13 research outputs found
What evidence is there to support skill mix changes between GPs, pharmacists and practice nurses in the care of elderly people living in the community?
Background: Workforce shortages in Australia are occurring across a range of health disciplines but are most acute in general practice. Skill mix change such as task substitution is one solution to workforce shortages. The aim of this systematic review was to explore the evidence for the effectiveness of task substitution between GPs and pharmacists and GPs and nurses for the care of older people with chronic disease. Published, peer reviewed (black) and non-peer reviewed (grey) literature were included in the review if they met the inclusion criteria. Results: Forty-six articles were included in the review. Task substitution between pharmacists and GPs and nurses and GPs resulted in an improved process of care and patient outcomes, such as improved disease control. The interventions were either health promotion or disease management according to guidelines or use of protocols, or a mixture of both. The results of this review indicate that pharmacists and nurses can effectively provide disease management and/or health promotion for older people with chronic disease in primary care. While there were improvements in patient outcomes no reduction in health service use was evident. Conclusion: When implementing skill mix changes such as task substitution it is important that the health professionals' roles are complementary otherwise they may simply duplicate the task performed by other health professionals. This has implications for the way in which multidisciplinary teams are organised in initiatives such as the GP Super Clinics
Primary care nurses: effects on secondary care referrals for diabetes
Background: Primary care nurses play an important role in diabetes care, and were introduced in
GP-practice
partly to shift care from hospital to primary care. The aim of this study was to assess whether
the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with
the introduction of primary care nurses, and whether these changes were related to the number of
diabetes-related contacts in a general practice.
Methods: Healthcare utilisation was assessed for a period of 365 days for 301 newly diagnosed
and 2124 known T2DM patients in 2004 and 450 and 3226 patients in 2006 from general practices that
participated in the Netherlands Information Network of General Practice (LINH). Multilevel
logistic and linear regression analyses were used to analyse the effect of the introduction of
primary care nurses on referrals to internists, ophthalmologists and cardiologists and
diabetes-related contact rate. Separate analyses were conducted for newly diagnosed and known
T2DM patients.
Results: Referrals to internists for newly diagnosed T2DM patients decreased between 2004 and
2006 (OR:0.44;
95%CI:0.22-0.87) in all practices. For known T2DM patients no overall decrease in referrals to
internists was found, but practices with a primary care nurse had a lower trend (OR:0.59). The
number of diabetes-related contacts did not differ between practices with and without primary care
nurses. Cardiologists’ and ophthalmologists’ referral rate did not change.
Conclusions: The introduction of primary care nurses seems to have led to a shift of care from
internists to primary care for known diabetes patients, while the diabetes-related contact rate
seem to have remained
unchanged.
Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial
Tabla de contenido: 1. ViolĂn primero; 2. ViolĂn segundo; 3. Trompa primera; 4. Trompa segunda; 5. BajĂłn; 6. Acompañamiento; 7. Tiple primero; 8. Tiple segundo; 9. Alto; 10. Bajete.Folio 1v. Acompañamiento al Magnificat.Folio 3. ViolĂn primero.Folio 7. ViolĂn segundo.Folio 9. Trompa primera.Folio 10. Trompa segunda.Folio 11. BajĂłn al Magnificat.Folio 12. Tiple primero.Folio 16. Tiple segundo.Folio 20. Alto.Folio 24. Bajete.Folio 12-26. Letra