Supporting primary care nurses to work at an advanced level through changing practices’ organisational governance

2018 ◽  
Vol 24 (2) ◽  
pp. 171
Author(s):  
Kirsty Forsdike ◽  
Tracy Ann Murphy ◽  
Kelsey Hegarty
Keyword(s):  
General Practice ◽  
Structural Diversity ◽  
Cultural Barriers ◽  
Structured Interviews ◽  
Advanced Level ◽  
Practice Nurses ◽  
Study Approach ◽  
Australian General Practice ◽  
Practice Culture ◽  
Changing Practices

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.

Pharmacists in general practice: a qualitative process evaluation of the General Practice Pharmacist (GPP) study

2020 ◽  
Vol 37 (5) ◽  
pp. 711-718
Author(s):  
Oscar James ◽  
Karen Cardwell ◽  
Frank Moriarty ◽  
Susan M Smith ◽  
Barbara Clyne
Keyword(s):  
General Practice ◽  
Process Evaluation ◽  
Controlled Trial ◽  
Qualitative Approach ◽  
Structured Interviews ◽  
Practice Staff ◽  
Practice Nurses ◽  
Practice Team ◽  
Prescribing Quality ◽  
Descriptive Qualitative

Abstract Background There is some evidence to suggest that pharmacists integrated into primary care improves patient outcomes and prescribing quality. Despite this growing evidence, there is a lack of detail about the context of the role. Objective To explore the implementation of The General Practice Pharmacist (GPP) intervention (pharmacists integrating into general practice within a non-randomized pilot study in Ireland), the experiences of study participants and lessons for future implementation. Design and setting Process evaluation with a descriptive qualitative approach conducted in four purposively selected GP practices. Methods A process evaluation with a descriptive qualitative approach was conducted in four purposively selected GP practices. Semi-structured interviews were conducted, transcribed verbatim and analysed using a thematic analysis. Results Twenty-three participants (three pharmacists, four GPs, four patients, four practice nurses, four practice managers and four practice administrators) were interviewed. Themes reported include day-to-day practicalities (incorporating location and space, systems and procedures and pharmacists’ tasks), relationships and communication (incorporating GP/pharmacist mode of communication, mutual trust and respect, relationship with other practice staff and with patients) and role perception (incorporating shared goals, professional rewards, scope of practice and logistics). Conclusions Pharmacists working within the general practice team have potential to improve prescribing quality. This process evaluation found that a pharmacist joining the general practice team was well accepted by the GP and practice staff and effective interprofessional relationships were described. Patients were less clear of the overall benefits. Important barriers (such as funding, infrastructure and workload) and facilitators (such as teamwork and integration) to the intervention were identified which will be incorporated into a pilot cluster randomized controlled trial.

scholarly journals Patient Centred Medical Home (PCMH) transitions in western Sydney, Australia: A qualitative study

2019 ◽  
Author(s):  
Christine Metusela ◽  
Tim Usherwood ◽  
Kenny Lawson ◽  
Lisa Angus ◽  
Walter Kmet ◽  
...  
Keyword(s):  
General Practice ◽  
Hospital Admissions ◽  
Healthcare Providers ◽  
Models Of Care ◽  
Shared Vision ◽  
Fee For Service ◽  
Structured Interviews ◽  
Practice Nurses ◽  
Funding Model ◽  
Sydney Australia

Abstract Objectives Patient Centred Medical Homes (PCMHs), increasingly evidenced to provide high quality primary care, are new to Australia. To learn how this promising new healthcare model works in an Australian setting we explored experiences of healthcare providers in outer urban Sydney, where a number of practices are transitioning from traditional Australian general practice models to incorporate elements of PCMH approaches. Design We collected qualitative data from semi-structured interviews with healthcare providers working in a range of transitioning practices and thematically analysed the data. Setting and participants We interviewed 35 participants including general practitioners, practice managers and practice nurses from 25 purposively sampled general practices in western Sydney, Australia, seeking maximal variation in practice size, patient demographics and type of engagement in practice transformation. Results Interviewees described PCMH transformation highlighting the importance of whole of practice engagement with a shared vision; key strategies for transformation to PCMH models of care including leadership, training and supportive information technology; structures and processes required to provide team-based, data-driven care; and constraints such as lack of space and the current Australian fee-for-service general practice funding model. They also reported their perceptions of early outcomes of the PCMH model of care, describing enhanced patient and staff satisfaction and also noting fewer hospital admissions, as likely to reduce costs of care. Conclusions Our study exploring the experience of early adopters of PCMH models of care in Australia, informs the international movement towards PCMH models of care. Our findings provide guidance for practices considering similar transitions and describe the challenges of such transitions within a fee-for-service payment system.

scholarly journals Patient Centred Medical Home (PCMH) transitions in western Sydney, Australia: A qualitative study

2019 ◽  
Author(s):  
Christine Metusela ◽  
Tim Usherwood ◽  
Kenny Lawson ◽  
Lisa Angus ◽  
Walter Kmet ◽  
...  
Keyword(s):  
General Practice ◽  
Hospital Admissions ◽  
Healthcare Providers ◽  
Models Of Care ◽  
Shared Vision ◽  
Fee For Service ◽  
Structured Interviews ◽  
Practice Nurses ◽  
Funding Model ◽  
Sydney Australia

Abstract Objectives Patient Centred Medical Homes (PCMHs), increasingly evidenced to provide high quality primary care, are new to Australia. To learn how this promising new healthcare model works in an Australian setting we explored experiences of healthcare providers in outer urban Sydney, where a number of practices are transitioning from traditional Australian general practice models to incorporate elements of PCMH approaches. Design We collected qualitative data from semi-structured interviews with healthcare providers working in a range of transitioning practices and thematically analysed the data. Setting and participants We interviewed 35 participants including general practitioners, practice managers and practice nurses from 25 purposively sampled general practices in western Sydney, Australia, seeking maximal variation in practice size, patient demographics and approaches to PCMH transitions. Results Interviewees described PCMH transformation highlighting the importance of whole of practice engagement with a shared vision; key strategies for transformation to PCMH models of care including leadership, training and supportive information technology; structures and processes required to provide team-based, data-driven care and constraints such as lack of space and the current Australian fee-for-service general practice funding model. They also reported early outcomes of the PCMH model of care, in particular enhanced patient and staff satisfaction and fewer hospital admissions which were described as likely to reduce the costs of care. Conclusions Our study exploring the experience of early adopters of PCMH models of care in Australia, informs the international movement towards PCMH Primary Health Care approaches. Our findings provide guidance for practices considering similar transitions and describe the challenges of such transitions within a fee-for-service payment system.

Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice

2013 ◽  
Vol 19 (2) ◽  
pp. 150 ◽  
Author(s):  
Diann S. Eley ◽  
Elizabeth Patterson ◽  
Jacqui Young ◽  
Paul P. Fahey ◽  
Chris B. Del Mar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Models Of Care ◽  
Practice Nurses ◽  
Australian General Practice ◽  
General Practices

The Australian government’s commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model’s feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients’ stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

Engagement of primary care practice in Australia: learnings from a diabetes care project

2019 ◽  
Vol 25 (1) ◽  
pp. 82
Author(s):  
Rajna Ogrin ◽  
Tracy Aylen ◽  
Toni Rice ◽  
Ralph Audehm ◽  
Arti Appannah
Keyword(s):  
General Practice ◽  
Chronic Disease ◽  
Diabetes Care ◽  
Descriptive Analysis ◽  
Healthcare Providers ◽  
Pilot Project ◽  
Care Practice ◽  
Structured Interviews ◽  
Contributing Factors ◽  
Practice Nurses

Effective community-based chronic disease management requires general practice engagement and ongoing improvement in care models. This article outlines a case study on contributing factors to insufficient participant recruitment through general practice for an evidence-based diabetes care pilot project. Key stakeholder semi-structured interviews and focus groups were undertaken at cessation of the pilot project. Participants (15 GPs, five practice nurses, eight diabetes educators) were healthcare providers engaged in patient recruitment. Through descriptive analysis, common themes were identified. Four major themes were identified: (1) low perceived need for intervention; (2) communication of intervention problematic; (3) translation of research into practice not occurring; and (4) the service providing the intervention was not widely viewed as a partner in chronic disease care. Engaging GPs in new initiatives is challenging, and measures facilitating uptake of new innovations are required. Any new intervention needs to: be developed with GPs to meet their needs; have considerable lead-in time to develop rapport with GPs and raise awareness; and ideally, have dedicated support staff within practices to reduce the demand on already-overburdened practice staff. Feasible and effective mechanisms need to be developed to facilitate uptake of new innovations in the general practice setting.

Practice manager expectations of new graduate registered nurses in Australian general practice: a national survey

2016 ◽  
Vol 22 (6) ◽  
pp. 559
Author(s):  
Christina Aggar ◽  
Jacqueline G. Bloomfield ◽  
Cynthia Stanton ◽  
Catherine Baynie ◽  
Christopher J. Gordon
Keyword(s):  
General Practice ◽  
Registered Nurses ◽  
Workforce Development ◽  
Demographic Data ◽  
First Year ◽  
Practice Nurses ◽  
Australian State ◽  
New Graduate ◽  
Australian General Practice ◽  
Predominantly Female

Practice managers are often involved in the employment of practice nurses and are likely to have a significant role in future transition programs in general practice. Therefore, the aim of the study was to explore practice managers’ expectations of new graduate registered nurses working in general practice. A nation-wide web-based electronic survey distributed by the Australian Association of Practice Management was used to collect demographic data and practice managers’ expectations of new graduate nurses directly transitioning into general practice in their first year of practice. The sample was broadly representative of the Australian state and territory population numbers. Respondents were predominantly female with postgraduate qualifications. The findings of this study highlight that practice managers who currently work with practice nurses would be supportive of graduate registered nurses in general practice in their first year with preceptor support. The results of this study have important implications for nursing workforce development and it is recommended that such initiatives are widely introduced with appropriate financial support.

Nurse - patient encounters in general practice: patterns in general practitioner involvement and use of nurse-specific Medicare items

2010 ◽  
Vol 16 (3) ◽  
pp. 224 ◽  
Author(s):  
Catherine M. Joyce ◽  
Leon Piterman
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Clinical Work ◽  
Test Results ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Practice Nurses ◽  
Australian General Practice ◽  
Data Collections ◽  
Medical Examinations

A significant gap exists in knowledge about general practice nurses’ (GPNs) patient care activities, despite their now strong presence in Australian general practice. The aim of this paper is to explore the extent of direct general practitioner (GP) involvement in nurse–patient consultations, and to compare consultations where nurse-specific Medicare items were claimable with consultations where they were not. Data from the Practice Nurse Work Survey, a national cross-sectional survey conducted between May 2007 and May 2008, were analysed. Of the total 5253 nurse–patient encounters, 29% did not involve any contact between the patient and a GP, either directly before, during or directly after the nurse consultation. Encounters without GP involvement were more likely to be indirect (e.g. by telephone) and off-site (e.g. home visits), and had higher rates of administrative actions such as documentation and arranging visits. Nurse-specific Medicare item numbers applied in less than half (42%) of nurse–patient encounters. Encounters where no such item applied were more likely to involve medical examinations, blood tests, electrical tracings, physical function tests, removal of sutures, test results, assisting at operations and preparing for procedures. These results confirm that existing data collections do not capture the extent and nature of GPNs’ clinical work.

scholarly journals Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jenny Haycock ◽  
Nicole Grivell ◽  
Anne Redman ◽  
Bandana Saini ◽  
Andrew Vakulin ◽  
...  
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Best Practice ◽  
Geographic Location ◽  
Behavioural Therapy ◽  
Chronic Insomnia ◽  
Structured Interviews ◽  
Treatment Pathways ◽  
Falling Asleep ◽  
Australian General Practice

Abstract Background Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. Methods A descriptive, pragmatic qualitative study. Purposive sampling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using thematic analysis.  Results Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care; 2) Complexities in managing insomnia; and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited.  Conclusions General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners. Greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services, such as benzodiazepine withdrawal support and psychologists, would benefit insomnia management within general practice.

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