Under the same roof: co-location of practitioners within primary care is associated with specialized chronic care management

Rumball-Smith, Juliet; Wodchis, Walter P.; Koné, Anna Péfoyo; Kenealy, Tim; Barnsley, Jan; Ashton, Toni

doi:10.1186/1471-2296-15-149

Cited by 34 publications

(24 citation statements)

References 24 publications

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“…The co-location of primary care teams, with a single point of access, contributes to reducing duplication and to ensuring services that are more responsive for patients [68]. It may also be due to a greater capacity of PCCs to provide a broad, specialized and preventive care for people with chronic diseases, thanks to their organisational characteristics.…”

Section: Discussionmentioning

confidence: 99%

Is the co-location of GPs in primary care centres associated with a higher patient satisfaction? Evidence from a population survey in Italy

Bonciani

Barsanti

Murante

2017

BMC Health Serv Res

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BackgroundSeveral countries have co-located General Practitioners (GPs) in Primary Care Centres (PCCs) with other health and social care professionals in order to improve integrated care. It is not clear whether the co-location of a multidisciplinary team actually facilitates a positive patient experience concerning GP care. The aim of this study was to verify whether the co-location of GPs in PCCs is associated positively with patient satisfaction with their GP when patients have experience of a multidisciplinary team. We also investigated whether patients who frequently use health services, due to their complex needs, benefitted the most from the co-location of a multidisciplinary team.MethodsThe study used data from a population survey carried out in Tuscany (central Italy) at the beginning of 2015 to evaluate the patients’ experience and satisfaction with their GPs. Multilevel linear regression models were implemented to verify the relationship between patient satisfaction and co-location. This key explanatory variable was measured by considering both the list of GPs working in PCCs and the answers of surveyed patients who had experienced the co-location of their GP in a multidisciplinary team. We also explored the effect modification on patient satisfaction due to the use of hospitalisation, access to emergency departments and visits with specialists, by performing the multilevel modelling on two strata of patient data: frequent and non-frequent health service users.ResultsA sample of 2025 GP patients were included in the study, 757 of which were patients of GPs working in a PCC. Patient satisfaction with their GP was generally positive. Results showed that having a GP working within a PCC and the experience of the co-located multidisciplinary team were associated with a higher satisfaction (p < 0.01). For non-frequent users of health services on the other hand, the co-location of multidisciplinary team in PCCs was not significantly associated with patient satisfaction, whereas for frequent users, the strength of relationships identified in the overall model increased (p < 0.01).ConclusionThe co-location of GPs with other professionals and their joint working as experienced in PCCs seems to represent a greater benefit for patients, especially for those with complex needs who use primary care, hospitals, emergency care and specialized care frequently.

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Section: Discussionmentioning

confidence: 99%

Is the co-location of GPs in primary care centres associated with a higher patient satisfaction? Evidence from a population survey in Italy

Bonciani

Barsanti

Murante

2017

BMC Health Serv Res

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“…Some studies point to the fact that co-location is a necessary prerequisite for integrated care [363738]. A recent study found that co-location of multiple disciplines within a primary care practice was associated with increased capacity to provide broad, specialised and preventive care for people with chronic disease [39 p. 5]. More specifically, studies demonstrate that there are positive associations between the number of co-located disciplines and the amount of consultations involving older adults, patients with diabetes or hypertension, and increased participation in disease management programs for diabetes, COPD and asthma, among other diseases [Ibid.].…”

Section: Theory and Methodsmentioning

confidence: 99%

Co-location as a Driver for Cross-Sectoral Collaboration with General Practitioners as Coordinators: The Case of a Danish Municipal Health Centre

Scheele¹,

Vrangbæk

2016

International Journal of Integrated Care

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The issue of integrated care and inter-sectoral collaboration is on the health policy agenda in many countries. Yet, there is limited knowledge about the effects of the different policy instruments used to achieve this. This paper studies co-location as a driver for cross-sectoral collaboration with general practitioners (GPs) acting as coordinators in a municipal health centre. The purpose of the health centre, which is staffed by health professionals from municipal, regional and private sectors, is to provide primary health services to the citizens of the municipality. Co-locating these professionals is supposed to benefit e.g., elder citizens and patients with chronic diseases who frequently require services from health professionals across administrative sectors.Methodologically, the analysis is based on qualitative data in the form of semi-structured interviews with the health professionals employed at the health centre and with administrative managers from municipal and regional government levels.The study finds that co-location does not function as a driver for cross-sectoral collaboration in a health centre when GPs act as coordinators. Cross-sectoral collaboration is hampered by the general practitioners’ work routines and professional identity, by organisational factors and by a lack of clarity concerning the content of collaboration with regard to economic and professional incentives.

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“…conditions [36]. To support an effective development and implementation of integrated care pathways, agreements on the whole care continuum are recommended.…”

Section: Number Of Participants Per Countrymentioning

confidence: 99%

The Manage Care Model – Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes

Timpel

Lang²,

Wens

et al. 2020

Int J Integr Care

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BackgroundA growing number of EU citizens suffers from diabetes, posing an emerging health, social and economic burden in the EU [1]. This burden is mostly driven by type 2 diabetes mellitus (T2DM), which is increasingly diagnosed at younger age and leads to a rising number of adults with T2DM aged 65 and older [1]. Due to these rising numbers in diabetes prevalence a growing number of patients faces accompanying comorbidities as well as complex needs [2][3][4][5]. However, many care systems are historically built on separate sectors (health vs. social care, in-vs. outpatient care). This traditional acute and episodic focus of care is inadequate to effectively meet the complex needs of patients as it increases the risk of care fragmentation and loss of information [6,7]. Although these circumstances are repetitively part of health policy initiatives [8,9], there is still an institutional and regulatory separation between health and social care services, as well as between ambulatory and inpatient care [10].Integrated care is said to improve outcomes of care by linking services of providers along the continuum of care and thus overcoming issues of fragmentation [11]. Back in 1996, Ed Wagner developed the Chronic Care Model (CCM), which became a cornerstone to improve care delivery for chronically ill patients. The CCM comprises the following six components: (1) community, (2) health system, (3) self-management support, (4) delivery system design, (5) decision support and (6) clinical information systems [12]. Ever since, different initiatives developed new models targeting specific weaknesses of the initial CCM.However, recent analysis uncovered that the understanding of established models' impact on chronic disease management is limited [13]. This is especially true for the effectiveness and applicability of chronic care models in different populations and settings [13]. Additionally, on behalf of the MANAGE CARE Study Group Background: Most current care models are disease-or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus. Method: An iterative approach was used combining systematic literature search with qualitative methods, including a standardised survey of experts in chronic care (n = 92), an expert workshop of professionals (n = 22) and a multilingual online survey (n = 659). Using three consensus meetings involving researchers, policy makers and experts in chronic care, a limited number of core components and care recommendations was set up to develop a new chronic care model. Results: The developed 'MANAGE CARE MODEL' includes aspects of the health and social care system, resources derived from the living environment, aspects of health promotion and prevention, as well as an expanded understanding of improved outcomes as an integral part of chronic care. Conclusion: The MANAGE CARE MODEL provides...

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Under the same roof: co-location of practitioners within primary care is associated with specialized chronic care management

Cited by 34 publications

References 24 publications

Is the co-location of GPs in primary care centres associated with a higher patient satisfaction? Evidence from a population survey in Italy

Is the co-location of GPs in primary care centres associated with a higher patient satisfaction? Evidence from a population survey in Italy

Co-location as a Driver for Cross-Sectoral Collaboration with General Practitioners as Coordinators: The Case of a Danish Municipal Health Centre

The Manage Care Model – Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes

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