Objective: To explore factors associated with the frequency of multidisciplinary Team Care Arrangements (TCAs) and the impact of TCAs on patient-assessed quality of care in Australian general practice.
Design and setting: Data were collected as part of a cluster randomised controlled trial conducted in 60 general practices in New South Wales, the Australian Capital Territory and Victoria between July 2006 and June 2008. Multilevel logistic regression analysis evaluated factors associated with the frequency of TCAs recorded in the 12 months after baseline, and multilevel multivariable analysis examined the association between TCAs and patient-assessed quality of chronic illness care, adjusted for patient and practice characteristics.
Results: Of 1752 patients with clinical audit data available at 12-month follow-up, 398 (22.7%) had a TCA put in place since baseline. Women, patients with two or more chronic conditions, and patients from metropolitan areas had an increased probability of having a TCA. There was an association between TCAs and practices with solo general practitioners and those with greater levels of teamwork involving non-GP staff for the control group but not the intervention group. Patients who had a TCA self-assessed their quality of care (measured by PACIC scores) to be higher than those who did not.
Conclusions: Findings were consistent with the purpose of TCAs — to provide multidisciplinary care for patients with longer-term complex conditions. Significant barriers to TCA use remain, especially in rural areas and for men, and these may be more challenging to overcome in larger practices.
- 1. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q 1996; 74: 511-544.
- 2. Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1998; 1: 2-4.
- 3. Renders CM, Valk GD, Griffin SJ, et al. Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care 2001; 24: 1821-1833.
- 4. de Sonnaville JJ, Bouma M, Colly LP, et al. Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study. Diabetologia 1997; 40: 1334-1340.
- 5. Australian Government Department of Health and Ageing. MBS primary care items. Chronic Disease Management (CDM) Medicare items. http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-chronicdiseasemanagement (accessed Oct 2010).
- 6. Zwar NA, Hermiz O, Comino EJ, et al. Do multidisciplinary care plans result in better care for type 2 diabetes? Aust Fam Physician 2007; 36: 85-89.
- 7. Blakeman TM, Harris MF, Comino EJ, Zwar NA. Evaluating general practitioners’ views about the implementation of the Enhanced Primary Care Medicare items. Med J Aust 2001; 175: 95-98.
- 8. Kirby SE, Chong JL, Frances M, et al. Sharing or shuffling — realities of chronic disease care in general practice [letter]. Med J Aust 2008; 189: 77. <MJA full text>
- 9. Taggart J, Schwartz A, Harris MF, et al. Facilitating teamwork in general practice: moving from theory to practice. Aust J Prim Health 2009; 15: 24-28.
- 10. Perkins D, Harris MF, Tan J, et al. Engaging participants in a complex intervention trial in Australian General Practice. BMC Med Res Methodol 2008; 8: 55.
- 11. Glasgow RE, Wagner EH, Schaefer J, et al. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care 2005; 43: 436-444.
- 12. Rosemann T, Laux G, Droesemeyer S, et al. Evaluation of a culturally adapted German version of the Patient Assessment of Chronic Illness Care (PACIC 5A) questionnaire in a sample of osteoarthritis patients. J Eval Clin Pract 2007; 13: 806-813.
- 13. Taggart J, Chan B, Jayasinghe UW, et al. Patients Assessment of Chronic Illness Care (PACIC) in two Australian studies: structure and utility. J Eval Clin Pract 2010 Sep 16. Epub ahead of print. doi: 10.1111/j.13652753.2010.01423.x.
- 14. Australian Bureau of Statistics. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia - Data only, 2006. Canberra: ABS, 2008. (ABS Cat. No. 2033.0.55.001.)
- 15. Proudfoot JG, Bubner T, Amoroso C, et al. Chronic Care Team Profile: a brief tool to measure the structure and function of chronic care teams in general practice. J Eval Clin Pract 2009; 15: 692-698.
- 16. Proudfoot J, Jayasinghe UW, Infante F, et al. Quality of chronic disease care in general practice: the development and validation of a provider interview tool. BMC Fam Pract 2007; 8: 21.
- 17. Rasbash J, Steele F, Browne W, Prosser B. Multilevel analysis with MLwiN software: a user’s guide to MLwiN version 2.0. Bristol: Centre for Multilevel Modelling, University of Bristol, 2005.
- 18. National Rural Health Alliance. Current issues for Australia’s rural and remote health workforce [position statement]. Canberra: NRHA, 2004.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.