Abstract
The escalation in the incidence of diabetes mellitus type 2 requires innovative approaches to manage the increasing burden of service provision, a particularly challenging issue for rural communities. Whereas shared care through specialist outreach clinics is a traditional approach to the management of chronic disease, the results on effectiveness are mixed. Where there is a joint consultation with both the General Practitioner (GP) and specialist present during the patient consultation, benefits are reported; however, this model of specialist outreach is uncommon when compared with the more typical model where a specialist sees the patient alone but at the GP's rooms, and later communicates with the GP. The explicit long-term goal of the Physician in Practice Clinic, which emulates the joint consultation model, is improved patient outcomes through better educated and more confident GPs, easier service access for patients and reduced waiting lists. The education of GPs in endocrinology, an early goal, is the focus of the article. Fifteen GPs were sampled purposively on sex, rural/regional location, place of training, practice size and length of time practising locally. Semi-structured interviews were conducted, transcribed then thematically analysed. General practitioners reported substantial educational benefits. One aspect is the face-to-face contract with the endocrinologist which promotes an interactive learning process. All GPs reported that they acquired new knowledge. An important aspect of this new knowledge is that it could be used quickly, often immediately, and also used in the longer term when generalised for use with other patients. A follow-on effect from the new knowledge and its short- and long-term application was an increase in professional confidence. A benefit with the potential for a long-term effect was improved relationships between the GPs and specialist, and the GPs reporting that they were making fewer referrals. The greatest benefits reported by those in small practices were the interactive learning and being able to generalise the new knowledge to other patients. For rural doctors most benefit was from the interactive learning, whereas for regional doctors it was increased confidence. Australian trained doctors reported mostly the benefits of being able to use the knowledge quickly and the interactive learning. By contrast, doctors not trained in Australia favoured the increased confidence and the generalisability of the new knowledge. Those who had practised locally for up to 10 years benefited most from the new knowledge and the increased confidence, and females benefited most from increased confidence and receiving new knowledge. From the GPs' perspective, the goal of creating better educated and more confident GPs in endocrinology in this rural/regional setting was achieved. Therefore this easily replicated but novel approach to specialist outreach has the potential to improve health outcomes in chronic disease in rural communities. In addition, a more tailored approach to shaping the Clinics based on the socio-demographic categories reported here could have additional short- and long-term benefits.
Highlights
The escalation in the incidence of diabetes mellitus type 2 requires innovative approaches to manage the increasing burden of service provision, a challenging issue for rural communities
Of the 15 General Practitioner (GP) interviewed, 10 were from large practices; 12 worked in a regional location (Toowoomba); 10 were trained in Australia; eight had been practising locally for up to 10 years; and eight were female (Table 1). Whereas these numbers reflected the proportions of GPs in Physician in Practice Clinic (PIPC) with these characteristics, there are differences between these and national and state data
In Queensland 79.7% of employed medical practitioners are Australian trained[27], whereas this was so for only 66.7% of Clinic GPs; this disparity could reflect that conditionally registered medical practitioners are not included in Queensland registration data
Summary
The escalation in the incidence of diabetes mellitus type 2 requires innovative approaches to manage the increasing burden of service provision, a challenging issue for rural communities. The greatest benefits reported by those in small practices were the interactive learning and being able to generalise the new knowledge to other patients. Doctors not trained in Australia favoured the increased confidence and the generalisability of the new knowledge. Conclusions: From the GPs’ perspective, the goal of creating better educated and more confident GPs in endocrinology in this rural/regional setting was achieved. This replicated but novel approach to specialist outreach has the potential to improve health outcomes in chronic disease in rural communities. Effective approaches to the management and prevention of diabetes are important, with General Practitioners (GPs) being at a key point of intervention in service provision[7]. The number of full time equivalent (FTE) medical practitioners in inner regional locations (186 per 100 000) is approximately half that in major cities
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