Evaluation of a General Practitioner with Special Interest model: lessons learned from staff experiences
L. Purtell A B C * , E. Whiting D , K. Muller D , C. McSherry D , K. Gillespie A , K. Havas D and A. Bonner A B DA School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, Qld 4222, Australia.
B Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Qld 4222, Australia.
C Research Development Unit, Caboolture Hospital, McKean Street, Caboolture, Qld 4510, Australia.
D Metro North Health, Herston, Qld 4029, Australia.
Australian Journal of Primary Health 28(4) 330-337 https://doi.org/10.1071/PY21065
Submitted: 18 March 2021 Accepted: 19 January 2022 Published: 25 March 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University.
Abstract
Background: The integration of general practitioners into specialist outpatient clinics is associated with improved access to care; however, little is understood about the organisation-level factors that affect successful implementation. We aimed to identify factors that were facilitators or barriers to the implementation of a General Practitioner with Special Interest (GPwSI) model of care across a range of specialties.
Methods: Semi-structured, in-depth interviews were conducted with 25 stakeholders at 13 GPwSI clinics in operation within a Queensland public health service. A deductive content analysis was conducted using the Consolidated Framework for Implementation Research (CFIR).
Results: Stakeholders generally supported the GPwSI model and saw advantages to patients and specialist medical practitioners in terms of waiting lists, workload, and improving clinician self-efficacy and knowledge. A number of factors were identified as being crucial to the success of the program, such as adequate support and planning for the implementation, appropriate funding and advocacy.
Conclusions: Our evaluation indicates that a GPwSI model can be a beneficial resource for improving care to patients and reducing wait lists, dependent upon adequate planning, training, and support.
Keywords: general practice, General Practitioner with Special Interest (GPwSI), health service evaluation, implementation science, integrated healthcare, interviews, models of care, qualitative.
References
Angeli F, Jaiswal AK (2016) Business model innovation for inclusive health care delivery at the bottom of the pyramid. Organization & Environment 29, 486–507.| Business model innovation for inclusive health care delivery at the bottom of the pyramid.Crossref | GoogleScholarGoogle Scholar |
Boggis AR, Cornford CS (2007) General practitioners with special clinical interests: A qualitative study of the views of doctors, health managers and patients. Health Policy 80, 172–178.
| General practitioners with special clinical interests: A qualitative study of the views of doctors, health managers and patients.Crossref | GoogleScholarGoogle Scholar | 16621121PubMed |
Bowling A, Bond M (2001) A national evaluation of specialists’ clinics in primary care settings. British Journal of General Practice 51, 264–269.
Burridge LH, Foster MM, Donald M, et al. (2017) A qualitative follow-up study of diabetes patients’ appraisal of an integrated diabetes service in primary care. Health & Social Care in the Community 25, 1031–1040.
| A qualitative follow-up study of diabetes patients’ appraisal of an integrated diabetes service in primary care.Crossref | GoogleScholarGoogle Scholar |
Cedillo-Couvert EA, Ricardo AC, Chen J, et al. (2018) Self-reported medication adherence and CKD progression. Kidney International Reports 3, 645–651.
| Self-reported medication adherence and CKD progression.Crossref | GoogleScholarGoogle Scholar | 29854972PubMed |
Coast J, Noble S, Noble A, et al. (2005) Economic evaluation of a general practitioner with special interests led dermatology service in primary care. British Medical Journal 331, 1444–1449.
| Economic evaluation of a general practitioner with special interests led dermatology service in primary care.Crossref | GoogleScholarGoogle Scholar | 16339217PubMed |
CFIR Research Team (2021) Consolidated Framework for Implementation Research [Online]. Available at https://cfirguide.org/ [Verified 16 July 2021]
Damschroder LJ, Aron DC, Keith RE, et al. (2009) Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science 4, 1–15.
| Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science.Crossref | GoogleScholarGoogle Scholar |
Donald M, Jackson CL, Byrnes J, et al. (2021) Community-based integrated care versus hospital outpatient care for managing patients with complex type 2 diabetes: Costing analysis. Australian Health Review 45, 42–50.
| Community-based integrated care versus hospital outpatient care for managing patients with complex type 2 diabetes: Costing analysis.Crossref | GoogleScholarGoogle Scholar | 33563370PubMed |
Feeley TW, Fly HS, Ronald Walters Md M, Burke TW, Amanda Henson M (2010) A method for defining value in healthcare using cancer care as a model/practitioner application. Journal of Healthcare Management 55, 399
| A method for defining value in healthcare using cancer care as a model/practitioner application.Crossref | GoogleScholarGoogle Scholar | 21166323PubMed |
Gerada C, Limber C (2003) General practitioners with special interests: Implications for clinical governance. Quality in Primary Care 11, 47–52.
Greenwood-Lee J, Jewett L, Woodhouse L, Marshall DA (2018) A categorisation of problems and solutions to improve patient referrals from primary to specialty care. BMC Health Services Research 18, 986
| A categorisation of problems and solutions to improve patient referrals from primary to specialty care.Crossref | GoogleScholarGoogle Scholar | 30572898PubMed |
Gruen RL, Weeramanthri TS, Knight SE, Bailie RS (2004) Specialist outreach clinics in primary care and rural hospital settings. The Cochrane Database Systematic Reviews CD003798
| Specialist outreach clinics in primary care and rural hospital settings.Crossref | GoogleScholarGoogle Scholar |
Hollingworth SA, Donald M, Zhang J, et al. (2017) Impact of a general practitioner-led integrated model of care on the cost of potentially preventable diabetes-related hospitalisations. Primary Care Diabetes 11, 344–347.
| Impact of a general practitioner-led integrated model of care on the cost of potentially preventable diabetes-related hospitalisations.Crossref | GoogleScholarGoogle Scholar | 28442341PubMed |
Naiker U, Fitzgerald G, Dulhunty JM, Rosemann M (2017) Time to wait: A systematic review of strategies that affect out-patient waiting times. Australian Health Review 42, 286–293.
| Time to wait: A systematic review of strategies that affect out-patient waiting times.Crossref | GoogleScholarGoogle Scholar |
National Health Service (2000) ‘The NHS plan: A plan for investment, a plan for reform.’ (National Health Service, UK Department of Health: London)
Powell J (2002) Systematic review of outreach clinics in primary care in the UK. Journal of Health Services Research & Policy 7, 177–183.
| Systematic review of outreach clinics in primary care in the UK.Crossref | GoogleScholarGoogle Scholar |
Queensland Health (2016) ‘Specialist outpatient strategy: Improving the patient journey by 2020.’ (Queensland Health: Brisbane)
Russell AW, Donald M, Borg SJ, et al. (2019) Clinical outcomes of an integrated primary-secondary model of care for individuals with complex type 2 diabetes: A non-inferiority randomised controlled trial. Diabetologia 62, 41–52.
| Clinical outcomes of an integrated primary-secondary model of care for individuals with complex type 2 diabetes: A non-inferiority randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 30284015PubMed |
Salisbury C, Noble A, Horrocks S, et al. (2005) Evaluation of a general practitioner with special interest service for dermatology: Randomised controlled trial. British Medical Journal 331, 1441–1446.
| Evaluation of a general practitioner with special interest service for dermatology: Randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 16332728PubMed |
Sibbald B, Mcdonald R, Roland M (2007) Shifting care from hospitals to the community: A review of the evidence on quality and efficiency. Journal of Health Services Research & Policy 12, 110–117.
| Shifting care from hospitals to the community: A review of the evidence on quality and efficiency.Crossref | GoogleScholarGoogle Scholar |
Van Hoof SJM, Quanjel TCC, Kroese MEAL, Spreeuwenberg MD, Ruwaard D (2019) Substitution of outpatient hospital care with specialist care in the primary care setting: A systematic review on quality of care, health and costs. PLoS One, 14, e0219957
| Substitution of outpatient hospital care with specialist care in the primary care setting: A systematic review on quality of care, health and costs.Crossref | GoogleScholarGoogle Scholar |
Wilkinson S, Mcintyre D, Nicholson C, et al. (2016) Implementation and evaluation of gestational diabetes care in general practice–development in “beacon” general practices. (APHCRI Centre of Research Excellence–Building Primary Health Care Quality, Governance Sustainability via Research Co-creation, The University of Queensland)
Winpenny EM, Miani C, Pitchforth E, King S, Roland M (2017) Improving the effectiveness and efficiency of outpatient services: A scoping review of interventions at the primary–secondary care interface. Journal of Health Services Research & Policy 22, 53–64.
| Improving the effectiveness and efficiency of outpatient services: A scoping review of interventions at the primary–secondary care interface.Crossref | GoogleScholarGoogle Scholar |
Yellamaty V, Ball L, Crossland L, Jackson C (2019) General practitioners with special interests: ‘An integrative review of their role, impact and potential for the future’. Australian Journal of General Practice 48, 639–645.
| General practitioners with special interests: ‘An integrative review of their role, impact and potential for the future’.Crossref | GoogleScholarGoogle Scholar | 31476836PubMed |
