Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Interorganisational and interprofessional partnership approaches to achieve more coordinated and integrated primary and community health services: the Australian experience

Julie McDonald A B , Gawaine Powell Davies A and Mark Fort Harris A

A Research Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.

B Corresponding author. Email: j.mcdonald@unsw.edu.au

Australian Journal of Primary Health 15(4) 262-269 https://doi.org/10.1071/PY09017
Published: 26 November 2009

Abstract

Improving collaboration and coordination in primary and community health is a national priority. Two major approaches have been taken: strengthening interorganisational and interprofessional collaboration. This paper reviews current and emerging models of partnerships: divisions of general practice and primary care partnerships (organisational models); and collaboration between general practitioners with practice nurses and with allied health professionals (interprofessional models). The models are reviewed in terms of the governance and formalisation of the partnership arrangements and the level of collaboration they achieve. The organisational models have had different purposes and taken different forms, the ‘hub and spoke’ model of divisions and decentralised ‘network’ relationships of primary care partnerships, both of which have broadly achieved their aims. Interprofessional collaboration involves a complex mix of allegiances and interests that influences the level of collaboration that is achieved. A combination of approaches is needed to achieve more coordinated and integrated primary health care. The implications for several current policy debates are discussed: the establishment of local integrated and comprehensive primary health care centres, regional level primary care organisations and alternative payment mechanisms.


References


Australian Divisions of General Practice (2006) National practice nurse workforce survey report. Canberra, Australian Division of General Practice.

Australian General Practice Network (2008) Submission to the National Health and Hospital Reform Commission. Canberra, Australian General Practice Network.

Australian Institute for Primary Care (2005) An evaluation of the primary care partnership strategy report. Melbourne, Australian Institute for Primary Care.

Australian Institute for Primary Care, Centre for Development and Innovation in Health (2002) Evaluation of the primary care partnership strategy interim report. Melbourne, Australian Institute for Primary Care.

Australian Institute of Health and Welfare (2008) Australia’s health. Australian Institute of Health and Welfare, Canberra.

Beaulieu M-D , Denis J-L , D’Amour D , Goudreau J , Haggerty J , et al (2006) Implementing family medicine groups: the challenge in the reorganisation of practice and interprofessional collaboration, Doctor Sadok Besrour Chair in Family Medicine. Montreal. Available at http://www.chsrf.ca/research_themes/pdf/implementing-family-medicine-groups_e.pdf? [Verified 8 June 2006]

Britt H , Miller GC , Charles J , Henderson J , Bayram C , et al (2008) General practice activity in Australia 2007–08. General practice series no. 22. Cat. no. GEP 22. Australian Institute of Health and Welfare, Canberra.

Commonwealth of Australia (2004) Divisions of general practice: future directions. Government response to the report of the review of the role of divisions of general practice. Commonwealth of Australia, Canberra.

D’Amour D, Ferrada-Videla M, San Martin-Rodriguez L, Beaulieu MD (2005) The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. Journal of Interprofessional Care 19(Suppl. 1), 116–131.
CrossRef | PubMed | open url image1

D’Amour D, Goulet L, Labadie J-F, San Martin-Rodriguez L, Pineault R (2008) A model and typology of collaboration among professionals in healthcare organizations. BMC Health Services Research 8, 188.
CrossRef | PubMed | open url image1

Department of Health (2008 a) ‘NHS next stage review: our vision for primary and community care.’ (Department of Health: London)

Department of Health (2008 b) ‘Integrated Care Pilot Programme. Prospectus for potential pilots.’ Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089338 [Verified 7 January 2009]

Department of Health and Ageing (2007) ‘More allied health services program review 2007 executive summary.’ Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pcd-programs-mahs-execsummary [Verified 12 February 2009]

Department of Health and Ageing (2008) ‘GP super clinics national program guide.’ Available at http://www.drinkingnightmare.gov.au/internet/main/publishing.nsf/Content/pacd-gpsuperclincs-programguide [Verified 7 July 2008]

Department of Human Services (2004) ‘Analysis of the impacts of service coordination on service capacity in the primary health care sector.’ Available at http://www.health.vic.gov.au/pcps/downloads/publications/kpmg_execsummary.pdf [Verified 15 November 2006]

Dickinson H (2006) The evaluation of health and social care partnerships: an analysis of approaches and synthesis for the future. Health & Social Care in the Community 14(5), 375–383.
CrossRef | PubMed | open url image1

Divisions Review Panel (2003) The future role of the divisions network. Report of the review of the role of Divisions of General Practice. Commonwealth of Australia, Canberra.

Foster MM, Mitchell G, Haines T, Tweedy S, Cornwell P, Fleming J (2008) Does enhanced primary care enhance primary care? Policy-induced dilemmas for allied health professionals. The Medical Journal of Australia 188, 29–32.
PubMed | open url image1

Grimmer-Somers K, Dolejs W, Atkinson J, Worley A (2008) Integrated GP and allied health care for patients with type 2 diabetes. Australian Family Physician 37(9), 774–779.
PubMed | open url image1

Halcomb EJ, Davidson PM, Daly JP, Griffiths R, Yallop J, Tofler G (2005) Nursing in Australian general practice: directions and perspectives. Australian Health Review 29(2), 156–166.
PubMed | open url image1

Halcomb EJ, Davidson PM, Salamonson Y, Ollerton R, Griffiths R (2008) Nurses in Australian general practice: implications for chronic disease management. Journal of Clinical Nursing 17(5a), 6–15.
CrossRef | PubMed | open url image1

Harris M , Powell-Davies G (2000) Integration between GPs, hospitals and community health services. In ‘General practice in Australia’. (Ed. Australian Department of Health and Aged Care) pp. 311–336. (Commonwealth of Australia: Canberra)

Healthcare Management Advisors (2005) Evaluation of the 2001 nursing in general practice initiative. Final report. Australian Government of Health and Ageing, Canberra.

Hordacre A-L , Howard S , Moretti C , Kalucy E (2008) Moving ahead. Report of the 2006–2007 annual survey of Divisions of General Practice. Primary Health Care Research and Information Service, Adelaide.

Keleher H, Joyce CM, Parker R, Piterman L (2007) Practice nurses in Australia: current issues and future directions. The Medical Journal of Australia 187(2), 108–110.
PubMed | open url image1

King A (2001) ‘The primary health care strategy.’ (New Zealand Ministry of Health: Wellington)

Kirby SE, Chong JL, Frances M, Powell Davies G, Perkins DA (2008) Sharing or shuffling – realities of chronic disease care in general practice. The Medical Journal of Australia 189(2), 77.
PubMed | open url image1

Leutz WN (1999) Five laws for integrating medical and social services: Lessons from the United States and the United Kingdom. The Milbank Quarterly 77(1), 77–110.
CrossRef | PubMed | CAS | open url image1

McDonald J, Powell Davies G, Cumming J, Fort Harris M (2007) What can the experiences of primary care organisations in England, Scotland and New Zealand suggest about the potential role of divisions of general practice and primary care networks/partnerships in addressing Australian challenges? Australian Journal of Primary Health 13(2), 46–55.
CrossRef | open url image1

McDonald J, Harris MF, Cumming J, Powell Davies G, Burns P (2008) The implementation and impact of different funding initiatives on access to multidisciplinary primary health care and policy implications. The Medical Journal of Australia 188(8), s69–s72.
PubMed | open url image1

National Health and Hospitals Reform Commission (2009) A healthier future for all Australians: interim report – overview. National Health and Hospitals Reform Commission. Available at http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report [Verified 4 February 2009]

National Primary Health Care Strategy Secretariat (2008) Towards a national primary health care strategy. A Discussion paper from the Australian Government. Commonwealth of Australia, Canberra.

NSW Department of Health (2006) Integrated primary and community health strategy. Department of Health, Sydney.

Powell-Davies G , Fry D (2005) General practice in the health system. In ‘General practice in Australia’. (Ed. Australian Department of Health and Ageing) pp. 421–467. (Commonwealth of Australia: Canberra)

Queensland Health (2007) Guidelines for the connecting healthcare in communities initiative: primary healthcare partnership councils. Queensland Health, Brisbane. Available at http://www.chicpartnerships.com.au/content/Document/04_Resources/02_Library/CHIC%20Guidelines%20290508.pdf [Verified 6 June 2008]

Rogers WA, Veale B (2000) Dollars, debts and duties: lessons from funding Australian general practice. Health & Social Care in the Community 8(5), 291–297.
CrossRef | PubMed | open url image1

Roxon N (2008) National primary health care strategy. Media Release, 11 June 2008. Parliament House, Canberra.

Rudd K , Roxon N (2007) ‘New directions for Australia’s health. Delivering GP super clinics to local communities.’ (Australian Labour Party: Canberra)

Schoen C , Osborn R , Huynh PT , Doty M , Davis K , et al (2004) Primary care and health system performance: adults’ experience in five countries. Health Affairs October 28. doi:10.1377/hlthaff.w4.487

Schoen C, Osborn R, How SKH, Doty MM, Peugh J (2009) In chronic condition: experiences of patients with complex health care needs, in eight countries, 2008. Health Affairs 28, w1–w16.
CrossRef | PubMed | open url image1

Scott IA (2007) Pay for performance in health care: strategic issues for Australian experiments. The Medical Journal of Australia 187(1), 31–35.
PubMed | open url image1

Sheehan D, Robertson L, Ormond T (2007) Comparison of language used and patterns of communication in interprofessional and multidisciplinary teams. Journal of Interprofessional Care 21(1), 17–30.
CrossRef | PubMed | CAS | open url image1

Shortus TD, McKenzie SH, Kemp LA, Proudfoot JG, Harris MF (2007) Multidisciplinary care plans for diabetes: how are they used? The Medical Journal of Australia 187, 78–81.
PubMed | open url image1

Sicotte C, D’Amour D, Moreault M-P (2002) Interdisciplinary collaboration within Quebec Community Health Care Centres. Social Science & Medicine 55(6), 991–1003.
CrossRef | open url image1

South Australia Department of Health (2007) ‘GP plus health care strategy.’ (Department of Health: Adelaide)

Vagholkar S, Hermiz O, Zwar NA, Shortus T, Comino EJ, Harris M (2007) Multidisciplinary care plans for diabetic patients: what do they contain? Australian Family Physician 36(4), 279–282.
PubMed | open url image1

Victorian Department of Human Services (2005) ‘Service coordination: achieving tangible benefits through a partnership approach.’ (Victorian Department of Human Services: Melbourne)

Victorian Department of Human Services (2007) ‘Primary care partnerships are making a difference.’ (Victorian Department of Human Services: Melbourne)

Wagner EH (2000) The role of patient care teams in chronic disease management. BMJ 320, 569–572.
CrossRef | PubMed | CAS | open url image1

Watson A (2008) 2006–07 e-referral capacity building through primary care partnerships. Summary report. Victorian Department of Human Services, Melbourne.

Wensing M, Wollersheim H, Grol R (2006) Organizational interventions to implement improvements in patient care: a structured review of reviews. Implementation Science; IS 1, 2.
CrossRef | PubMed | open url image1

Zwar NA, Hermiz O, Comino EJ, Shortus T, Burns J, Harris M (2007) Do multidisciplinary care plans result in better care for type 2 diabetes? Australian Family Physician 36, 85–89.
PubMed | open url image1

Zwar NA, Hasan I, Hermiz O (2008) Multidisciplinary care plans and diabetes. Benefits for patients with poor glycaemic control. Australian Family Physician 37(11), 960–962.
PubMed | open url image1








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