New Workforce-based Models of Primary Care and an evaluation of the quality of evidence underpinning...
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Transcript of New Workforce-based Models of Primary Care and an evaluation of the quality of evidence underpinning...
New Workforce-based Models of Primary Care and an evaluation of the quality of evidence underpinning them
Professor Deborah SchofieldChair of Health Economics, NHMRC Clinical Trials Centre and School of Public Health, Sydney Medical School, University of Sydney
Dr Lucio Naccarella NHMRC Postdoctoral Training Fellow, The Australian Health Workforce Institute, The University of Melbourne and General Practice
Victoria
13th International Health Workforce Collaborative Conference October 24-26, 2011, Brisbane, Australia
Remembering Our Elders
“Imagination is more important than
knowledge. Knowledge is limited. Imagination
encircles the world”
Albert Einstein
(18-12-1932 to 10–06-2011)
Context
Strengthening primary care by extending workforce roles and skills within health
systems is one way to meet the increasing demands upon the health system
• Essential to assess the available evidence for each new or revised workforce-based models of primary care, and to conduct well designed rigorous evaluations
Paper Objectives
1. Models of primary care using different workforce arrangements
2. Framework for assessing evidence about models of primary care
3. Evaluate the quality of evidence in relation to models of diabetes care in the primary care setting
Primary Care Workforce Model Typology
• Innovation
• Supplementation/ enhancement
• Substitution/delegation
Framework for assessing the quality of evidence
• Relevant and replicable
• Theoretical framework• Strength of the
evidence • Size of the effect • Transferability and
representative • Duration • Value for money
Evidence of Workforce Models Models of Diabetes Care Workforce Models– roles, skills mix…
• Point of care testing Shephard et al(2005) • local GP, diabetes educator, podiatrist
•Diabetes model of care – WA (2008) •GP-coordinated multidisciplinary approach ?
• Pharmacy diabetes care Krass et al (2007)
• Pharmacists
• POCT Shephard (2006) • Clinical staff, aboriginal health care workers, allied health professionals
• Greater green triangle diabetes prevention project Laatikainen et al (2007) and Kilkkinen et al (2007)
• Nurses, dietician, physiotherapist
• Enhanced primary care Foster et al (2008) • GPs, allied health professional
• Chronic disease management in primary care Dennis et al (2008)
• Multidisciplinary team care?
Discussion
• Policy directions are:– Supporting & strengthening a well-trained multidisciplinary team-
based primary care workforce– Piloting new approaches for the delivery of PHC services
• Coordinated Care for Diabetes Pilot in the primary care setting
BUT….• Review revealed need for higher standard of evidence about
the merits of models of primary care. – Limited representativeness & replicability– No study included assessment of cost effectiveness
And… – Limited evidence about workforce models - roles & skills mix
In Conclusion
• Proliferation of new models of primary care in Australia + new workforce roles & skills mix
• Need for more robust studies to assess whether:– interventions are effective in producing improved
health outcomes– effective interventions represent value for money
• Need for more evidence about workforce models of primary care -> sustainability
Thank You
“The intuitive mind is a sacred gift and the rational mind is the faithful servant. We have created a
society that honours the servant and has forgotten the gift”
Albert Einstein
Source• Wade Davis (2009) The Wayfinders: why ancient wisdom matters in the
modern world. Chapter 4: Sacred Geography