Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice: an exploratory survey.

Jo-Anne Manski-Nankervis,Irene Blackberry,Elizabeth Patterson,Doris Young,John Furler,David O’Neal

doi:10.1186/s12913-014-0515-3

Jo-Anne Manski-Nankervis, Irene Blackberry + Show 4 more

Open Access

https://doi.org/10.1186/s12913-014-0515-3

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Abstract

BackgroundThe majority of people with type 2 diabetes (T2D) receive their care in general practice and will eventually require initiation of insulin as part of their management. However, this is often delayed and frequently involves referral to specialists. If insulin initiation is to become more frequent and routine within general practice, coordination of care with specialist services may be required. Relational coordination (RC) provides a framework to explore this. The aim of this study was to explore RC between specialist physicians, specialist diabetes nurses (DNEs), generalist physicians in primary care (GPs) and generalist nurses (practice nurses (PNs)) and to explore the association between RC and the initiation of insulin in general practice, and the belief that it is appropriate for this task to be carried out in general practice.MethodsA survey was distributed to a convenience sample of specialist physicians, DNEs, GPs and practice nurses. We collected data on demographics, models of care and RC in relation to insulin initiation. We expected that RC would be higher between specialists than between specialists and generalists. We expected higher RC between specialists and generalists to be associated with insulin initiation in general practice and with the belief that it is appropriate for insulin initiation to be carried out in general practice. We used descriptive statistics and non-parametric tests to explore these hypotheses.Results179 health professionals returned completed surveys. Specialists reported higher RC with each other and lower RC with PNs. All groups except PNs reported their highest RC with DNEs, suggesting the potential for DNEs to serve as boundary spanners. Lower RC with specialists was reported by those working within a general practice model of care. Health professionals who felt that a general practice model was appropriate reported lower communication with specialist physicians and higher shared knowledge with GPs.ConclusionGiven the need for coordination between specialist and generalist care for the task of insulin initiation, this study’s results suggest the need to build relationships and communication between specialist and generalist health professional groups and the potential for DNE’s to play a boundary spanner role in this process.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0515-3) contains supplementary material, which is available to authorized users.

Highlights

The majority of people with type 2 diabetes (T2D) receive their care in general practice and will eventually require initiation of insulin as part of their management
When insulin initiation is eventually needed it is often delayed [9,10,11] in part because the majority of people with Type 2 diabetes (T2D) (PwT2D) are referred to specialist physicians and diabetes nurse educators (DNEs) [12]
Models of care for insulin initiation The majority of specialist physicians indicated that they worked within a specialist routine model in which General practitioner (GP) referred PwT2D to them for primary responsibility of insulin initiation and ongoing management. 50% of GPs and 65% of practice nurses reported that the majority of initiation and management of insulin occurred in general practice, with or without the assistance of a practice nurse

Summary

Introduction

The majority of people with type 2 diabetes (T2D) receive their care in general practice and will eventually require initiation of insulin as part of their management. This is often delayed and frequently involves referral to specialists. If insulin initiation is to become more frequent and routine within general practice, coordination of care with specialist services may be required. Type 2 diabetes (T2D) is a complex chronic condition where the coordinated efforts of a number of health professionals may be needed to support patients as they manage this lifelong illness. New models of care to support this are being explored [16,17,18]

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