General Practitioners Communication Research Articles

Walking in their shoes: How primary-care experiences of adults aged 50+ reveal the benefits of e-learning intervention for general practitioners.

Patient experiences and activation are increasingly researched. However, related data are limited in three areas: interventions for general practitioners (GPs) working with mature adults (50+), dedicated e-learning interventions for GPs, and assessments of e-learning for medical staff through patient experiences. We examined how e-learning intervention focused on improving GPs' skills in activating communication (understood as promoting engagement and active participation in healthcare) can enhance the experiences of mature patients. The intervention was designed for GPs, yet innovative assessment was based on patient experiences post-visit. Three research conditions for GPs (n = 165) were introduced: (1) e-learning or (2) pdf-article intervention and (3) control. Two independent waves of their patients participated before and after the intervention. Experience measures for patients (n = 1639) included the Patient Expectations Scale (post-visit), perceived GP's Communication Skills scale, and Patient Satisfaction with Visit scale. E-learning intervention compared with the control group had a favorable effect for 5 out of 8 dimensions of patient experience. Change in emotional support and quality of life was particularly visible. Mature patient experiences can be improved with the e-learning intervention for GPs. Measuring patient experience enriches the available knowledge and can help design future research and interventions.

Communication of personalised disease risk by general practitioners to motivate smoking cessation in England: a cost-effectiveness and research prioritisation study.

Communication of personalised disease risk can motivate smoking cessation. We assessed whether routine implementation of this intervention by general practitioners (GPs) in England is cost-effective or whether we need further research to better establish its effectiveness. Cost-effectiveness analysis (CEA) with value of information (VoI) analysis from the UK National Health Service perspective, using GP communication of personalised disease risk on smoking cessation versus usual care. GP practices in England. Healthy smokers aged 35-60 years attending the GP practice. Effectiveness of GP communication of personalised disease risk on smoking cessation was estimated through systematic review and meta-analysis. A Bayesian CEA was then performed using a lifetime Markov model on smokers aged 35-60 years that measured lifetime costs and quality-adjusted life-years (QALYs) assigned to the four diseases contributing the most to smoking-related morbidity, mortality and costs: chronic obstructive pulmonary disease, lung cancer, myocardial infarction and stroke. Costs and QALYs for each disease state were obtained from the literature. VoI analysis identified sources of uncertainty in the CEA and assessed how much would be worth investing in further research to reduce this uncertainty. The meta-analysis odds ratio for the effectiveness estimate of GP communication of personalised disease risk was 1.48 (95% credibility interval, 0.91-2.26), an absolute increase in smoking cessation rates of 3.84%. The probability of cost-effectiveness ranged 89-94% depending on sex and age. VoI analysis indicated that: (i) uncertainty in the effectiveness of the intervention was the driver of the overall uncertainty in the CEA; and (ii) a research investment to reduce this uncertainty is justified if lower than £27.6 million (£7 per smoker). Evidence to date shows that, in England, incorporating disease risk communication into general practitioners' practices to motivate smoking cessation is likely to be cost-effective compared with usual care.

Improving patient self-reporting of antihypertensive adverse drug events in primary care: a stepped wedge cluster randomised trial

BackgroundAbout 25% of patients experience adverse drug events (ADE) in primary care, but few events are reported by the patients themselves. One solution to improve the detection and management of ADEs in primary care is for patients to report them to their general practitioner. The study aimed to assess the effect of a booklet designed to improve communication and interaction between patients treated with anti-hypertensive drugs and general practitioners on the reporting of ADEs.MethodsA cluster randomized controlled cross-sectional stepped wedge open trial (five periods of 3 months) was conducted. A cluster was a group of general practitioners working in ambulatory offices in France. Adults consulting their general practitioner to initiate, modify, or renew an antihypertensive prescription were included. A booklet including information on cardiovascular risks, antihypertensive treatments, and ADE report forms was delivered by the general practitioner to the patient in the intervention group. The primary outcome was the reporting of at least one ADE by the patient to his general practitioner during the three-month period after enrolment. Two clusters were randomised by sequence for a total of 8 to receive the intervention. An intention-to-treat analysis was conducted. A logistic mixed model with random intercept was used.ResultsSixty general practitioners included 1095 patients (median: 14 per general practitioner; range: 1–103). More patients reported at least one ADE to their general practitioner in the intervention condition compared to the control condition (aOR = 3.5, IC95 [1.2–10.1], p = 0.02). The modification and initiation of an antihypertensive treatment were also significantly associated with the reporting of ADEs (aOR = 4.4, CI95 [1.9–10.0], p < 0.001 and aOR = 11.0, CI95 [4.6–26.4], p < 0.001, respectively). The booklet delivery also improved patient satisfaction on general practitioner communication and high blood pressure management.ConclusionA booklet can improve patient self-reporting of ADEs to their general practitioners. Future research should assess whether it can improve general practitioner management of ADEs and patient’s health status.Trial registrationTrial registry identifier NCT01610817 (2012/05/30).

Cardiologists\u2019 perceptions on multidisciplinary collaboration in heart failure care - a qualitative study

BackgroundCardiologists play a key role in multidisciplinary care by guiding heart failure (HF) management in the hospital and in the community. Regional implementation of multidisciplinary health care interventions depends on how they perceive collaboration with other health care disciplines, yet research on this topic is limited. This study aimed to explore the views and opinions of cardiologists on multidisciplinary collaboration in HF care.MethodsWe conducted a qualitative study based on face-to-face semi-structured interviews with 11 Belgian cardiologists between September 2019 and February 2020. We used the Qualitative Analysis Guide of Leuven (QUAGOL) method as guidance for data analysis until data saturation was reached.ResultsCardiologists consider the general practitioner (GP) and HF nurse as the most important partners in HF management. Cardiologists identified four problems in current multidisciplinary collaboration: the communication of a HF diagnosis to the patient, advanced care planning, titration of HF medication by the GP and electronic data exchange and communication. Three themes emerged as ideas for improvement of HF care: 1) expansion of the role of the HF nurse, 2) implementation of a structured, patient-centered, and flexible model of disease management program and 3) integrated data approaches.ConclusionCardiologists value close cooperation with GPs in HF management. They advocate an expanded future role for the HF nurse, increased eHealth, and structured disease management to optimize current HF care.

Exploring the Processes Involved in Seeking Help from a General Practitioner for Young People Who Have Been at Risk of Suicide.

General practitioners (GPs) play a key role in the early identification and management of suicide risk in young people. However, little is known about the processes involved in how, when and why a young person decides to seek help from their GP. Eight young people, aged 17–23, took part in semi-structured interviews exploring their experiences of help seeking when feeling suicidal. Data were analysed using framework analysis. The analysis identified three main themes and seven subthemes. The main themes explored were: understanding when to seek help from a GP, barriers and facilitating factors at the GP consultation, and help seeking as a non-linear and dynamic process. The processes involved in how, when and why young people seek help from a GP when feeling suicidal were found to be dynamic and to fluctuate over time. Help seeking was initially related to how young people were able to understand and articulate their distress, the availability of informal support networks, and their perception of the GP as a source of help. During a GP consultation, help seeking was influenced by how safe and supported the young people felt. Perceived GP training, communication and validation of young people’s concerns were important factors to help facilitate this process. Subsequent help seeking was influenced by prior experience of GP consultations and the availability of alternative support.

Effectiveness of a peer-mediated educational intervention in improving general practitioner diagnostic assessment and management of dementia: a cluster randomised controlled trial

ObjectiveTest effectiveness of an educational intervention for general practitioners (GPs) on quality of life and depression outcomes for patients.DesignDouble-blind, cluster randomised controlled trial.SettingGeneral practices in Australia between 2007 and 2010.ParticipantsGeneral...

Interventions to increase uptake of faecal tests for colorectal cancer screening: a systematic review.

International guidelines promote screening by faecal tests in asymptomatic individuals at average risk of colorectal cancer (CRC), but uptake does not reach recommended levels in most countries. The aim of this study was to synthetize evidence on (a) interventions aiming to increase uptake of faecal tests for CRC screening, in asymptomatic individuals at average risk of CRC, (b) interventions that targeted general practitioner (GP) involvement and (c) interventions that targeted nonresponders or disadvantaged groups. A systematic review of randomized-controlled trials, searching PubMed, Embase and the Cochrane Library database, based on the Cochrane's Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guidelines was performed. The risk of bias of included trials was assessed. From 24 included RCTs, the following interventions increase uptake of faecal tests: advance notification letter (OR 1.20-1.51), postal mailing (OR 1.31-7.70), telephone contacts with an advisor (OR 1.36-7.72). Three interventions showed positive effects of GP involvement such as a GP-signed invitation letter [odds ratio (OR)=1.26], GP communication training (OR=1.22) or mailing reminders to GPs (OR=14.8). Inconclusive results were found for studies comparing different types of faecal tests and those testing the effectiveness of providing various types of written information. Advance notification letters, postal mailing of the faecal tests, written reminders and telephone contacts with an advisor increase patient uptake of faecal tests. There was only limited evidence on the effect of GP involvement on screening test uptake and a lack of studies focusing on nonresponders or disadvantaged groups.

Developing a Regional Medicines Optimisation Model for Older People in Care Homes: Refinement and Reproducibility

Introduction & Practice Change: In 2012, the Northern Health and Social Care Trust (NHSCT) implemented consultant pharmacist led trust outreach medicines optimisation clinics for care home patients. This model required the consultant pharmacist to conduct clinics either alone or in collaboration with a consultant geriatrician with recommendations being communicated to General Practitioners (GPs) via a letter. This service resulted in a 14% reduction in Emergency Department (ED) admissions together with improved appropriateness of prescribing and drug cost savings1. Results (2012-2014) indicated the pharmacist working alone produced similar outcomes as to when working together with the geriatrician; the decision was therefore made for pharmacists to conduct clinics alone and to refer complex patients to a medical specialist only when deemed necessary. Aim: The aim of this work is to refine the medicines optimisation care home model and reproduce it in another trust, thereby informing the potential to roll out this new pharmacy service throughout care homes in Northern Ireland. Target Population: Patients aged ≥65 years residing in residential and nursing homes (care homes). Timeline: In August 2015 two older people specialist independent prescribing pharmacists were recruited into the NHSCT service under the mentorship of the consultant pharmacist. The Western Health and Social Care Trust (WHSCT) recruited two similar full time pharmacists who have delivered the same consultant pharmacist led model to care homes since September 2015. Data collection for patients seen over a 12-month period and followed up for 90 days is ongoing with full results to be reported early 2017. Highlights: Interim results (February 2016) revealed improved appropriateness of prescribing [measured via the medication appropriateness index (MAI)2] with associated annual drug cost savings estimated at £273k to £382k across the two trusts representing an ‘invest to save’ return of £1.51 - £2.12 per £1 invested in drug cost savings alone. Post clinic healthcare resource usage is being measured and an economic model is being developed to quantify the impact of the pharmacy service on these; interim analysis suggests reduced attendance at hospital ED and decreased GP callouts. Sustainability/Transferability: Preliminary evaluation of the service suggests it is both reproducible and sustainable. Discussion/Lessons Learnt: The WHSCT pharmacists tested different GP communication models where interventions may be actioned via letter, teleconference or direct access into GP systems. The method of communicating recommended clinical interventions between the trust pharmacist and GP can vary depending upon the size and location of the care home and the wishes of the GP responsible for patient care. Conclusion: Consultant pharmacist led medicines optimisation trust outreach services for care homes are reproducible with positive clinical and economic outcomes achievable when transferring the service into another geographical area.

How do trained raters take context factors into account when assessing GP trainee communication performance? An exploratory, qualitative study.

Communication assessment in real-life consultations is a complex task. Generic assessment instruments help but may also have disadvantages. The generic nature of the skills being assessed does not provide indications for context-specific behaviour required in practice situations; context influences are mostly taken into account implicitly. Our research questions are: 1. What factors do trained raters observe when rating workplace communication? 2. How do they take context factors into account when rating communication performance with a generic rating instrument? Nineteen general practitioners (GPs), trained in communication assessment with a generic rating instrument (the MAAS-Global), participated in a think-aloud protocol reflecting concurrent thought processes while assessing videotaped real-life consultations. They were subsequently interviewed to answer questions explicitly asking them to comment on the influence of predefined contextual factors on the assessment process. Results from both data sources were analysed. We used a grounded theory approach to untangle the influence of context factors on GP communication and on communication assessment. Both from the think-aloud procedure and from the interviews we identified various context factors influencing communication, which were categorised into doctor-related (17), patient-related (13), consultation-related (18), and education-related factors (18). Participants had different views and practices on how to incorporate context factors into the GP(-trainee) communication assessment. Raters acknowledge that context factors may affect communication in GP consultations, but struggle with how to take contextual influences into account when assessing communication performance in an educational context. To assess practice situations, raters need extra guidance on how to handle specific contextual factors.

Context factors in general practitioner - patient encounters and their impact on assessing communication skills - an exploratory study

BackgroundAssessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor’s proficiency.Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account.MethodsWe used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests.ResultsIn 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p < 0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17.ConclusionsApplying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent ‘adequate GP communication behaviour’. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as ‘signal’ instead of ‘noise’ in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.

What makes them (not) talk about proper medication use with their patients? An analysis of the determinants of GP communication using reflective practice

Many patients do not use their medication as prescribed. This non-adherence is a well-known and resistant problem, requiring good physician-patient communication. However, when it comes to talking about (non-)adherence, both physician and patient refrain from putting the topic high on the agenda. The reasons for doing so are far from clear. We therefore conducted a qualitative, video-facilitated study to find out why physicians communicate with their patients about medication use and adherence in the way they do. Using reflective practice, 20 general practitioners (GPs) independently watched videorecordings of their own visits and were asked to reflect on ‘critical incidents’ operationalised as segments of a visit which ask for a discussion of proper medication use or adherence. Determinants of such a discussion appeared to be the type of medication, patient and GP characteristics, and particular elements of the medical visit and of the broader practice organisation in which the visit took place. Determinants mentioned most often were a lack of time, other priorities, being acquainted with the patient, reluctance to disclose too much information out of a risk of reinforcing side-effects, and relying on the patient for returning to the GP office when existing complaints persist. Apparently, many GPs are biased when it comes to discussing proper medication use and preventing non-adherence. These results provide input for developing communication interventions and guidelines for discussing medication use with patients more elaborately. Reflective practice appeared to be a valuable and appreciated tool to investigate determinants of physician behaviour.

C-reactive protein point of care testing and physician communication skills training for lower respiratory tract infections in general practice: economic evaluation of a cluster randomized trial

An economic evaluation of general practitioner (GP) use of C-reactive protein (CRP) point of care test, GP communication skills training, and both GP use of CRP and communication skills training on antibiotic use for lower respiratory tract infections (LRTIs) in general practice. Cost-effectiveness analysis with a time horizon of 28 days alongside a factorial, cluster randomized trial in 431 patients with LRTIs recruited by 40 GPs. usual care (control group), GP use of CRP point of care test, GP communication skills training, and both CRP use and communication skills training. health care costs. Cost-effectiveness, using the primary outcome measure antibiotic prescribing at index consultation, was assessed by incremental cost-effectiveness ratios (ICER). To adjust for skewed data and clustering, we used non-parametric bootstrapping re-sampling to derive percentile intervals for the mean difference in total costs and the mean difference in effectiveness between the groups. Various implementation scenarios according to GP preference were modelled with corresponding net monetary benefit (NMB) curves based on a given willingness-to-pay (λ) for a 1% lower antibiotic prescribing rate. The total mean cost per patient in the usual care group was €35.96 with antibiotic prescribing of 68%, €37.58 per patient managed by GPs using CRP tests (antibiotic prescribing 39%, ICER €5.79), €25.61 per patient managed by GPs trained in enhanced communication skills (antibiotic prescribing 33%, dominant) and €37.78 per patient managed by GPs using both interventions (antibiotic prescribing 23%, ICER €4.15). The interventions are cost-effective in any combination (yielding NMB at no willingness-to-pay), taking into account GPs' preferences where at least 15% of GPs chose to implement the communication skills training. The two strategies, both singly and combined, are cost-effective interventions to reduce antibiotic prescribing for LRTI, at no, or low willingness-to-pay. Taking GP preferences into account will optimize investment in strategies to reduce antibiotic prescribing for LRTI.

Frequency of GP communication addressing the patient's resources and coping strategies in medical interviews: a video-based observational study

BackgroundThere is increasing focus on patient-centred communicative approaches in medical consultations, but few studies have shown the extent to which patients' positive coping strategies and psychological assets are addressed by general practitioners (GPs) on a regular day at the office. This study measures the frequency of GPs' use of questions and comments addressing their patients' coping strategies or resources.MethodsTwenty-four GPs were video-recorded in 145 consultations. The consultations were coded using a modified version of the Roter Interaction Analysis System. In this study, we also developed four additional coding categories based on cognitive therapy and solution-focused therapy: attribution, resources, coping, and solution-focused techniques.The reliability between coders was established, a factor analysis was applied to test the relationship between the communication categories, and a tentative validating exercise was performed by reversed coding.ResultsCohen's kappa was 0.52 between coders. Only 2% of the utterances could be categorized as resource or coping oriented. Six GPs contributed 59% of these utterances. The factor analysis identified two factors, one task oriented and one patient oriented.ConclusionThe frequency of communication about coping and resources was very low. Communication skills training for GPs in this field is required. Further validating studies of this kind of measurement tool are warranted.

Gelesen ist noch nicht getan: Hinweise zur Akzeptanz von hausärztlichen Leitlinien. Eine Befragung in Zirkeln der Hausarztzentrierten Versorgung (HZV)

Successful guideline implementation requires that the authors get feedback from target groups on the general acceptance of a guideline and the barriers to its implementation. The Guideline Group of General Practitioners (GPs) in Hesse continually surveyed participants of quality circles on pharmacotherapy who discussed these GP specific guidelines together with an analysis of their prescription behaviour.Written survey of six general practice guidelines conducted among the members of quality circles in Hesse during 2006 and 2007. The response rate ranged from 69% (n=268; guideline on 'GP Communication Skills') and 80% (n=374; Guideline on 'Chronic Heart Failure'). The questionnaire focused on both general acceptance and the relevance and practicability of individual recommendations.With pharmacotherapeutic guidelines, between 75% (guideline for dyslipidaemia) and 86% (guideline for stable angina) would be recommended by the respondent GPs to colleagues. High practice relevance was attributed to the communication skills guideline by 70% of the GPs, but only about 50% would recommend it. Three quarters of the GP rated 18 out of 22 selected recommendations as being relevant to therapeutic quality assurance, and 11 of these recommendations as being practicable. Non-medical procedures requiring communication resources and time input as well as motivated patients were more often assessed as being more difficult to implement.A written survey is a suitable tool for gaining insight into the acceptance of diagnostic and therapeutic strategies and for investigating reasons for the refusal of or the barriers to implementation. Recommendations that are poorly accepted and less likely to be implemented as well as possible barriers should be discussed within the guideline group and during circle sessions in order to modify the recommendation and/or develop aids to assist with its transfer into everyday practice.

Does training general practitioners to elicit patients’ illness representations and action plans influence their communication as a whole?

Objective To examine whether the discussion of illness representations and action plans during medical encounters affects the way patients and general practitioners (GPs) communicate. Methods In a quasi-experimental design, 10 GPs first performed care-as-usual conversations with patients. After a 6 h training they performed consultations either emphasizing patients’ illness representations or action plans. Data were collected from 70 videotaped consultations with hypertensive patients, which were analyzed using the Roter Interaction Analysis System. Results Compared with care-as-usual consultations, communication in the action plan condition resulted in an increased discussion of lifestyle issues whereas communication in the illness representation condition resulted in more discussion of patient concerns. In both experimental conditions the proportion of affective GP utterances was higher while patients contributed more to the conversation. When GPs changed their communication style, patients did accordingly. Conclusion The explicit address of illness representations or action plans during consultations results in more attention to patient concerns and lifestyle issues and an overall improvement in patient–GP communication in terms of affective atmosphere and patient involvement. Practice implications These findings show that after a brief training GPs are able to change their communication style in a way that allows for a more thorough consideration of patient self-management.

Training general practitioners in behavior change counseling to improve asthma medication adherence

Objective: Adherence to asthma medication regimens is problematic in general practice. We developed and evaluated a communication training for general practitioners (GPs) to help them address medication adherence during routine consultations. This paper describes the development of the training and evaluation results of a pilot study. Methods: The training was based on behavior change counseling (BCC), a technique derived from motivational interviewing. We developed a five phases BCC consultation model. Participating GPs answered questions at baseline (T0), directly after (T1) and 4–10 months after (T2) the training that assessed their attitudes and confidence regarding adherence communication. They completed evaluation forms at T1 and T2. Results: The 19 participating GPs were positive about the course and the feasibility of BCC in GP consultations. Also, after the training, their attitudes and confidence had improved ( p < 0.05) and all reported to use BCC skills at least sometimes 4–10 months after the training. Conclusion: These positive effects provide us with some hope that the training positively influenced the GP's communication behavior. Practice implications: If further data on physician behavior and patient outcomes justify implementation of the training, it would then be worthwhile to also involve practice nurses.

Are effects of depression management training for General Practitioners on patient outcomes mediated by improvements in the process of care?

Background: Depression treatment by General Practitioners (GPs) and patient outcomes improved significantly after a comprehensive 20-h training program of GPs. This study examines whether the effects on patient outcomes are caused by the improvements in the process of care. Methods: Seventeen GPs participated in the training program. A pre-test–post-test design was used. A total of 174 patients (85 pre-test, 89 post-test) aged 18–65 met ICD-10 criteria for recent onset major depression. The main indicator of mediation was a drop in training effect size ( η 2) on patient outcome after adjustment for individual and combined process of care variables. We evaluated depression-specific (recognition, accurate diagnosis, prescription of antidepressant, adequate antidepressant treatment) and a non-specific process of care variable (communicative skillfulness of the GP) as well as the combination of adequate antidepressant treatment and communicative skillfulness. Patient outcomes were assessed at 3 months and consisted of change in severity of symptomatology, level of daily functioning and activity limitation days from baseline. Results: Depression-specific interventions mediated up to one third of the observed improvement in patient outcome. ‘Adequate dosage and duration of an antidepressant’ explained 36% of the training effect on patient outcome ( η 2 from 0.044 to 0.028). ‘Communicative skillfulness of the GP’ only was a weak mediator (18% explained; η 2 from 0.044 to 0.036). However, the combination of both, that is adequate antidepressant treatment by a communicative skillful GP, proved to be the strongest mediator of the observed training effect on patient outcomes (59% explained; η 2 from 0.044 to 0.018). Limitations: The training effects on patient outcomes in this sample were small. Hence, the scope for mediation was limited. Conclusion: GP communication skills are important to enhance depression-specific interventions in bringing about improvements in patient outcomes and should be addressed in GP training programs for the treatment of depression.

General Practitioners' Collaboration with Service Coordinators: What Makes it Work? Lessons from the SA HealthPlus Coordinated Care Trial

In the past, a number of factors have been identified that discourage collaboration between GPs and other health professionals in providing care to patients with chronic illness. These include financing arrangements, lack of time and lack of knowledge of the role of other professions. This paper uses data from the independent evaluation of the SA HealthPlus Coordinated Care Trial to examine the factors that encourage and inhibit collaboration between general practitioners (GPs) and Service Coordinators (a role introduced by the trial and carried out by nurses and allied health professionals). Both quantitative and qualitative methods were used to evaluate the role of the GP and the Service Coordinator in the trial. These data were analysed to determine what factors encouraged and inhibited collaboration. Results indicated that effective communications, knowledge of and respect for each other's roles and responsibilities, and a clearly perceived benefit from collaboration were the most important predictors of successful collaboration for both parties. These results also suggest strategies for increasing the likelihood of collaboration between GPs and others such as the location of the Service Coordinator in the practice and ways of dealing with GP workloads and communication needs. These findings are relevant to recent policy initiatives including the MBS Enhanced Primary Care item numbers, the employment of practice nurses, and allied health staff via Divisions of General Practice.