Abstract
BackgroundThe healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. General practitioners are encouraged to delegate more clinical tasks to their staff in order to respond to the changing circumstances. Nevertheless, the degree of task delegation varies substantially between general practices, and how these different degrees affect the quality of care for the patients is currently not known. Using chronic obstructive pulmonary disease (COPD) as our case scenario, the aim of the study was to investigate associations between degrees of task delegation in general practice and spirometry testing as a measure of quality of care.MethodsWe carried out a cross-sectional study comprising all general practices in Denmark and patients suffering from chronic obstructive pulmonary disease. General practitioners (GPs) were invited to participate in a survey investigating degrees of task delegation in their clinics. Data were linked to national registers on spirometry testing among patients with COPD. We investigated associations using multilevel mixed-effects logit models and adjusted for practice and patient characteristics.ResultsGPs from 895 practices with staff managing COPD-related tasks responded, and 61,223 COPD patients were linked to these practices. Hereof, 24,685 (40.3%) had a spirometry performed within a year. Patients had a statistically significant higher odds ratio (OR) of having an annual spirometry performed in practices with medium or maximal degrees of task delegation compared to practices with a minimal degree (OR = 1.27 and OR = 1.33, respectively).ConclusionDelegating more complex tasks to practice staff implies that COPD-patients are more likely to be treated according to evidence-based recommendations on spirometry testing.
Highlights
The healthcare systems in the western world have in recent years faced major challenges caused by changes in demography and the pattern of diseases as well as political decisions influencing the organisation of healthcare provision [1]
A total of 3404 of the 3440 invited General practitioner (GP) were eligible for participation, and 1580 responded to the questionnaire corresponding to 46.4%
In accordance with our hypothesis, the analyses showed that chronic obstructive pulmonary disease (COPD) patients had a statistiscally significantly higher odds ratio of having spirometry performed if they were listed with a general practice with medium or maximal degree of delegation compared to a practice with minimal degree of delegation
Summary
The healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. The healthcare systems in the western world have in recent years faced major challenges caused by changes in demography and the pattern of diseases as well as political decisions influencing the organisation of healthcare provision [1]. The increase in people suffering from chronic conditions and the shift of tasks from secondary to primary care has increased the amount of tasks in general practice [2]. Based on the literature in the area, we hypothesize that higher degrees of task delegation are associated with a higher adherence to guidelines when treating patients with chronic disease
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