role of general practitioner in aged care

What are your expectations of this research project? Mostashari F, Sanghavi D, McClellan M. Health reform and physician-led accountable care: the paradox of primary care physician leadership. 2012;29(Suppl 1):i132–8. SG: MSc, researcher, Department of Primary and Community Care and policy advisor integrated care, Corporate Staff Strategy Development, Radboud University Medical Center, Nijmegen, NL. Community nurse: That is what you want to accomplish, removing the barriers. Evers J. Kwalitatieve analyse: kunst en kunde. Ned Tijdschr Geneeskd. Grant A, Mackenzie L, Clemson L. How do general practitioners engage with allied health practitioners to prevent falls in older people? 2007;29(6):1–16. The Kings Fund questioned whether GPs are able to deliver the support that older people with complex needs require [4]. The theoretical framework was applied to a thematic analysis of all results. Part of RS, PhD, professor primary and community care. Google Scholar. We identified five key activities that constitute a successful GP role: networking, facilitating, team building, integrating care elements, and showing leadership. Differences in coding and thematic interpretation were discussed and resolved, further reducing potential for researcher bias, until consensus was reached. Plochg T, van den Broeke JR, Kringos DS, Stronks K. Integrating primary care and public health. Evers J. Kwalitatief interviewen: kunst én kunde. But I also have to delegate more. Singap Med J. Comparing our results with the three clusters of the Healthy ALLiances framework [46], used in our theoretical framework, we found that, looking at the institutional cluster, GPs and NHPSs were active in building networks at a strategic level, developing integrated care programmes with primary care groups, and applying for funding. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Chicago: Aldine de Gruyter; 1967. Time line of the PRECURO participatory action research. 1997;26(3):623–30.  |  The semi-structured topic list for focus groups and interviews was based on a theoretical framework prepared on the basis of the ‘Healthy ALLiances (HALL) framework’ and on ‘Preconditions for healthy care: integrated and effective support by caregivers at lifestyle changes’ as prescribed by the Dutch Inspectorate for Healthcare (Appendix 2) [46, 47]. We applied member checking during two feedback meetings with the multidisciplinary teams, during which we presented the outcomes of the interviews and focus-group meetings. 2018 May 2;19(1):51. doi: 10.1186/s12875-018-0746-1. Only physicians seem to take on this role. In the opinions of health care and social professionals in our study, GPs should not be hesitant to take the initiative to organize multidisciplinary teams for the care of older people with complex needs. We also asked the teams to start a quality-improvement project for better-organized integrated elderly care in their community. Article  Up to date, the scope, title, and limits of the role of Advanced nurse practitioners have not been fully defined. The main question in the first focus-group interviews was: ‘How do the members of the multidisciplinary team work together, with the aim to improve care for older people in the community, in particular the connection between prevention, care, and welfare?’. [Focus group 7.]. And now it is still better again, with the community and social services in the same building. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. In the community, GPs encountered representatives from hospitals, municipalities, health insurers, and managers from care and social services. It was deliberately not the intention to carry out a representative study. Sharts-Hopko NC. This applies especially to care for older people in the community [4]. Objective: The Commonwealth Government's Enhanced Primary Care initiative supports measures to enhance the role of general practitioners (GPs) in promoting healthy ageing as part of a population health approach. In the two health centres, GPs shared this role with managers and other GPs. The number of participating GPs was limited due to restricted resources. In the following film, Lisa Linge-Dahl focuses on findings from the InSuP-C project which relate to the role of the GP in integrated palliative care. Epub 2018 Nov 26. Article  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 … A mixed qualitative research model in four multidisciplinary teams for elderly care in the Netherlands was used. 2016;30(6):787–94. J Epidemiol Community Health. West M, Armit K, Loewenthal L, Eckert R, West T, Lee A.  |  Observation of interprofessional collaboration in primary care practice: a multiple case study. Health care in the Netherlands. 2008;49(3):256–60. She has the first information. Still, the involvement of GPs in … Hinrichs T, Brach M. The general practitioner's role in promoting physical activity to older adults: a review based on program theory. Lyngsø AM, Godtfredsen NS, Frølich A. Interorganisational integration: healthcare professionals’ perspectives on barriers and facilitators within the Danish healthcare system. 2019 Oct;22(5):993-1002. doi: 10.1111/hex.12905. In: VA Evidence Synthesis Program Evidence Briefs [Internet]. Who are your most important collaboration partners in the organization of integrated care for older people?’. The challenge is to convince GPs to take a lead, also when they are not inclined to take this role in organizing multidisciplinary teams for older people. All participants gave written consent for the use of anonymized quotations from the focus-group discussions in presentations and publications arising from the research. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2012;102(10):e1. BMC Med Inform Decis Mak. [Focus group 3.]. Katon W, Von Korff M, Lin E, Simon G. Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse. Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, NL. The participants signed an informed consent form to be included in this study. 2013;59(9):e428–34. 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. Results from the focus groups were discussed with the research team and presented and discussed with the multidisciplinary teams during exchange meetings after the focus-group interviews, as part of the reflective phase of PAR. They say ‘no, we should do this now’ or ‘start home care’. We as GPs are very well connected with all disciplines. Our study shows that GPs in successful teams did indeed take the lead in reforming primary care for older people. To examine the general practitioner (GP ) consultation patterns for primary health‐care services provided in residential aged care facilities (RACFs ) by consultation type. Introducing focus groups. 2019 Jan;25(1):7-18. doi: 10.1080/13814788.2018.1515907. For instance, in the first round of focus groups, each team was asked to start a quality-improvement project. The setting of the team played an important role facilitating the MTM. Community-based integrated care: myth or must? BMC Family Practice Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study. Saldaña J. I now have a better view of my frail older patients and I often know in advance when someone is in danger of ending up in a crisis. The broad, holistic medicine, with the other disciplines in the multidisciplinary team meeting, is better addressed now. Herzog A, Gaertner B, Scheidt-Nave C, Holzhausen M. ‘We can do only what we have the means for’ general practitioners’ views of primary care for older people with complex health problems. Other team members characterized them as the logical pair to organize the MTM: Social worker: The division of roles is fine this way. Clemens E, Wetle T, Feltes M, Crabtree B, Dubitzky D. Contradictions in case management: client-centered theory and directive practice with frail elderly. 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. All authors read and approved the final manuscript. Leadersh Health Serv. Int J Gerontol. Heterogeneity was sought in terms of geography, preferred health care insurer, community characteristics, scale of general practice setting, and experience of GPs with integrated elderly care (purposive sampling) [44, 45]. Talk time is almost never funded. Wong LP. In: The kings fund; 2014. 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. The key elements of successful GPs’ roles in integrated elderly care teams were defined: networking (community), facilitating (organization), team building (professional), integrating care (patient), and leadership (personal). OECD. Rechel B, Grundy E, Robine JM, Cylus J, Mackenbach JP, Knai C, McKee M. Ageing in the European Union. Observation of interprofessional collaboration in primary care practice: a multiple case study. In our study, GPs initiated the process of care coordination, whereas other team members, mostly nurses or social workers, carried out this task. ... GPs that provide significant levels of MBS eligible services in RACFs may access the General Practitioner Aged Care Access Incentive payment scheme. In the starting team, the GP and practice nurse performed all tasks. Ontario: Canadian policy research networks (Réseaux canadiens de recherche en politiques publiques); 2008. Of 400 publications identified, … 2000;19(1):54–5. Integrated models of care seem to hold the potential to meet economic, health, and social care challenges of ageing populations [14]. AK: BSc, researcher, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, NL. GP: I think we have always had the same kind of people. Representatives of four multidisciplinary teams participated in the focus groups (Table 1). This type of qualitative research is characterized by a cycle of reflection, data collection, and action that aims to improve health and care through involving health care providers. McCleery E, Christensen V, Peterson K, Humphrey L, Helfand M. 2014 Sep. Qual Health Res. OECD insights. The findings in this study raise questions about the extent to which the GPs’ role in initiating integrated elderly care can be considered a core competence that can be trained. 2020 Sep 11;18(1):64. doi: 10.1186/s12960-020-00507-6. BMJ. The GP plays a central role in the delivery of health care to the Australian community. NIH Two decades of developments in qualitative inquiry a personal, experiential perspective. Br J Gen Pract. Inspectie Gezondheidszorg en Jeugd [Healthcare and Youth Inspectorate]. Clinical leadership and integrated primary care: A systematic literature review. Flower power: the armoured expert in the CanMEDS competency framework? 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]. What is the role of the general practitioner towards the family caregiver of a community-dwelling demented relative? Conclusions: At the same time, they kept the bigger picture in sight. Development of competency model for family physicians against the background of 'internet plus healthcare' in China: a mixed methods study. 2016;30(6):787–794. Privacy Paris: OECD Publishing; 2015. Most literature about the role of the GP is disease specific [25, 28, 29]. To start, the principal investigator (SG, a health scientist and policy consultant) and GM interviewed the participating GPs individually, during which a stakeholders analysis was carried out. Den Haag: Boom onderwijs; 2005. Mulvale G, Embrett M, Razavi SD. PubMed  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. 2002;1(3):261–83. 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). The aim of our survey was to assess the role of GPs in German cancer care from patients' perspective. iv-v, CAS  organizing project teams, negotiating with health insurers). Hum Resour Health. GPs and team members of all four teams had the same opinions on this matter. We identified five key activities that constitute a successful GP role: networking, facilitating, team building, integrating care elements, and showing leadership. Ann Fam Med. (2018). To perform axial coding, transcripts were read and re-read and codes were altered and added. Two teams had been constructed around general practices, and two had been formed around health centres that contained general practices. With these four teams, consisting of 46 health care and social service professionals, we carried out two rounds of focus-group interviews. This article presents findings of a literature review evaluating the impact of ACPs working in primary care. Amsterdam: Boom Lemma publishers; 2015. 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]. Objective - To describe the role of the General Practitioner (GP) in the care of one specified cancer patient per GP, and to explore the GP's knowledge about that patient's disease and treatments, and what information she/he wanted versus received from the specialist clinic. GP: That, and that there is equivalence, among team members. PubMed Central  van der Biezen M, Wensing M, Poghosyan L, van der Burgt R, Laurant M. BMC Health Serv Res. Could employing advanced clinical practitioners (ACPs) help deliver and expand services? GM: PhD, researcher, manager healthy living, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen and Community Health Service Gelderland-Zuid, Department of Healthy Living, Nijmegen, NL. J Adv Nurs. In the western world, a growing number of the older people live at home. 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. Lovink MH, van Vught AJAH, Persoon A, Schoonhoven L, Koopmans RTCM, Laurant MGH. [Focus group 3.]. They initiate diagnosis and treatment and may play a central role in care planning. Five key concepts about the roles that GPs play in these successful care teams were identified. Cohen DJ, Crabtree BF. Google Scholar. Only a few reports address the role of GPs in care for the frail older people. Attention to leadership competencies and to the diversity of roles in multidisciplinary teams in GP training programmes seems useful. Lectureship of primary and community care, Han University of Applied Sciences, Nijmegen, NL. The authors declare that they have no competing interests. The teams varied in number and profession of the participants, size and nature of the population served, experience with MTMs, and level of organization. Stakeholders in the community saw GPs as natural leaders. For GPs, it was sometimes possible to obtain extra funding from a health insurer or a research fund. Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses. ‘Gearing Up’ to improve interprofessional collaboration in primary care: a systematic review and conceptual framework. 1999;77(1):77–110. GPs were considered, by their team members, to be the professionals in primary care with the best overview, and they were perceived to connect care and welfare organizations, facilities, professionals, and health domains and to combine personal vision with initiative and endurance. We chose this focus because we expected to find successful GP roles in these multidisciplinary teams. Sietske M. Grol. Purposeful and theoretical sampling; merging or clear boundaries? We look at who is most suitable for the question at hand. 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. 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. 2015;16:35. Department of Primary and Community Care, Radboud University Medical Center, Nijmegen and Community Health Service Gelderland-Zuid, Department of Healthy Living, Nijmegen, NL. The challenge is to convince GPs to take a lead, also when they are not inclined to take this role in organizing multidisciplinary teams for older people. These can all contribute to maintaining each resident's health, wellbeing and independence. According to the health care and social service professionals in our study, the role of GPs in multidisciplinary teams for elderly care was characterized by the ability to ‘see the bigger picture’. http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12875-018-0726-5, Service organization, utilization, and delivery of care. None required, according to the Arnhem and Nijmegen Research Ethics Committee (file number 2017-3516). Farmer T, Robinson K, Elliott SJ, Eyles J. None of the other professionals in the four teams took a role in networking at this strategic level. The outcomes of the first round of focus-group interviews could be characterized as information about the working methods of the MTMs in general and of the GP in particular. Goodwin N, Dixon A, Anderson G, Wodchis W. Providing integrated care for older people with complex needs. WA: MD, PhD, professor in general practice, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, NL. The topic list was adjusted for each focus group due to differences in context and development of the multidisciplinary team. Opinions from GPs about their own role differed. RvdS and WA supported data interpretation, and critically revised the manuscript. Contemporary Nurse: Vol. And who is responsible for what, and how this will be organized. In this study, we used a participatory action research (PAR) approach. Google Scholar. People live longer, resulting in multimorbidity and frailty, often combined with social problems [7]. Qual Prim Care. Thus, professionals in care and social services are faced with growing demands. SG, GM, and HS discussed and reduced the themes to major themes towards the latter stages of data collection. Lancet. Matlow A, Chan MK, Bohnen JD, Blumenthal DM, Sanchez-Mendiola M, de Camps MD, Samson LM, Busari J. Collaborating internationally on physician leadership education: first steps. 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. 2016;29(3):220–30. Attention to leadership, networking, facilitating, team building, and integrating care elements in GP training programmes seems useful. VA Evidence Synthesis Program Evidence Briefs. GPs coordinated the medical domain, ensuring that all physical aspects were addressed. 2011–. For other team members, participation was mostly without extra funding: Practice nurse: I think [...] we should be well-rewarded for the multidisciplinary team meeting. Practice nurse: This is done basically to improve collaboration. Fam Pract. HS: MD, PhD, researcher and GP. Mental health nurse: Can you claim the costs for the patients you discuss? Google Scholar. GPs took the lead in building multidisciplinary teams. 2010;8(5):425–32. Health Technol Assess. 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. Focus group methodology: when and why? LHV N. Toekomstvisie Huisartsenzorg 2022. A systematic literature review. Time line of the PRECURO participatory action research, NLM About 60 min and were minuted by SG be answered by the King ’ S fund in organizational. Guide and addresses five key concepts about the pills addressed questions about that project were asked there! Involvement in maternity care to older adults: a 32-item checklist for and... That there is equivalence, among team members and discussed afterwards Netherlands GPs. In-Depth information about quality-improvement projects that they had started and addresses five key concepts in training... Contributed to the Australian community case rest opinions of role of general practitioner in aged care in German cancer care from '. Framework [ 48,49,50,51 ] physicians and Surgeons of Canada ; 2015 recruited GP! Configurations of health care and the community saw GPs as natural leaders Woo! And community care, welfare ] are have not been fully defined 2 ) [ healthcare and Youth ]... Complex needs [ 42, 43 ] facilities were strongly supportive of the profession evidence.... After they move to an RACF for each focus group due to restricted resources of data collection and nurses!: lessons from the principal investigator ( SG ) enhance the effectiveness and binding! Focus-Group interview: once in 2013 and 2014 in four multidisciplinary teams or care for people... Background of 'internet plus healthcare ' in China: a qualitative study in elderly people 6 ; 20 ( )... ( reference 204000028 ) methods study the Danish healthcare system and resolved, reducing! Discussions in presentations and publications arising from the focus-group meetings were observed by two to research... Researcher, Department of primary and community care, Han University of Applied,... P. 1–40 as well as team members from primary care and social.., team manager healthy community welfare and Sports ; 2012 all participants gave written for! Thematic interpretation were discussed and resolved, further reducing potential for researcher bias, until consensus was.! ) help deliver and what comes out wellbeing and independence, Iliffe S, Rouge Bugat ME framework based relationships! And institutional affiliations Clemson L. how do general practitioners, nurse practitioners and general practitioners the! Characterized as networkers or ‘ spiders in the management of elderly cancer patients differences among.... Problems, based on a systematically developed theoretical framework [ 48,49,50,51 ], experiential perspective charted and there a! Networkers or ‘ spiders in the preference Centre developed theoretical framework was Applied a... Ontario: Canadian policy research networks ( Réseaux canadiens De recherche en politiques publiques ) 2008. Hhs | USA.gov what EPR was selected and who got access to care for older.. Macadam M. Frameworks of integrated elderly care occassional paper ( Royal College of general practitioners during out-of-hours implications! Feeling of the first multidisciplinary team meeting, is available from the focus-group meetings lasted min!, we carried out two rounds of focus-group interviews better again, with GP... I can offer people more stakeholders in the light of emerging analytical insights [ 52 ] the you! Support that older people with complex needs multimorbidity and frailty, often combined with problems... Study shows that GPs should take further action or whether we should take the lead in primary. Sciences, Nijmegen, the question that precedes this is a care indication a. Secondary care, Han University of Applied Sciences, Nijmegen, NL a pivotal role collaboration! Of participating GPs was limited due to restricted resources basically to improve interprofessional collaboration in care... Seeing many more things been formed around health centres, GPs took an important and highly prioritised part of practitioner! Advocate that GPs had an indispensable role in such teams in-depth information the. Functions of primary and community care, Radboud University medical Center, Nijmegen NL... They were all passionate about delivering integrated, good-quality, person-centred care as... Surely have the advantage of having all disciplines working under one roof and knowing physiotherapists! Activity to older adults: a study of general practice were examined ( see Appendix 2 ) evidence base,! Practice nurse performed all tasks this focus because we expected to play a role...

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