Evaluation of the GP Super Clinics Program 2007-2008

6.2 Multi-disciplinary and Integrated Care

Page last updated: 2012

6.2.1 Multi-disciplinary Care

Older patients (>65 years) represented 17% of the patient survey sample with 32% (n= 221) of patients identifying as having a chronic illness. All GP Super Clinic Directors indicated when interviewed and through the self-assessment form that the GP Super Clinics were providing high quality multi-disciplinary care.

A total of 170 clinicians provided services at the six GP Super Clinics completing the self-assessment form; this equates to 94 full-time equivalents (FTEs). These numbers do not include information from one of the GP Super Clinics that did not complete the self-assessment form. An overview of the disciplines involved and their employment status (FTEs) is provided in Table 8. The GP Super Clinic which did not respond to the self-assessment survey reported 6 GPs providing services at the clinic.

Multi-disciplinary care occurred mainly through mechanisms such as the shared health record and the provision of multiple disciplines under one roof, thus facilitating referral, access and communication about patient care. Access to Medicare Items such as those for Team Care Arrangements or Chronic Disease Management items was also identified as facilitating multi-disciplinary care. Care planning was mostly undertaken by a specific discipline such as a practice nurse or allied health staff, following assessment and clinical treatment advice by a GP. In most instances this occurred with the patient attending multiple appointments with the different disciplines.

Table 8: Overview of Numbers and Employment Status of Clinicians*

Clinician CharacteristicClinician Interview Data
Number
FTEs
Discipline
General practitioner
60
39
Nurse
32
20
Psychologist
13
6
Dietician
6
4
Physiotherapist
13
8
Occupational therapist
3
2
Social worker
3
3
Podiatrist
6
3
Dentist
1
1
Non GP Medical specialist
21
4
Other
12
4
Total
170
94

* Missing data from one clinic

Clinicians in interviews commonly reported that multi-disciplinary care was in place and was providing significant benefits for patients. Further, 83% of patients surveyed indicated agreement or a strong level of agreement that the reason they attended the GP Super Clinics was that they could see a range of other health professionals in the one location.

Table 9 reports the proportion of clinicians who rated elements of care as important or very important (Level 4 or 5), and the proportion who rated the same elements as extensively or fully implemented (Level 4 or 5). The elements of care are listed in the table in order of perceived decreasing level of importance.

The three elements of care ranked by the most participants as being important are Multi-disciplinary model of service delivery for people with chronic illness (96%; 95% CI 87%-100%), recruitment of a range of clinicians (94%; 95% CI 84%-99%) and preventative care (92%; 95% CI 82%-98%). These elements of care were considered to have been extensively or fully implemented by 87% (95% CI 75%-95%), 70% (95% CI 56%-82%) and 79% (95% CI 66%-89%) of clinicians respectively (ranked 3rd, equal 4th and equal 5th). Participation in research was ranked as least important (45%; 95% CI 32%-60%) and most poorly implemented (25%; 95% CI 14%-38%). After hours care was considered second least important element, but considered as being implemented reasonably well (62%; 95% CI 48%-75%).

While the extent of implementation was comparable to ratings of importance for multi-disciplinary model of care (87%), the proportions indicating extensive or full implementation for recruitment of a range of clinicians (70%) and preventative care (79%) was much less than importance ratings. The biggest difference in ratings for importance (72%) compared to implementation (47%) was for training opportunities for clinicians.

Table 9: Clinicians Ratings of Importance and Extent of Implementation of Key Elements of GP Super Clinics in Providing High Quality care

Importance^
Implementation#
%
95% Confidence Interval
%
95% Confidence Interval
Multi-disciplinary model
96
87
100
87
75
95
Recruitment of a range of clinicians
94
84
99
70
56
82
Preventative care
92
82
98
79
66
89
Enhanced sharing of patient information
89
77
96
91
79
97
IT systems to support multi-disciplinary care
87
75
95
89
77
96
Retention of clinicians
85
72
93
70
56
82
Self-management for patients with chronic illness
83
70
92
66
52
78
Engagement with local community
81
68
91
62
48
75
Multi-disciplinary involvement in clinical governance
79
66
89
64
50
77
Multi-disciplinary involvement in development of service models
79
66
89
55
40
68
Meeting health needs of Aboriginal and Torres Strait Islanders
74
60
85
60
46
74
Physical infrastructure to support training
74
60
85
79
66
89
Training (professional development) opportunities for clinicians
72
58
83
47
33
61
Shared planning with external health services
70
56
82
55
40
68
Training opportunities in multi-disciplinary care
70
56
82
55
40
68
Meeting health needs of older Australians
64
50
77
70
56
82
Multi-disciplinary involvement in organisational governance
64
50
77
57
42
70
After-hours care
58
44
72
62
48
75
Participation in research
45
32
60
25
14
38

^ Percentage of clinicians who rated this aspect as importance level 4 or 5
# Percentage of clinicians who rated this aspect as being implemented at level 4 or 5

Clinicians were asked about their perceptions about factors which support multi-disciplinary care at their GP Super Clinics (Table 10).

Table 10: Clinicians’ Perception of Factors which Support Multi-disciplinary Care

%^
95 % Confidence Interval
Management commitment
94
84
99
Respect for the contribution of all disciplines
94
84
99
Communication systems within this GP Super Clinic
94
84
99
IT systems
94
84
99
Clinical protocols and guidelines
91
79
97
Clinical leadership from all clinical leaders
85
72
93
Data collection systems which support understanding of performance and outcomes
79
66
89
Time availability for provision of multi-disciplinary care planning
79
66
89
Funding for all aspects of multi-disciplinary care
75
62
86
Processes for involvement of all disciplines in clinical governance approaches
74
60
85
Processes for involvement of all disciplines in organisational governance approaches
64
50
77

^ Percentage of clinician agreeing or strongly agreeing that the factors support multi-disciplinary care at this GP Super Clinic

Management commitment, respect for the contribution of all disciplines, communication systems within the GP Super Clinics and IT systems were all considered by almost all clinicians to support multidisciplinary care at GP Super Clinics (94%; 95% CI 84%-99%). The factor considered by the least number of clinicians as supporting multi-disciplinary care in the GP Super Clinics was processes for involvement of all disciplines in organisational governance approaches (64%; 95% CI 50%-77%).