Patient perceptions of their health care professionals Implications - PowerPoint PPT Presentation

Patient perceptions of their health care professionals Implications for innovative and sustainable rural primary health care delivery in Queensland Lisa Crossland School of Medicine and Dentistry & Mount Isa Centre Place image/s within black outline if you want. If you choose to include images, the black outline is for positioning purposes only. Remove outline after For Rural Health images are placed. Prof Craig Veitch Dr Sarah Larkins Prof Richard Hays

Introduction 1. Background 2. Aims and objectives 3. Methods 4. Key results – patient perceptions 5. Implications 6. References

Background International and National • System review and restructure • Workforce shortages • Debate on the role and function of new services 1,2,3 Australia It is unrealistic to introduce innovation to the • Workforce shortages primary health care workforce without first • Increasing elderly population understanding how the general public • Rationalise costs and service provision perceives the role of existing professionals (9) • National Hospital and Health Reform 4,5,6,7, 8,9

Aims & objectives Investigate patient perceptions of the skills and roles of existing primary health care professionals in rural and remote service settings (i) patient perceptions of existing health care professionals; and perceptions of the PHC professionals themselves (ii) differences and similarities between rural patients’ perceptions of PHC professionals and the key factors that contribute to these (iii) patients’ broad stereotypical views of the health care disciplines (iv) how these perceptions impact on existing and innovative approaches to rural primary health care delivery

Method 1 Phase 1: Case studies – service and community profile information (The Context) Phase 2 : In-depth interviews with patients to investigate skills and roles (The Perceptions ) Phase 3: Comparative, inductive analysis of results – unique and common to each service model (case studies) (The Findings)

Method 2 Comparative case study approach • 4 discrete service types • RRMAs 5-7 Theoretical frameworks • Social interactionism • Organisational Change Theory (OCT) Participants • 16 PHC professionals • 43 patients • All interviews completed in the PHC services

Four service types Model A: GP-led Model B : GP-led The “Hospital Doctor” The “He’s It” Solo GP with hospital Solo GP , no hospital Practice Nurse Practice Nurse Local paramedics Local paramedics Local allied health Visiting allied health Model C: RIPERN-led Model D: Multipurpose The “No different to a GP” The “Does Everything” Rural Isolated Practice Endorsed GP Nurse (RIPERN) Multipurpose Health Service No local paramedic Community & ward-based nurses Visiting allied health Highly flexible RFDS support Local GP practices in town

Patient perceptions of skills 1 • “Knows Us” Well [the nurse], the biggest skill is she knows us all and she knows our conditions. She works with bush people, she lives here and she knows we put up with a lot before we come to the clinic. (F, RIPERN model) • “Refers” You don’t get the same treatment anywhere else, they know me here, my • “Is confident & history…they are happy and they want gives you to get well. (M, Solo GP no hospital confidence” model)

Patient perceptions of skills 2 • Clinical skills only [The RIPERN] is the key… the doctors, well they just back her up… They’re not when prompted much different, they do pretty much the same things. (M, RIPERN model) - No difference GP & RIPERN The nurses, they do things on the front - Differences in practice line – see everyone – wound dressings and blood and things – all of that. (F, nurses solo GP no hospital) • Limited knowledge of Well, I never really see the nurse… I’ve allied health never had anything done by the nurse professionals & in the doctors surgery. (F, solo GP with paramedics hospital)

Stereotypes of disciplines 1 • GP-led models I think, the nurses, you know, they’re like - Perceptions of medical Florence Nightingale . hierarchies persist They have the caps and I see a GP as the the starched uniforms and - Nurses as caring leader…its his degree, his all of that . They care “Florence Nightingales” training … and his about you… - GPs as “leaders” communication (solo GP, (M, solo GP no hospital) no hospital)

Stereotypes of disciplines 2 • RIPERN & MPHS - Medical hierarchies less pronounced • RIPERN I come up here to the clinic Nurses as “leaders” - but it’s usually to see the GP, GPs as “supporters” - the GP is the one who will help with my problems, he’s • MPHS the one who can write the - Less clarity scripts … (F, RIPERN service) - Roles interchangeable - Flexible

Factors influencing perceptions 1. Age and gender 2. Disease status and role 3. Long-term exposure to service models • longevity of PHC professional in community • organisation and delivery of health care

Implications for existing models • Maintenance of solo practitioner models? • Equal support for both solo GP and non GP-led models – Funding, relief, onsite opportunities for clinical training – Recruitment and retention strategies

Implications for team-work • Defining the concept and practice of team- based health care in rural settings • Review existing organisation and government based reporting structures, policies and infrastructure to maintain existing and facilitate flexible team-based approaches • Who is and should be the co-ordinator?

Implications for innovation • Community consultation and education • Education for existing PHC professionals • Taking into account current health care organisation enabling new roles to fit most effectively into existing service models

Table of Characteristics COMMUNITY characteristics SERVICE characteristics IMPLICATIONS: Trial of innovative approaches Demonstrated desire to secure a Long standing vacancy: No present Physician Assistants resident PHC service PHC service or history of high PHC professional turnover Community experience of Use of team-based approaches to care Team-based approaches flexible PHC professional roles by resident PHC professionals within PHC Paramedics an existing PHC service (eg. MPHS) Experience of coordinated care Use of team-based approaches to care PHC Paramedics within single PHC clinic setting delivery with visiting health care Physician Assistants professionals Long-term experience of non-GP Care historically provided by non-GP Physician Assistants led models of care led models (eg. RIPERN service)

Conclusion 1. The normal mode of health care delivery matters 2. Important to support both GP and non-GP led models 3. Further research: existing team-work approaches; how to link patient perceptions to quality care and health outcomes 4. Trial of innovative workforce approaches matched to appropriate service settings There are so many people like myself … my blood pressure, I mean I don’ t know how we’d manage with anyone else here… anything half -baked, you know? There are a lot of people in town that need constant attention – that’s work for a GP. (F, solo GP with hospital)

References… 1. Building a Health Service fit for the Future. A National Framework for Service Change in the NHS Scotland , The Scottish Executive, National Health Service; National Parliament of Scotland, 2005. Brooks, P and Ellis N (2006) Health Workforce Innovations Conference , Medical Journal of Australia, 2. Vol 184 (3): pp 106. 3. Duckett, S (2005 ) Interventions to facilitate workforce restructure , Australian and New Zealand Health Policy, Vol 2 (14) Accessed online: www.anzhealthpolicy.com/info 22/06/06. 4 . National Health and Hospitals Reform Commission (2009) A healthier future for all Australians: Final Report Department of Health and Ageing; Canberra, Australian Government. 5 . Sinking Deeper into the Abyss: A concise overview of current and future trends in the Australian urban, rural and remote general practice workforce , Health Workforce Queensland, 2006. Australian Health Workforce Productivity Commission , Australian Productivity Commission, 6. Australian Government, 2005. 7. Veitch C, (2005) Rural health: Past, Present and Future, Inaugural Lecture , James Cook University, Townsville, Queensland, Australia. 8. National Health and Hospitals Reform Commission (2009) A healthier future for all Australians: Final Report Department of Health and Ageing; Canberra, Australian Government. 9. Black, N; Rafferty, A; et al. (2004) Health care workforce research: Identifying the agenda, Journal of Health Services Research and Policy, Vol 9, Suppl 1: S62-4.