Super Clinics Research Articles

P027 Are skin cancer teaching ‘super clinics’ safe and effective? Results of a UK pilot study

P027 Are skin cancer teaching ‘super clinics’ safe and effective? Results of a UK pilot study

GP Super Clinics - The Cockburn Experience in the Development of an Integrated Service Model

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Supports and hindrances to the integration of co-located services in multiple models of primary health care delivery Integration in co-located primary health care services

Introduction: In 2008 the Australian Government funded the establishment of GP Super Clinics based loosely on the UK Darzi polyclinic model. The intention was to collocate general practice and allied health services. The initiative was centred in primary care and integration between primary care and specialist medical or hospital services was not a prime objective. No specific model for how integration was to be achieved was mandated. This study is an evaluation integration of six GP Super Clinics in South Australia and Victoria funded by the Australian Primary Care Research Institute conducted between 2014-5. Methods: The design was a multiple case study (mixed methods design). Quantitative data was collected using three surveys (clinic manager survey, health professional survey, patient survey) and qualitative data from patient and health professional focus groups. Each collection tool was applied concurrently at each case study site. Survey tools were administered first, sample GP management plans collected, and then focus groups conducted. Explanatory sequential process was used as the basis for data analysis (quantitative data then qualitative data to explain findings). A case study database was established to collate information collected for each site. Each case study site was described in terms of the seven components (for example, level of variety of services co-located, level of internal service integration mechanisms). Quantitative survey data was manually coded, entered into a Microsoft Excel spreadsheet and imported into SPSS for analysis. Frequencies, means, standard deviation and range, as well as cross-tabulations with percentages were calculated. Results: There was mixed evidence that the health clinics were aligning their services to match surrounding community demand with only two centres basing their decisions on service development on local research. All clinics started with a core set of services that expanded over time usually starting with at least GPs. In Australia, all GP pathology, radiology, specialist services and some allied health services have a Medicare funded rebate. While often there was no out-of-pocket expense to clinic patients access for some services or for patients not considered disadvantaged required a ‘gap’ payment. This impact on access to comprehensive care for some patients The clinics had similar ways of reimbursing health care professionals but there was some variation for allied health professionals. Nurses were most commonly salaried across all organizations and the State funded clinics were able to provide allied health free to patients by having the resources to pay staff a salary. Patients and practitioners felt the collocation improved patient convenience and satisfaction. Practitioners identified a lack of formal integrated care structures. The important role of nurses working in these clinics at integrating care between other health professionals was identified. Patients participating in the focus groups sensed that integration was not occurring in the clinics. Conclusions: When contemplating integration health professionals focused on communication, trust, familiarity and the importance of process in defining if it could be successful. Integration tended to be understood in terms of sharing of information about an approach to treatment, treatment proposed for the patient and not about how treatment was delivered. Patients perceived an absence of communication and information sharing among health professionals. Lessons learned: Health professionals are the drivers of integrated care. There were low rates of integrated care across all health service models in our study. Currently there are few incentives to achieve integrated care in Australia Limitations: Limited resource study examining only 6 of the 64 funded clinics in a limited geographical area. Data coded by only one researcher. Suggestions for future research: To what extent have resources and infrastructural supports been concertedly reviewed for their facilitation or obstruction to integration within different co-located PHC models within GP Super Clinics?

The informatics capability maturity of integrated primary care centres in Australia

ContextIntegrated primary care requires systems and service integration along with financial incentives to promote downward substitution to a single entry point to care. Integrated Primary Care Centres (IPCCs) aim to improve integration by co-location of health services. The Informatics Capability Maturity (ICM) describes how well health organisations collect, manage and share information; manage eHealth technology, implementation, change, data quality and governance; and use “intelligence” to improve care. AimDescribe associations of ICM with systems and service integration in IPCCs. MethodsMixed methods evaluation of IPCCs in metropolitan and rural Australia: an enhanced general practice, four GP Super Clinics, a “HealthOne” (private-public partnership) and a Community Health Centre. Data collection methods included self-assessed ICM, document review, interviews, observations in practice and assessment of electronic health record data. Data was analysed and compared across IPCCs. FindingsThe IPCCs demonstrated a range of funding models, ownership, leadership, organisation and ICM. Digital tools were used with varying effectiveness to collect, use and share data. Connectivity was problematic, requiring “work-arounds” to communicate and share information. The lack of technical, data and software interoperability standards, clinical coding and secure messaging were barriers to data collection, integration and sharing. Strong leadership and governance was important for successful implementation of robust and secure eHealth systems. Patient engagement with eHealth tools was suboptimal. ConclusionsICM is positively associated with integration of data, systems and care. Improved ICM requires a health workforce with eHealth competencies; technical, semantic and software standards; adequate privacy and security; and good governance and leadership.

When colocation is not enough: a case study of General Practitioner Super Clinics in Australia

Developed nations are implementing initiatives to transform the delivery of primary care. New models have been built around multidisciplinary teams, information technology and systematic approaches for chronic disease management (CDM). In Australia, the General Practice Super Clinic (GPSC) model was introduced in 2010. A case study approach was used to illustrate the development of inter-disciplinary CDM over 12 months in two new, outer urban GPSCs. A social scientist visited each practice for two 3-4-day periods. Data, including practice documents, observations and in-depth interviews (n=31) with patients, clinicians and staff, were analysed using the concept of organisational routines. Findings revealed slow, incremental evolution of inter-disciplinary care in both sites. Clinic managers found the facilitation of inter-disciplinary routines for CDM difficult in light of competing priorities within program objectives and the demands of clinic construction. Constraints inherent within the GPSC program, a lack of meaningful support for transformation of the model of care and the lack of effective incentives for collaborative care in fee-for-service billing arrangements, meant that program objectives for integrated multidisciplinary care were largely unattainable. Findings suggest that the GPSC initiative should be considered a program for infrastructure support rather than one of primary care transformation.

The potential role for a pharmacist in a multidisciplinary general practitioner super clinic.

The Australian government's General Practitioner (GP) super clinics programme aims to provide well-integrated, multidisciplinary, patient-centred care for people with chronic disease. However, there is no research into the current role of pharmacists in this setting. To explore the perspectives of GP super clinic staff on current and potential (future) pharmacist-led services provided in this setting. Individual interviews (facilitated using a semi-structured interview guide and thematically analysed) were conducted with purposively sampled staff of a GP super clinic in a semirural location in the state of New South Wales, until theme saturation. Participating staff included (n=9): three GPs, one pharmacist, one nurse, one business manager, and three reception staff. Three themes emerged conveying perspectives on: working relationships between staff; a pharmacist's current role; and potential future roles for a pharmacist. All clinic staff actively engaged the pharmacist in their "team approach". Currently established roles for home medicines reviews (HMRs) and drug information were well supported, but needed to be expanded, for example, with formalised case conferences between GPs, pharmacists, and other staff. New roles needed be explored in auditing medication use, optimising medication records, specialised drug information, dispensing, and prescribing. Although GPs had differing views about opportunities for pharmacists' prescribing in this setting, they saw several benefits to this service, such as reducing the time pressure on GPs to enable more effective consultations. Results suggest a pharmacist's services can potentially be better used within the multidisciplinary super clinic model of care to address current gaps within the semi-rural practice setting. Any future role for the pharmacist could be addressed as part of a formalised, strategic approach to creating an integrated healthcare team, with attention to funding and government legislation.

Telephone triage is not the answer to ED overcrowding

Yusuf Nagree, Peter Cameron, Andrew Gosbell and David Mountain Emergency Department, Fremantle Hospital, Fremantle, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Emergency Medicine, Monash University, Melbourne, Victoria, and Policy and Research, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia

Meeting local complex health needs by building the capacity of general practice: the University of Queensland GP super clinic model

The GP Super Clinics Program is a highly topical and controversial initiative with varying levels of support within the policy, consumer and health care communities. Here, we describe the GP super clinic initiative of the University of Queensland (UQ), and how it aims to enhance primary-care capacity in the regions where clinics are based. The UQ GP super clinic model has considered the concerns of general practitioners, patients and other stakeholders, and addresses the needs of these groups while providing an excellent opportunity for the university to be involved in innovative service delivery, community-based education, primary-care service design and evaluation.

General Practice Super Clinics — how will they meet their educational objectives?

General Practice Super Clinics — how will they meet their educational objectives?

General Practice Super Clinics — how will they meet their educational objectives?

General Practice Super Clinics — how will they meet their educational objectives?

General Practice Super Clinics — how will they meet their educational objectives?

The Australian Government will provide $275 million over 4 years to general practice infrastructure across Australia with the rollout of 31 General Practice Super Clinics. One of the core objectives of these Super Clinics is to support medical education. Several studies have demonstrated that the major barriers to teaching in general practice are time, space and money. We argue that General Practice Super Clinics can provide a responsive, flexible work culture; and improved payment and targeted resources to support the need for increased teaching capacity, and to attract and retain workforce for general practice and primary care.

What evidence is there to support skill mix changes between GPs, pharmacists and practice nurses in the care of elderly people living in the community?

BackgroundWorkforce shortages in Australia are occurring across a range of health disciplines but are most acute in general practice. Skill mix change such as task substitution is one solution to workforce shortages. The aim of this systematic review was to explore the evidence for the effectiveness of task substitution between GPs and pharmacists and GPs and nurses for the care of older people with chronic disease. Published, peer reviewed (black) and non-peer reviewed (grey) literature were included in the review if they met the inclusion criteria.ResultsForty-six articles were included in the review. Task substitution between pharmacists and GPs and nurses and GPs resulted in an improved process of care and patient outcomes, such as improved disease control. The interventions were either health promotion or disease management according to guidelines or use of protocols, or a mixture of both. The results of this review indicate that pharmacists and nurses can effectively provide disease management and/or health promotion for older people with chronic disease in primary care. While there were improvements in patient outcomes no reduction in health service use was evident.ConclusionWhen implementing skill mix changes such as task substitution it is important that the health professionals' roles are complementary otherwise they may simply duplicate the task performed by other health professionals. This has implications for the way in which multidisciplinary teams are organised in initiatives such as the GP Super Clinics.