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

Practice-based chronic condition care coordination: challenges and opportunities1

Carolyn Ehrlich A B , Elizabeth Kendall A and Heidi Muenchberger A
+ Author Affiliations
- Author Affiliations

A Centre of National Research on Disability and Rehabilitation, Griffith Health Institute, Griffith University, University Drive, Meadowbrook, Qld 4131, Australia.

B Corresponding author. Email: c.ehrlich@griffith.edu.au

Australian Journal of Primary Health 17(1) 72-78 https://doi.org/10.1071/PY10053
Submitted: 30 August 2010  Accepted: 4 January 2011   Published: 16 March 2011

Abstract

This paper explores issues related to the types of support that practice nurses require to engage in care coordination for people with chronic conditions. A sample of practice nurses and general practitioners participated in a focus group discussion to identify their perspectives on the role of practice nurses as providers of care coordination, the specific tasks that might be conducted and the types of support that might be required. The data were analysed using thematic analysis. The findings suggested there was considerable confusion about care coordination and a lack of conceptual clarity. Nevertheless, nurses were committed to engaging in activities that would promote care coordination. Four main themes emerged that indicated the importance of a developmental and well-supported implementation process. These themes included the need for cultural change within the whole practice, increased capacity to develop trusted and tested partnerships, appropriate role definition and a full understanding of the financial models that could support care coordination. Practice nurses clearly have a role in care coordination, but models of care coordination need to be localised and contextualised within specific GP practices. Cultural change will, in many instances, be critical to the development of localised programs. Broad supportive structures, including ongoing mentorship and administrative assistance (particularly with financial and procedural aspects of care coordination) will be required when implementing programs that enhance roles for practice nurses.


References

Australian Government (2010) A national health and hospitals network for Australia’s future – delivering better health and better hospitals. (Commonwealth of Australia: Canberra) Available at http://www.health.gov.au/internet/yourhealth/publishing.nsf/Content/report-redbook/$File/HRT_report3.pdf [Verified 21 January 2011]

Barr VJ, Robinson S, Marin-Link B, Underhill L, Dotts A, Ravensdale D, Salivaras S (2003) The expanded chronic care model: An integration of concepts and strategies from population health promotion and the chronic care model. Hospital Quarterly 7, 73–82.

Bodenheimer T (2008) Coordinated care – A perilous journey through the health care system. The New England Journal of Medicine 358, 1064–1071.
Coordinated care – A perilous journey through the health care system.CrossRef | 1:CAS:528:DC%2BD1cXjtVagsrg%3D&md5=5fbc2835768c4ea49fd9f2583f520950CAS |

Chen A, Brown R, Archibald N, Aliotta S, Fox PD (2000) Best practices in coordinated care. (Centre for Health Plans and Providers) Available at http://www.mathematica-mpr.com/publications/PDFs/bestpractices.pdf [Verified 21 January 2011]

Daly J, Bryant R (2007) Professional organisations and regulatory bodies: Forging and advancing the role of nurses in Australian primary care. Contemporary Nurse 26, 27–29.
Professional organisations and regulatory bodies: Forging and advancing the role of nurses in Australian primary care.CrossRef |

DeSantis L, Ugarriza D (2000) The concept of theme as used in qualitative nursing research. Western Journal of Nursing Research 22, 351–372.

Duckett SJ (2007) ‘The Australian health care system.’ (Oxford University Press: Melbourne)

Dunbar J, Reddy P (2009) Integration and coordination of care. The Australian Journal of Rural Health 17, 27–33.
Integration and coordination of care.CrossRef | 19161497PubMed |

Fern EF (2001) ‘Advanced focus group research.’ (Sage: Thousand Oaks)

Fitzpatrick M (2008) Frameworks for supporting patients with long term conditions. In ‘Managing long term conditions: A social model for community practice’. (Ed. M Presho) pp. 1–20. (Wiley-Blackwell: Chichester)

Forrest CB (2003) Primary care gatekeeping and referrals: effective filter or failed experiment. British Medical Journal 326, 692–695.
Primary care gatekeeping and referrals: effective filter or failed experiment.CrossRef |

Greb S, Baan CA, Calnan M, Dedeu T, Goenewegen PP, Howson H, Maroy L, Nolte E, Redaelli M, Saarelma O, Schmacke N, Schumacher K, van Lente EJ, Vrighoef B (2009) Co-ordination and management of chronic conditions in Europe: the role of primary care – position paper of the European Forum for Primary Care. Quality in Primary Care 17, 75–86.

Halcomb EJ, Patterson E, Davidson PM (2006) Evolution of practice nursing in Australia. Journal of Advanced Nursing 55, 376–388.
Evolution of practice nursing in Australia.CrossRef |

Halcomb EJ, Davidson PM, Patterson E (2008a) Promoting leadership and management in Australian general practice nursing: what will it take? Journal of Nursing Management 16, 846–852.
Promoting leadership and management in Australian general practice nursing: what will it take?CrossRef |

Halcomb E, Davidson PM, Salamonson Y, Ollerton R, Griffiths R (2008b) Nurses in Australian general practice: implications for chronic disease management. Journal of Clinical Nursing 17, 6–15.
Nurses in Australian general practice: implications for chronic disease management.CrossRef | 18298752PubMed |

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

Kitzinger J (1994) The methodology of focus groups: the importance of interaction between research participants. Sociology of Health & Illness 16, 103–121.
The methodology of focus groups: the importance of interaction between research participants.CrossRef |

May C (2006) A rational model for assessing and evaluating complex interventions in health care. BMC Health Services Research 6, 1–11.

May C, Finch T, Mair R, Ballini L, Dowrick C, Eccles M, Gask L, MacFarlane A, Murray E, Rapley T, Rogers A, Treweek S, Wallace P, Anderson G, Burns J, Heaven B (2007) Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Services Research 7, 1–7.

McKee M, Nolte E (2004) Responding to the challenge of chronic disease: ideas from Europe. Clinical Medicine 4, 336–342.

Mills J, Fitzgerald M (2008) The changing role of practice nurses in Australia: an action research study. The Australian Journal of Advanced Nursing 26, 16–20.

Nagykaldi Z, Mold J, Aspy C (2005) Practice facilitators: a review of the literature. Family Medicine 37, 581–588.

Patterson E, McMurray A (2003) Collaborative practice between registered nurses and medical practitioners in Australian general practice: Moving from rhetoric to reality. The Australian Journal of Advanced Nursing 20, 43–48.

Patterson E, Muenchberger H, Kendall E (2007) The role of practice nurses in coordinated care of people with chronic and complex conditions. Australian Health Review 31, 231–238.
The role of practice nurses in coordinated care of people with chronic and complex conditions.CrossRef | 17470044PubMed |

Pearce C, Hall S, Phillips C (2010) When policy meets the personal: general practice nurses in Australia. Journal of Health Services Research and Policy 15, 26–34.
When policy meets the personal: general practice nurses in Australia.CrossRef |

Ryan GW, Bernard HR (2003) Techniques to identify themes. Field Methods 15, 85–109.
Techniques to identify themes.CrossRef |

Shuler PA, Huebscher R (1998) Clarifying nurse practitioners’ unique contributions: Application of the Shuler Nurse Practitioner Practice Model. Journal of the American Academy of Nurse Practitioners 10, 491–499.
Clarifying nurse practitioners’ unique contributions: Application of the Shuler Nurse Practitioner Practice Model.CrossRef | 1:STN:280:DyaK1M7osFOrsw%3D%3D&md5=60147606112cbbbb7e07dde6f3fa5785CAS |

Sibbald B, Shen J, McBride A (2004) Changing the skill-mix of the health care workforce. Journal of Health Services Research & Policy 9, 28–38.
Changing the skill-mix of the health care workforce.CrossRef | 15006226PubMed |

Sim J (1998) Collecting and analysing qualitative data: issues raised by the focus group. Journal of Advanced Nursing 28, 345–352.
Collecting and analysing qualitative data: issues raised by the focus group.CrossRef | 1:STN:280:DyaK1czptFGksw%3D%3D&md5=7d0c42c1986898069aca4c6167663971CAS |

Soubhi H (2007) Toward an ecosystemic approach to chronic care design and practice in primary care. Annals of Family Medicine 5, 263–269.
Toward an ecosystemic approach to chronic care design and practice in primary care.CrossRef |

Southern DM, Young D, Dunt D, Appleby NJ, Batterham RW (2002) Integration of primary health care services: perceptions of Australian general practitioners, non-general practitioner health service providers and consumers at the general practice-primary care interface. Evaluation and Program Planning 25, 47–59.
Integration of primary health care services: perceptions of Australian general practitioners, non-general practitioner health service providers and consumers at the general practice-primary care interface.CrossRef |

Starfield BH, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. The Milbank Quarterly 83, 457–502.
Contribution of primary care to health systems and health.CrossRef | 16202000PubMed |

Wagner EH (2000) The role of patient care teams in chronic disease management. British Medical Journal 320, 569–572.
The role of patient care teams in chronic disease management.CrossRef | 1:STN:280:DC%2BD3c7ltlemuw%3D%3D&md5=9a805f98c8704e8c52c6de3f65e116c5CAS | 10688568PubMed |

Wagner EH, Austin B, Von Korff M (1996) Organizing care for patients with chronic illness. The Milbank Quarterly 74, 511–544.
Organizing care for patients with chronic illness.CrossRef | 1:STN:280:DyaK2s%2Fps1agtA%3D%3D&md5=61fb008ef25b2035045d17cffe3f54eaCAS |

Way D, Jones L, Baskerville B, Busing N (2001) Primary health care services provided by nurse practitioners and family physicians in shared practice. Canadian Medical Association Journal 165, 1210–1214.

Willis E, Condon J, Litt J (2000) Working relationships between practice nurses and general practitioners in Australia: a critical analysis. Nursing Inquiry 7, 239–247.
Working relationships between practice nurses and general practitioners in Australia: a critical analysis.CrossRef |



Export Citation Cited By (6)