It has also been observed that although GPs are heavily involved in providing care to people with chronic illness, they provide the majority of care to those whose illness is mild to moderately severe.…”

How is Primary Health Care conceptualised in nursing in Australia? A review of the literature

“…Rebates only apply to a small range of activities including immunisation, wound care, pap smears and chronic disease prevention and management activities (Patterson et al . ). Recent changes to the Medicare Act have also extended the capacity to apply for MBS provider numbers to nurse practitioners and midwives (Department of Health & Ageing , Harvey , Lane ).…”

“…In addition to the Practice Nurse Incentives programme, funding has been targeted towards employment of PNs in rural settings and training and support schemes (Patterson et al . ). There has been accompanying growth of nursing employment in primary care and in particular, within general practice.…”

Best-practice care for people with advanced chronic obstructive pulmonary disease: the potential role of a chronic obstructive pulmonary disease care co-ordinator

“…(13) In Australia, both the National Health and Hospitals Reform Funding is also a major barrier to practice nurses taking on a care co-ordination role. (38) Although specific funding for some practice nurse activities has been introduced through Medicare (e.g. development of care plans), care co-ordination for complex patients is not supported.…”

“…(21,22,(38)(39)(40) A COPD care co-ordinator should be pro-active, supporting as much independence as possible through education and assistance with problem solving, but also have the skills and capacity to intervene with more specific assistance when needed. Such aThis advanced practice role should combine the skills of a palliative approach, with those specific to COPD, e.g.…”