Cross-sectional survey of older patients’ views regarding multidisciplinary care for chronic conditions in general practice
Andrew Bonney A B D , Christopher Magee B and Russell Pearson CA Graduate School of Medicine, Building 28, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
B Centre for Health Initiatives, Building 233 (ITAMS), Innovation Campus, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
C Shell Cove Family Health, Shallows Drive, Shell Cove, NSW 2529, Australia.
D Corresponding author. Email: abonney@uow.edu.au
Australian Journal of Primary Health 20(1) 27-33 https://doi.org/10.1071/PY12101
Submitted: 16 August 2012 Accepted: 24 October 2012 Published: 19 November 2012
Abstract
The ageing population and increasing prevalence of chronic illness have contributed to the need for significant primary care reform, including increased use of multidisciplinary care and task substitution. This cross-sectional study explores conditions under which older patients would accept having health professionals other than their general practitioner (GP) involved in their care for chronic disease management (CDM). Ten practices were randomly sampled from a contiguous major city and inner regional area. Questionnaires were distributed to consecutive patients aged 60 years and over in each practice. Agency theory was used to inform analyses. Statistical analysis was undertaken using Wald’s test, growth modelling and linear regression, controlling for the clustered design. The response rate was 53% (n = 272). Most respondents (79%) had at least one chronic health condition. Respondents were more comfortable with GP than with practice nurse management in the CDM scenario (Wald’s test = 105.49, P < 0.001). Comfort with practice nurse CDM was positively associated with increased contact with their GP at the time of the visit (β = 0.41, P < 0.001), negatively associated with the number of the respondent’s chronic conditions (β = –0.13, P = 0.030) and not associated with the frequency of other health professional visits. Agency theory suggests that patients employ continuity of care to optimise factors important in CDM: information symmetry and goal alignment. Our findings are consistent with the theory and lend support to ensuring that interpersonal continuity of care is not lost in health care reform. Further research exploring patients’ acceptance of differing systems of care is required.
Additional keywords: agency theory, practice nurse, team care.
References
AIHW (2008) ‘Incidence and prevalence of chronic diseases.’ (Australian Government: Canberra) Available at http://www.aihw.gov.au/cdarf/data_pages/incidence_prevalence/index.cfm [Verified 26 May 2010]Bonney A, Farmer E (2010) Health care reform: can we maintain personal continuity? Australian Family Physician 39, 455–456.
Bonney A, Magee C, Caputi P (2011) Measuring older patients’ attitudes to general practice registrars: exploratory factor analysis of a survey instrument. Focus on Health Professional Education: A Multi-Disciplinary Journal 12, 74–85.
Bonney A, Jones SC, Iverson D (2012) The older patient, the general practitioner and the trainee: patients’ attitudes and implications for training. Education for Primary Care 23, 186–195.
Britt H, Miller GC, Charles J, Henderson J, Bayram C, Pan Y, Valenti L, Harrison C, Fahridin S, O’Halloran J (2009) ‘General practice activity in Australia, 2008–09.’ General practice series no. 25. Cat. no. GEP 25. (AIHW: Canberra)
Donaldson MS (2001) Continuity of care: a reconceptualization. Medical Care Research and Review 58, 255–290.
| Continuity of care: a reconceptualization.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvotVSrsQ%3D%3D&md5=6ac925d897bdbcf4cda02afeeb0a8518CAS |
Douglas KA, Rayner FK, Yen LE, Wells RW, Glasgow NJ, Humphreys JS (2009) Australia’s primary health care workforce – research informing policy. The Medical Journal of Australia 191, 81–84.
Eisenhardt KM (1989) Agency theory: an assessment and review. Academy of Management Review 14, 57–74.
Eley DS, Patterson E, Young J, Fahey PP, Del Mar CB, Hegney DG, Synnott RL, Mahomed R, Baker PG, Scuffham PA (2012) Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice. Australian Journal of Primary Health
| Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice.Crossref | GoogleScholarGoogle Scholar |
Guthrie B, Saultz JW, Freeman GK, Haggery JL (2008) Continuity of care matters. British Medical Journal 337, a867
| Continuity of care matters.Crossref | GoogleScholarGoogle Scholar |
Harrison C, Britt H (2011) General practice − workforce gaps now and in 2020. Australian Family Physician 40, 12–15.
Ionescu-Ittu R, McCusker J, Ciampi A, Vadeboncoeur AM, Roberge D, Larouche D, Verdon J, Pineault R (2007) Continuity of primary care and emergency department utilization among elderly people. Canadian Medical Association Journal 177, 1362–1368.
| Continuity of primary care and emergency department utilization among elderly people.Crossref | GoogleScholarGoogle Scholar |
Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B (2005) Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Reviews 2, CD001271
Laurant MGH, Hermens RPMG, Braspenning JCC, Akkermans RP, Sibbald B, Grol RPTM (2008) An overview of patients’ preference for, and satisfaction with, care provided by general practitioners and nurse practitioners. Journal of Clinical Nursing 17, 2690–2698.
| An overview of patients’ preference for, and satisfaction with, care provided by general practitioners and nurse practitioners.Crossref | GoogleScholarGoogle Scholar |
Muthén LK, Muthén BO (1998–2010) ‘Mplus user’s guide.’ 6th edn. (Muthén & Muthén: Los Angeles, CA)
NHHRC (2009) A healthier future for all Australians − final report of the National Health and Hospitals Reform Commission, June 2009. Commonwealth of Australia, Canberra. Available at http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report [Verified 28 September 2010]
Nutting PA, Goodwin MA, Flocke SA, Zyzanski SJ, Stange KC (2003) Continuity of primary care: to whom does it matter and when? Annals of Family Medicine 1, 149–155.
| Continuity of primary care: to whom does it matter and when?Crossref | GoogleScholarGoogle Scholar |
Schneider H, Mathios A (2006) Principal agency theory and health care utilization. Economic Inquiry 44, 429–441.
| Principal agency theory and health care utilization.Crossref | GoogleScholarGoogle Scholar |
Scott IA (2009) Health care workforce crisis in Australia: too few or too disabled? The Medical Journal of Australia 190, 689–692.
Sekwat A (2000) Principal-agent theory: a framework for improving health care reform in Tennessee. Journal of Health and Human Services Administration 22, 277–291.
Shapiro SP (2005) Agency theory. Annual Review of Sociology 31, 263–284.
| Agency theory.Crossref | GoogleScholarGoogle Scholar |
Worrall G, Knight J (2011) Continuity of care is good for elderly people with diabetes: retrospective cohort study of mortality and hospitalization. Canadian Family Physician Medecin de Famille Canadien 57, e16–e20.
