Establishing a new model of integrated primary and secondary care based around general practice: a case study of lessons learned and challenges
Claire L. Jackson A E , Maria Donald A , Anthony W. Russell B C and H. David McIntyre DA Primary Care Clinical Unit, Faculty of Medicine, Level 8 Health Sciences Building, Royal Brisbane and Women’s Hospital, The University of Queensland, Herston, Qld 4006, Australia. Email: m.donald@uq.edu.au
B Department of Diabetes and Endocrinology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: Anthony.Russell2@health.qld.gov.au
C PAH-Southside Clinical Unit, Faculty of Medicine, University of Queensland, Level 2, Translational Research Institute, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia.
D Mater-Southside Clinical Unit, Faculty of Medicine, Mayne Medical Building, The University of Queensland, 288 Herston Road, Herston, Qld 4006, Australia. Email: h.d.mcintyre@uq.edu.au
E Corresponding author. Email: c.jackson@uq.edu.au
Australian Health Review 42(3) 299-302 https://doi.org/10.1071/AH16147
Submitted: 4 July 2016 Accepted: 14 March 2017 Published: 9 May 2017
Abstract
This case study describes the development and implementation of an innovative integrated primary–secondary model of care for people with complex diabetes. The aim of the paper is to present the experiences of clinicians and researchers involved in implementing the ‘Beacon’ model by providing a discussion of the contextual factors, including lessons learned, challenges and solutions. Beacon-type models of community care for people with chronic disease are well placed to deliver on Australia’s health care reform agenda, and this commentary provides rich contextual information relevant to the translation of such models into policy and practice.
What is known about the topic? Better integrated clinical models of care with close cooperation between hospital-based specialists and general practitioners (GPs) is fundamental to chronic disease management.
What does this paper add? A real world example of the challenges faced in implementing models of integrated care across diverse settings and business models.
What are the implications for clinicians? Practice, organisational and external factors including energy clinician leadership and resourcing are critical for translation of evidence into ongoing practice.
References
[1] Primary Health Care Advisory Group. Better outcomes for people with chronic and complex health conditions. Canberra: Department of Health; 2015.[2] Medicare Benefits Schedule Review Panel. Medicare Benefits Schedule review. Canberra: Department of Health; 2016. Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/mbsreviewtaskforce [verified December 2016].
[3] Australian Government Department of Health. Private health insurance consultations 2015–16. Canberra: Department of Health; 2016. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/PHIconsultations2015-16 [verified December 2016].
[4] Australian Government Department of Health. Review of the personally controlled electronic health record. 2013. Available at: https://health.gov.au/internet/main/publishing.nsf/Content/17BF043A41D470A9CA257E13000C9322/$File/FINAL-Review-of-PCEHR-December-2013.pdf [verified December 2016].
[5] Gruen RL, Weeramanthri TS, Knight SE, Bailie RS. Specialist outreach clinics in primary care and rural hospital settings. Cochrane Database Syst Rev 2003; 4 CD003798
| Specialist outreach clinics in primary care and rural hospital settings.Crossref | GoogleScholarGoogle Scholar |
[6] Mitchell GK, Burridge LH, Zhang J, Donald M, Scott IA, Dart J, Jackson CL. Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness? Aust J Primary Health 2015; 21 391–408.
| Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?Crossref | GoogleScholarGoogle Scholar |
[7] Jackson CL, Askew DA. Is there a polyclinic alternative acceptable to general practice? The ‘Beacon’ practice model. Br J Gen Pract 2008; 58 733
| Is there a polyclinic alternative acceptable to general practice? The ‘Beacon’ practice model.Crossref | GoogleScholarGoogle Scholar |
[8] Jackson CL, Askew DA, Nicholson C, Brooks P. The primary care amplification model: taking the best of primary care forward. BMC Health Serv Res 2008; 8 268
| The primary care amplification model: taking the best of primary care forward.Crossref | GoogleScholarGoogle Scholar |
[9] Jackson CL, Tsai J, Brown C, Askew DA, Russell AW. GPs with special interests impacting on complex diabetes care. Aust Fam Physician 2010; 39 972–4.
[10] Russell AW, Baxter KA, Askew DA, Tsai J, Ware RS, Jackson CL. Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial. Diabet Med 2013; 30 1112–21.
| Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3sjhvVCmsA%3D%3D&md5=58ad7a64d3e375bb74bca7eeb2a74262CAS |
[11] Hepworth J, Askew DA, Jackson CL, Russell AW. ‘Working with the team’: an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care. Aust J Primary Health 2013; 19 207–12.
| ‘Working with the team’: an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care.Crossref | GoogleScholarGoogle Scholar |
[12] Zhang J, Donald M, Baxter KA, Ware RS, Burridge LH, Russell AW, Jackson CL. Impact of an integrated model of care on potentially preventable hospitalizations for people with Type 2 diabetes mellitus. Diabet Med 2015; 32 872–80.
| Impact of an integrated model of care on potentially preventable hospitalizations for people with Type 2 diabetes mellitus.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2MvosVCmtQ%3D%3D&md5=e8cb6b82e7ee305d05b481987ec2ba2dCAS |
[13] Zhang J, Burridge LH, Baxter KA, Donald M, Foster MM, Hollingworth SA, Ware RS, Russell AW, Jackson CL. A new model of integrated primary–secondary care for complex diabetes in the community: study protocol for a randomised controlled trial. Trials 2013; 14 382
| A new model of integrated primary–secondary care for complex diabetes in the community: study protocol for a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[14] Tomoaia-Cotisel A, Scammon DL, Waitzman NJ, Cronholm PF, Halladay JR, Driscoll DL, Solberg LI, Hsu C, et al Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change. Ann Fam Med 2013; 11 S115–23.
| Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change.Crossref | GoogleScholarGoogle Scholar |
[15] Kaplan HC, Brady PW, Dritz MC, Hooper DK, Linam WM, Froehle CM, Margolis P. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q 2010; 88 500–59.
| The influence of context on quality improvement success in health care: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |
[16] Burridge LH, Foster MM, Donald M, Zhang J, Russell AW, Jackson CL. A qualitative follow-up study of diabetes patients’ appraisal of an integrated diabetes service in primary care. Health Soc Care Community 2017; 25 1031–40.
| A qualitative follow-up study of diabetes patients’ appraisal of an integrated diabetes service in primary care.Crossref | GoogleScholarGoogle Scholar |
[17] Foster MM, Burridge LH, Donald M, Zhang J, Jackson CL. The work of local healthcare innovation: a qualitative study of GP-led integrated diabetes care in primary health care. BMC Health Serv Res 2016; 16 11
| The work of local healthcare innovation: a qualitative study of GP-led integrated diabetes care in primary health care.Crossref | GoogleScholarGoogle Scholar |
[18] Australian Government Department of Health. A healthier Medicare for chronically-ill patients. 2016. Available at: http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2016-ley021.htm [verified December 2016].
[19] Council of Australian Governments. COAG meeting communiqué, 1 April 2016. 2016. Available at: https://www.coag.gov.au/meeting-outcomes/coag-meeting-communiqué-1-april-2016 [verified 3 April 2017].
[20] Johnson M, Goyder E. Changing roles, changing responsibilities and changing relationships: an exploration of the impact of a new model for delivering integrated diabetes care in general practice. Qual Prim Care 2005; 13 85–90.
[21] Larme AC, Pugh JA. Evidence-based guidelines meet the real world: the case of diabetes care. Diabetes Care 2001; 24 1728–33.
| Evidence-based guidelines meet the real world: the case of diabetes care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrjvF2rtg%3D%3D&md5=285cafe98d110ffa6fcffa0ec6b4ce97CAS |
[22] Neta G, Glasgow RE, Carpenter CR, Grimshaw JM, Rabin BA, Fernandez ME, Brownson RC. A framework for enhancing the value of research for dissemination and implementation. Am J Public Health 2015; 105 49–57.
| A framework for enhancing the value of research for dissemination and implementation.Crossref | GoogleScholarGoogle Scholar |