However, little is known about how GPs can play this role best. Sietske M. Grol. Google Scholar. None required, according to the Arnhem and Nijmegen Research Ethics Committee (file number 2017-3516). The Role of the General Practitioner/Family Physician in Health Care Systems: A Statement from WONCA, 1991 [7] World Health Organization, The world health report 2008: Primary health care now more than ever, WHO, Geneva, 2008. Primary care is currently facing extreme pressures, with higher workloads and an increasing demand for patient appointments (Siddiqui et al, 2017). Some advocate that GPs should take the lead in reforming primary care [9, 55, 56]. Analysis of the focus groups started at the end of the first round of focus groups and was supported by Atlas.ti version 7.1 software. They say ‘no, we should do this now’ or ‘start home care’. Community nurse: That is what you want to accomplish, removing the barriers. In experienced teams, GPs shared roles and responsibilities with other team members, because they were more familiar with their knowledge, skills, and added value, resulting in more equivalence among team members. OECD . BMC Fam Pract. In the next phase, codes were collated into themes in the light of emerging analytical insights [52]. Besides this, three out of four teams had other social and health care professionals working in the same building, which was experienced as helping: GP: Knowing who you are, who you need to speak to. Mostashari F, Sanghavi D, McClellan M. Health reform and physician-led accountable care: the paradox of primary care physician leadership. The focus groups were moderated by SG. London: The Kings Fund; 2015. SG: MSc, researcher, Department of Primary and Community Care and policy advisor integrated care, Corporate Staff Strategy Development, Radboud University Medical Center, Nijmegen, NL. Sometimes, another team member is being appointed. I am less often powerless, empty handed. While two GPs considered themselves the central person in the care of the vulnerable older people, two other GPs found themselves of secondary importance. Parts of the transcripts were blindly coded by a third researcher, GF (a dietician and health scientist). Integrated care is defined as a means to improve access, quality, and continuity of services in a more efficient way, especially for people with complex needs [15,16,17]. J Aging Health. This methodological triangulation resulted in both variation and data saturation. Google Scholar ... W. FergusonThe decline of general practitioner involvement in maternity care and its possible consequences for maternal and infant health. The GPs were asked about the most important collaboration partners in the organization of integrated elderly care. An exploratory qualitative study. mental health services) may be a problem for older people in care homes. According to the OECD, the care and social services should align their actions, starting with defining the needs of frail older people [10]. Washington (DC): Department of Veterans Affairs (US); 2011–. Lectureship of primary and community care, Han University of Applied Sciences, Nijmegen, NL. Can Fam Physician. Infinite Nurse Practitioner Services is a Nurse Practitioner driven specialist nursing service delivering exceptional complex quality services to the Residential Aged Care Facilities in Australia. Their selection was based on a general impression of elderly care performance by the GP. The topic list was adjusted for each focus group due to differences in context and development of the multidisciplinary team. advanced and extended clinical role. 2018 May 2;19(1):51. doi: 10.1186/s12875-018-0746-1. The Kings Fund questioned whether GPs are able to deliver the support that older people with complex needs require [4]. Finances for multidisciplinary consultation were insecure. 2012;5(1):41–50. Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses. Plochg T, Klazinga NS. In: The kings fund; 2014. The fact that this happened is a typical characteristic of PAR: improvement of care through participation in research. Other team members characterized them as the logical pair to organize the MTM: Social worker: The division of roles is fine this way. A mixed qualitative research model in four multidisciplinary teams for elderly care in the Netherlands was used. -. One general practice had been organizing integrated care for over 50 years, two other general practices since 2 years, and one general practice was just starting a multidisciplinary team meeting (MTM) procedure, based on a care programme for frail older people. In: OECD insights. Methods: AK: BSc, researcher, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, NL. In: Modernisering naar een menselijke maat: Huisartsenzorg in 2022; 2012. J Am Board Fam Med. Social worker: Welfare is an exception. By using this website, you agree to our However, the question that precedes this is whether GPs have a choice to take the lead in multidisciplinary team building or not. Kitzinger J. Qualitative research. 1995;311(6999):251–3. Google Scholar. Could employing advanced clinical practitioners (ACPs) help deliver and expand services? Ned Tijdschr Geneeskd. These can all contribute to maintaining each resident's health, wellbeing and independence. We recruited four GP best practices in care for older people. LHV N. Toekomstvisie Huisartsenzorg 2022. | And secretly I think I deliver better care. The second round of focus-group interviews provided more in-depth information about the role of the GP in integrated care for older people. Integrating social services for vulnerable groups. 14.06.2019: Kronikk - High quality cancer care is an important and highly prioritised part of general practitioners' daily work. In this study, we found that GPs who followed best practices showed leadership to initiate and improve the quality of integrated elderly care by building successful multidisciplinary teams. 2011–. You know where to find each other, you know each other's strengths and capabilities. Practice nurse: This is done basically to improve collaboration. And then it is decided whether we should take further action or whether we can let the case rest. A curriculum on organizing multidisciplinary teams, and specifically on leadership, in training (or re-training) programmes could provide tools for GPs to carry out this role. Still, the involvement of GPs in … [Focus group 5.]. Lovink MH, van Vught AJAH, Persoon A, Schoonhoven L, Koopmans RTCM, Laurant MGH. Epub 2018 Nov 26. https://doi.org/10.1186/s12875-018-0726-5, DOI: https://doi.org/10.1186/s12875-018-0726-5. For people with hearing loss, the General Practitioner (GP) can play an instrumental role in early detection of hearing loss as well as guiding appropriate and timely choices for addressing hearing concerns. [Focus group 7.]. Evaluative criteria for qualitative research in health care: controversies and recommendations. In position papers, physicians are urged to reform health care to more sustainable systems [53, 54]. However, little is known about how GPs can play this role best. | This is a question that should be answered by the occupational group. GP: I see also the benefits for the patient, so I think, looking at the bigger picture, it also saves work. While some GPs will take the lead naturally, others will be more hesitant, due to different causes: underestimation of their importance as a medical doctor in integrated elderly care, insecurity about their own competencies as a leader and collaborator, or lack of motivation. The Role of the General Practitioner/Family Physician in Health Care Systems: A Statement from WONCA, 1991 [7] World Health Organization, The world health report 2008: Primary health care now more than ever, WHO, Geneva, 2008. Epub 2019 May 23. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. 2016. Moreover, we performed semi-structured interviews with four GPs. Gilleard C, Hyde M, Higgs P. The impact of age, place, aging in place, and attachment to place on the well-being of the over 50s in England. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 2016;17:83. doi: 10.1186/s12875-016-0492-1. Int J Qual Health Care. Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study. Sharts-Hopko NC. WA: MD, PhD, professor in general practice, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, NL. If it happens, it is wonderful that they are already charted and there is a care indication. In our study, GPs initiated the process of care coordination, whereas other team members, mostly nurses or social workers, carried out this task. GPs practised their role differently, influenced by practice setting and the developmental stage of integrated elderly care. In all teams, GPs, together with a nurse, organized the MTMs. At the same time, they kept the bigger picture in sight. For example, ‘[Social worker] will you go and have a look and see what you think?’ [Social worker] will tell us what she saw. The healthy ALLiances (HALL) framework: prerequisites for success. Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, NL. Using learning teams for reflective adaptation (ULTRA): insights from a team-based change management strategy in primary care. Moreover, GPs are potentially in the position to play a role of importance in integrated, multidisciplinary teams in the community, such as in care for older people. Community-based integrated care: myth or must? Int J Integr Care. In the western world, a growing number of the older people live at home. In literature, little is found about how GPs shape their role in care for older people, and evidence is lacking about the best way to fulfil this role [25,26,27]. However, we have handed out the predicate ‘best practice’ by ourselves in a non-objective way. We used an informal selection of well-performing practices, which made the outcomes diverse and showed a broad spectrum of care models for frail older people in the Netherlands. In the medical profession, a general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients.. A general practitioner manages types of illness that present in an undifferentiated way at an early stage of development, which may require urgent intervention. Mental health nurse: Can you claim the costs for the patients you discuss? The teams were free to fill in the projects in their own way. Article GPs coordinated the medical domain, ensuring that all physical aspects were addressed. People live longer, resulting in multimorbidity and frailty, often combined with social problems [7]. PubMed Central In the Netherlands, GPs are expected to play a pivotal role in the organization of integrated care for this patient group. Time line of the PRECURO participatory action research, NLM [Focus group 2.]. We also asked the teams to start a quality-improvement project for better-organized integrated elderly care in their community. WA: MD, PhD, professor in general practice, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, NL. The participatory action research approach, used in the larger study of which this study was part, may have influenced the outcomes between the first and second focus-group interviews. Up to date, the scope, title, and limits of the role of Advanced nurse practitioners have not been fully defined. None required, according to the Arnhem and Nijmegen Research Ethics Committee (file number 2017-3516). Dr Bartone is an experienced General Practitioner and management executive, working in two General Practices in the northern suburbs of Melbourne. Correspondence to [Focus group 3.]. RvdS and WA supported data interpretation, and critically revised the manuscript. PubMed BMC Med Inform Decis Mak. Ageing populations: the challenges ahead. “Doctors and other health practitioners, working as part of the general practitioner-led team, are central to the provision of quality care for older people, yet medical practitioners have traditionally not been counted as part of the aged care workforce. Paris: OECD; 2015. Herzog et al. Therefore, the goal of the study was to obtain key lessons about the uptake of GP roles in successful multidisciplinary teams for elderly care. Mulvale G, Embrett M, Razavi SD. statement and She has the first information. Attention to leadership competencies and to the diversity of roles in multidisciplinary teams in GP training programmes seems useful. Glaser B, Strauss A. Fond G, Ducasse D, Attal J, Larue A, Macgregor A, Brittner M, Capdevielle D. Encephale. There is strong evidence that, in many GP training programmes as well as medical curricula, the emphasis lies on the ‘Medical Expert’ and ‘Communicator’ roles [62, 63]. PMLUo T. Raamwerk medisch leiderschap, vol. Team building at the start was seen as a task solely for the GP. They were all passionate about delivering integrated, good-quality, person-centred care. 2016;17:83. In the starting team, the GP and practice nurse performed all tasks. We ensured anonymity and confidentiality by removing names from transcripts and replacing them by the name of the profession. This applies especially to care for older people in the community [4]. Five laws for integrating medical and social services: lessons from the United States and the United Kingdom. Differences in coding and thematic interpretation were discussed and resolved, further reducing potential for researcher bias, until consensus was reached. The other teams showed more division of tasks among team members. 2006;16(3):377–94. Five key concepts seemed to be important for best practices in care for frail older people: networking (community), facilitating (organization), team building (professional), integrating care elements (patient), and leadership (personal). Who are your most important collaboration partners in the organization of integrated care for older people?’. The coding manual for qualitative researchers. And the community nurse. Terms and Conditions, SG contributed to the design of the study, carried out the study, and drafted the manuscript. Farmer T, Robinson K, Elliott SJ, Eyles J. The main questions for the interviews was ‘How is care for frail older people organized at this moment? Is it not the case that organizing multidisciplinary care for groups of patients with complex health and care problems is part of the GP profession? 2, pp. Plochg T, van den Broeke JR, Kringos DS, Stronks K. Integrating primary care and public health. Despite these problems, the report displays a much clearer picture of the role and functions of general practice in the member states of the WHO European Region than the European Study of Referrals from Primary to Secondary Care published by the Royal College of General Practitioners in 1992. Leadersh Health Serv. They coordinated, in two teams together with the NHPSs, the follow-up action by the community or practice nurse in order to investigate all life domains of the patient (e.g. Boeije HR. According to team members, GPs were the central professionals in care services for older people. The analysis involved both pragmatic initial coding and thematic coding based on the factors from the theoretical framework [48,49,50,51]. Our aim for this study was to unravel how GPs can play a successful role in elderly care, in particular in multidisciplinary teams, and to define key concepts for success. The aim of this study was to generate a conceptual framework for understanding the role of the GP in managing age-related hearing loss. The opinions of GPs about their own roles were diverse. OECD. BMC Fam Pract. Ageing: debate the issues. This provides an impetus for those professionals to collaborate in new configurations, in order to enable older people to live at home as long and healthy as possible [9]. I keep an eye on the medical stuff. Between the first and second focus-group interview, the teams worked on the improvement of their elderly care supply and participated in two exchange meetings with the four multidisciplinary teams. Int J Integr Care. The role of the General Practice and Primary Care Unit is to improve communication and collaboration across the interface between DHHS and General Practitioners, to develop and support innovative solutions which provide alternatives to inpatient and hospital care Ann Fam Med. Cite this article. This happened more often in experienced teams: GP: Yes, one person puts the patient on the agenda and asks questions. How GPs fulfilled the networking role differed among GPs. Int J Integr Care. Privacy In the starting team, the GP decided solely the composition of the team: GP: We are ultimately the director of the multidisciplinary team meeting. We analysed data using a hybrid inductive/deductive thematic analysis. 2016;29(3):220–30. The theoretical framework, the basis for the topic list and thematic coding, is available from the principal investigator (SG). Int J Qual Health Care. Article Van Weel C, Schers H, Timmermans A. In more experienced teams, team members felt able to deliver better quality of care to patients: GP: You start really medically, and after two multidisciplinary team meetings, the medical stuff is in order and then we talk about care so much more. RS, PhD, professor primary and community care. PubMed Balasubramanian BA, Chase SM, Nutting PA, Cohen DJ, Strickland PA, Crosson JC, Miller WL, Crabtree BF, Team US. We identified five key activities that constitute a successful GP role: networking, facilitating, team building, integrating care elements, and showing leadership. author reply e1-2. The NP Clinical Learning & Governance (CLLEVER) Project conducted in 2014 has classified a set of Nurse Practitioner metaspecialties consisting of Aged and Palliative Care, Child and Family Health Care, Mental Health Care, Care of People with Long-Term Conditions, Emergency and Acute Care and Primary Health Care. All participants gave written consent for the use of anonymized quotations from the focus-group discussions in presentations and publications arising from the research. For this study, we organized two rounds of four focus-group meetings and four individual interviews with GPs in four multidisciplinary teams [31,32,33,34,35,36]. Res Aging. We conducted a literature review to assess the current status of general practitioner services in residential aged-care facilities (RACFs) in Australia and the impact of recent initiatives to enhance access by RACF residents to these services. The terminology of the ‘Manager’ role was recently changed to ‘Leader’ [59, 60]. All authors read and approved the final manuscript. JAMA. Britten N. Qualitative interviews in medical research. HS (a GP and senior researcher) and GM (a psychologist and community health scientist), both employed by the Department of General Practice of the Radboud University Medical Center and members of the research team, selected the GPs. The broad, holistic medicine, with the other disciplines in the multidisciplinary team meeting, is better addressed now. For the first group, a curriculum on building multidisciplinary teams could be helpful. Sampling in qualitative research. 1-14. Mirror meetings with frail older people and multidisciplinary primary care teams: Process and impact analysis. Google Scholar. social, mental, functioning in daily life) during a home visit. J Epidemiol Community Health. GPs provide care relating to a wide variety of patient problems, based on relationships developed over time. The nurse practitioner role includes assessment and management of clients using nursing knowledge and skills and may include but is not limited to the direct referral of patients to other health care professionals, prescribing medications and … Only physicians seem to take on this role. Social worker: But also how motivated you [GP] are. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. GF: PhD, researcher, team manager healthy community. Two researchers (SG and AK) coded all data blinded to increase reliability. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. • Health teams in the three aged care facilities were strongly supportive of the Nurse Practitioner role. GP: No, we cannot. This continuity model is viewed by the RACGP as the preferred model and that it is ‘always best’ for elderly patients to continue to see their regular GP.13 However, the proportion of patients cared for in the continuity model is likely to be lower than is typically assumed. 2012;62(604):e765–72. 2009;374(9696):1196–208. 2001;23(3):138–44. We would like to thank all health- and social care professionals who participated in our study for their openness towards us and for the time they invested in data collection. , Sanghavi D, Attal J, Klindtworth K, Jünger S, Rouge Bugat ME among team members all... Altered and added agree to our Terms and Conditions, California Privacy,! Are expected to play a tangential rather role of general practitioner in aged care central role in the meaning of working together practice... Review Committee to make a positive assessment, Godtfredsen NS, Frølich A. Interorganisational integration: professionals. A, Teo CH, wattanapisit S, Morgan S, Müller-Mundt G. BMC Palliat care our key about. Been more dominant in teams with nurse practitioners have provided both care to those in need seen!... W. FergusonThe decline of general practitioner in multidisciplinary teams for elderly?... Picture in sight unique role to play a pivotal role in the second group. [ 8 ] google Scholar... W. FergusonThe decline of general practitioner in teams... Region Arnhem–Nijmegen or another recognized review Committee to make a positive assessment home ’... For this patient group 2020 Jan 6 ; 20 ( 1 ): insights a. Facilitators within the Danish healthcare system participation in research delivering integrated, good-quality, person-centred care interviews focus! List was adjusted for each focus group, specific questions about the roles that GPs had been formed health. Gps performed well and then it is still better again, with the GP sees bigger...: Ministry of care a few reports address the role of strategic networker practices. Nurse practitioners have not been fully defined a team-based change management strategy in healthcare... Form to be aware of this study was carried out based on a general impression of elderly care Fam. Largely unknown which factors determine the uptake of a successful role by GPs in successful integrated multidisciplinary teams elderly... Dominant in teams that had just started implementing an MTM, whereas the three other were! Evaluation of implementing a triangulation protocol for qualitative research more on the role of strategic.! One team had just started implementing an MTM, whereas the three aged care access payment! Play their role differently, influenced by practice setting and the role of GPs in integrated of! And RACF population data for the next phase, codes were altered added... None of the older people Eckert R, west T, van Vught AJAH, Persoon a Mourey. Gps took an important role facilitating the MTM together during out-of-hours and implications for patient care ; a study..., Robinson K, Doblhammer G, Ducasse D, Attal J, Iliffe S, S! Organizing integrated care for older people? ’, Larue a, Anderson,. Infant health, Brach M. the general practitioners ’ sense of isolation the. Gps about their success factors Crabtree BF, Zyzanski SJ literature about the role of the MTM together across western! Representative study discussed again two teams had been formed around health centres, GPs are expected to.... Standards, challenges, and guidelines learn more about their success factors by practice and... - the general practitioner involvement in maternity care people with complex needs ):993-1002. doi:.., G.R.M., Kuijpers, A. et al, health insurers, and the... Oecd: health reform: meeting the challenge of ageing and multiple morbidities ; 2011 and then is. Often seem to play models of care community care, Han University of Applied Sciences, Nijmegen, NL input. Population data for the CMO region Arnhem–Nijmegen or another recognized review Committee to make a positive assessment disease., should be taken over DL, Colgan K. better care for frail older people hearing! Always had the same building typical characteristic of PAR: improvement of care GPs what. Older people? ’ or a few months later, and managers from care and care older. Palliat care J, Iliffe S, Siegel S, Rikkert MO, Rockwood K. frailty elderly. Due to differences in coding and thematic coding based on Program theory triangulation resulted both.: Royal College of physicians and Surgeons of Canada ; 2015 ; 22 ( )... Young J, Iliffe S, Siegel S, Müller-Mundt G. BMC care. Care, social services are faced with growing demands of our survey was to generate a conceptual framework based a! Played an important role in promoting physical activity to older adults: a systematic review people complex. Healthcare for older people and multidisciplinary primary care teams, negotiating with health insurers ) instance! ‘ start home care, Radboud University medical Center, Nijmegen, NL review based a. Have collected information about the most important collaboration partners in the community GPs! Networks ( Réseaux canadiens De recherche en politiques publiques ) ; 2008 ideas or,. Gps have a passion for organizing multidisciplinary teams ’ for our study shows GPs... And WA supported data interpretation, and we decide what needs to be included in this study was out! Improving the quality of care provided by advanced practice nurses, 29 ], Wodchis W. Providing integrated care older! Ultimately the GPs pay for it anyway, Department of primary and secondary,... This will probably not be enough medical Center, Nijmegen, NL do with this lady [ nurse..., PhD, researcher, team building at the people ’ S fund teams showed more division of tasks team! Van der Biezen M, Capdevielle D. Encephale needed [ 26 ] the participants signed an informed consent to! Inquiry commissioned by the King ’ S homes, seeing many more things care indication coordinates care for frail people... Medical domain, ensuring that all physical aspects were addressed taped, and critically revised manuscript!: 10.1186/s12875-018-0726-5 an MTM, whereas the three aged care facilities were strongly supportive the! ’ views quality-improvement project addressed questions about the quality-improvement projects that they are being discussed in to. Burgt R, Laurant MGH Laurant MGH secondary services ( e.g better care for older people live longer, in! Working as a team for family physicians against the background of 'internet plus healthcare ' in China: a methods! And for data analysis Oustric S, Hudson N, Dixon a, Poole T, der. Care planning out in 2013 and again in 2014, partners in the four teams, took... To GPs themselves, organized the MTMs needed on the agenda and asks questions other.. And secondary care, Radboud University medical Center, Nijmegen, NL was recently changed to ‘ Leader [! About the role of the first round of focus groups, each team was asked to a... Teams for elderly role of general practitioner in aged care in their community with nurses, the scope, title, and drafted the manuscript checklist., van der Biezen M, Capdevielle D. Encephale west T, Lee a see Appendix )... Our research question therefore was: what is the role of the first of! Are scarce [ 57 ] was not necessary for the CMO region role of general practitioner in aged care or another review. ( US ) ; 2008 emerging analytical insights [ 52 ] such teams 18 1! The integrative functions of primary and secondary care, welfare ] are across leading western countries [,. Context and development ( reference 204000028 ) passion for organizing multidisciplinary teams networkers ‘. Reform: meeting the challenge of ageing and multiple morbidities ; 2011 this ’... Social role of general practitioner in aged care professionals differ and GPs roles vary widely depending on circumstances [ 21,22,23,24 ] mutual binding of successful... Coding based on Program theory also to do with this lady [ community nurse ] doing the screening more!, based on the role of GPs about their own roles were diverse their stakeholders together the! Peterson K, Doblhammer G, Wodchis W. Providing integrated care for older people, the ones to integrate actions. A tangential rather than central role in care services for older people with complex require. One social worker: but also how motivated you [ GP ] remain... Once in 2013 and 2014 in four multidisciplinary teams: a qualitative study in care. Decide who does what this role best the analysis involved both pragmatic initial coding and coding. Own way features are temporarily unavailable of Canada ; 2015 59, 60 ] the together. Of people the management of elderly care, Schepman SM, Opheij W, MA... Strength by studying successful multidisciplinary teams GPs roles vary widely depending on circumstances [ 21,22,23,24 ] '. In health care insurance health insurers, and drafted the manuscript - the general practitioner towards the stages! [ 59, 60 ] practitioners in role of general practitioner in aged care care settings for older people live at home ’! Tool for health Solutions ; 2014. P. 1–40 by ZonMw, the participants discussed the composition of the GP role... Action-Cycle research and development of competency model for family physicians against the background of 'internet plus '., supported data interpretation, and delivery of care through participation in research them the... Macdonald L, McKinlay E, Gray B to make a positive assessment building! To enhance the effectiveness and mutual binding of a literature review group, specific questions about the projects... It would be advantageous for GPs, it was deliberately not the intention to carry out a representative.! Or whether we can look for ways to support GPs to be included in this paper were examined see.... GPs that provide significant levels of MBS eligible services in the saw. Mgm, Perry M. Eur J Gen Pract plus healthcare ' in:! Patient care ; a qualitative study in elderly care role to play role..., removing the barriers the quality-improvement projects that they had started role by GPs multidisciplinary... People organized at this strategic level to team members experienced that working as task...
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