Integration, Coordination and Multidisciplinary Care: What can These Approaches Offer to Australian Primary Health Care?

Tieman, Jennifer; Mitchell, Geoffrey; Shelby‐James, Tania; Currow, David C.; Fazekas, Belinda; O’Doherty, Lorna; Hegarty, Margaret; Eriksson, Lars; Brown, Robyn; Reid-Orr, Desley

doi:10.1071/py07024

Cited by 31 publications

(47 citation statements)

References 20 publications

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“…Specific issues from the individual reviews are briefly described here, and in more detail in a companion article 18 . In early‐stage diabetes, the review found that care planning and the subsequent care were normally based in the community and managed by general practice.…”

Section: Resultsmentioning

confidence: 99%

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Multidisciplinary care planning and teamwork in primary care

Mitchell

Tieman

Shelby‐James

2008

Medical Journal of Australia

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Objective: To examine policy and implementation issues around multidisciplinary care planning (MDP) as a means of improving outcomes for patients with chronic disease and/or complex care needs. Methods: We conducted a series of five systematic reviews of the literature from 1990 to 2006, sampling a spectrum of issues associated with chronic disease and complex health care needs, with a focus on planning and provision of multidisciplinary care. Results: Our review showed that MDP does improve many functional outcomes in the areas studied. Analysis of MDP programs involves examination of two groups of variables — the multidisciplinary components (a range of clinical perspectives and specialist knowledge) and team components (eg, communication and support). Implementing MDP requires changing patterns of interaction between care providers, alignment of roles and work practices, and changes to organisational arrangements. Conclusion: While MDP improves many functional outcomes, widespread implementation of MDP in standard practice will require complex and targeted strategies. Devising and testing such strategies is a prerequisite for widespread, routine use of MPD in chronic disease management.

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Section: Resultsmentioning

confidence: 99%

“…The conduct of each systematic review was similar, and the methodology is briefly outlined in Box 3. Full details on the study methodology can be found elsewhere 18 , 19…”

mentioning

confidence: 99%

Multidisciplinary care planning and teamwork in primary care

Mitchell

Tieman

Shelby‐James

2008

Medical Journal of Australia

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“…Different terms have been described for multidisciplinary care. Tieman et al (2007) have described different elements of care that involve multiple providers. Coordination was seen as processes and activities that enhance the relationships, linkages, transitions and responsibility for care within the existing structural arrangements such as shared health records, case conferences or shared assessment tools, leading to improved care arrangements for the patient.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?

Mitchell

Burridge

Zhang

et al. 2015

Aust. J. Prim. Health

116

144

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Abstract.Integrated multidisciplinary care is difficult to achieve between specialist clinical services and primary care practitioners, but should improve outcomes for patients with chronic and/or complex chronic physical diseases. This systematic review identifies outcomes of different models that integrate specialist and primary care practitioners, and characteristics of models that delivered favourable clinical outcomes. For quality appraisal, the Cochrane Risk of Bias tool was used. Data are presented as a narrative synthesis due to marked heterogeneity in study outcomes. Ten studies were included. Publication bias cannot be ruled out. Despite few improvements in clinical outcomes, significant improvements were reported in process outcomes regarding disease control and service delivery. No study reported negative effects compared with usual care. Economic outcomes showed modest increases in costs of integrated primary-secondary care. Six elements were identified that were common to these models of integrated primary-secondary care: (1) interdisciplinary teamwork; (2) communication/information exchange; (3) shared care guidelines or pathways; (4) training and education; (5) access and acceptability for patients; and (6) a viable funding model. Compared with usual care, integrated primary-secondary care can improve elements of disease control and service delivery at a modestly increased cost, although the impact on clinical outcomes is limited. Future trials of integrated care should incorporate design elements likely to maximise effectiveness.

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“…Coordinated multidisciplinary care can contribute to improved outcomes (Tierman et al 2007), promote positive patient experiences (Murphy et al 1992), and influence the ways in which patients think about and self-manage their condition (Lawton et al 2005). In Australia, the Enhanced Primary Care (EPC) program, and successive initiatives including the Medicare allied health initiatives, enables multidisciplinary team care for patients with chronic conditions managed in the primary care setting.…”

Section: Introductionmentioning

confidence: 99%

Better than nothing? Restrictions and realities of enhanced primary care for allied health practitioners

Foster

Cornwell

Fleming

et al. 2009

Aust. J. Prim. Health

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Participation of allied health professionals (AHP) in the Enhanced Primary Care (EPC) program is increasing. However, access to allied health services is strictly delineated under the EPC program and AHP face unique practice realities in providing care to patients with chronic conditions. This paper examines the discretionary practices adopted by AHP in response to the realities at the policy-practice interface and situates the discussion within a description of their experiences with EPC. Semistructured telephone interviews were conducted with a purposive sample of fifteen AHP. Participants were selected from a larger cohort who responded to a questionnaire about EPC. The EPC program was perceived as a positive start, although some aspects were problematic. Participants reported that the restriction on the number of subsidised sessions was not conducive to providing a good allied health service to patients with complex care needs and remuneration was not commensurate with the nature and scope of treatment required. The AHP in this study spoke of the dilemma of wanting to assist patients but at the same time to operate a financially viable business. Moreover, their experience was that multidisciplinary team care was implied rather than reality. Abbreviated care practices, reasonable solutions for access, and entrepreneurial practices were strategies used to manage the policy-practice tensions.

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Integration, Coordination and Multidisciplinary Care: What can These Approaches Offer to Australian Primary Health Care?

Cited by 31 publications

References 20 publications

Multidisciplinary care planning and teamwork in primary care

Multidisciplinary care planning and teamwork in primary care

Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?

Better than nothing? Restrictions and realities of enhanced primary care for allied health practitioners

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