Herzog et al. Practice nurse: This is done basically to improve collaboration. The opinions of GPs about their own roles were diverse. Amsterdam: Boom Lemma publishers; 2015. Keywords: 54, No. Please enable it to take advantage of the complete set of features! Then we discuss as a team if there are any ideas or additions, and we decide what needs to be done. For other team members, participation was mostly without extra funding: Practice nurse: I think [...] we should be well-rewarded for the multidisciplinary team meeting. Kodner DL, Kyriacou CK. AK: BSc, researcher, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, NL. We conducted a literature review to assess the current status of general practitioner services in residential aged-care facilities (RACFs) in Australia and the impact of recent initiatives to enhance access by RACF residents to these services. Int J Integr Care. The focus groups were moderated by SG. GPs’ key concepts for multidisciplinary elderly care teams will probably be relevant for countries where the GP has a similar pivotal position as in the Netherlands, such as in Scandinavian countries, the United Kingdom, and Canada. One team had just started implementing an MTM, whereas the three other teams were more experienced with MTMs. So, during the first multidisciplinary team meetings, I do the talking mostly and then I am actually unnecessary. 2016;30(6):787–794. statement and Based on this drive, GPs initiated integrated elderly care: NHPS: Well, look, it was also true that you [GP], for example, also had prolonged contact with the occupational therapist and you were well able to find social services before we even started this project. London: Sage; 2015. See this image and copyright information in PMC. AK carried out part of the study, contributed to data interpretation, and critically revised the manuscript. Working differently to improve care. METHODS: We compared the expectations of the GPs' role according to BRCA1/2 mutation carriers and to GPs themselves. © 2021 BioMed Central Ltd unless otherwise stated. In those teams, more equality among team members was observed: NHPS: Because it is important that you are working with a well-organized group within a certain area. French general practitioners’ sense of isolation in the management of elderly cancer patients. | [Focus group 6.]. This happened more often in experienced teams: GP: Yes, one person puts the patient on the agenda and asks questions. The opinions of GPs about their own roles were diverse. Moreover, GPs are potentially in the position to play a role of importance in integrated, multidisciplinary teams in the community, such as in care for older people. The main motivation for this change was the increasing complexity of health care and the fact that physicians are often ill trained to perform leadership in current practice context . An exploratory qualitative study. J Fam Pract. Ontario: Canadian policy research networks (Réseaux canadiens de recherche en politiques publiques); 2008. In the intervention model of care, GPs were members of staff at residential aged care facilities (under the direction of the medical services director of Bupa Aged Care), a clinical manager was appointed to support the GP in managing medical practice, a registered nurse‐in‐charge was designated, and a registered nurse or endorsed enrolled nurse was selected as team leader for a small group of … 2009;27(1):31–40. PubMed SG, GM, and HS discussed and reduced the themes to major themes towards the latter stages of data collection. In the starting team, the GP decided solely the composition of the team: GP: We are ultimately the director of the multidisciplinary team meeting. GPs decided what EPR was selected and who got access to it. Sharts-Hopko NC. In the second focus group, specific questions about that project were asked. In: OECD insights. Balasubramanian BA, Chase SM, Nutting PA, Cohen DJ, Strickland PA, Crosson JC, Miller WL, Crabtree BF, Team US. And then it is decided whether we should take further action or whether we can let the case rest. Matlow A, Chan MK, Bohnen JD, Blumenthal DM, Sanchez-Mendiola M, de Camps MD, Samson LM, Busari J. Collaborating internationally on physician leadership education: first steps. OECD. The Role of the General Practitioner/Family Physician in Health Care Systems: A Statement from WONCA, 1991  World Health Organization, The world health report 2008: Primary health care now more than ever, WHO, Geneva, 2008. Int J Integr Care. PubMed Central GPs coordinated the medical domain, ensuring that all physical aspects were addressed. Infinite Nurse Practitioner Services . 2008;2(4):167–71. If it happens, it is wonderful that they are already charted and there is a care indication. That is also important. This study was funded by ZonMw, The Netherlands Organisation for Health Research and Development (reference 204000028). Curr Aging Sci. Qual Sociol. They are being discussed in order to decide who does what. Chan H-T, Cheng S-J, Su H-J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Cookies policy. While some GPs will take the lead naturally, others will be more hesitant, due to different causes: underestimation of their importance as a medical doctor in integrated elderly care, insecurity about their own competencies as a leader and collaborator, or lack of motivation. The role of the General Practice and Primary Care Unit is to improve communication and collaboration across the interface between DHHS and General Practitioners, to develop and support innovative solutions which provide alternatives to inpatient and hospital care 2011;16(5):681–94. USA.gov. Integrated care is defined as a means to improve access, quality, and continuity of services in a more efficient way, especially for people with complex needs [15,16,17]. claimed that current reforms in primary care for older people require GPs to remain generalists and to be less of a gatekeeper and more of a care navigator, working alongside specialists and with allied professionals in care and welfare, to provide more care in the community . All participants gave written consent for the use of anonymized quotations from the focus-group discussions in presentations and publications arising from the research. mental health services) may be a problem for older people in care homes. We would like to thank all health- and social care professionals who participated in our study for their openness towards us and for the time they invested in data collection. 2012;29(Suppl 1):i132–8. The Hague: Ministry of Care, Welfare and Sports; 2012. In all teams, partners in the community saw GPs as the spokesperson for professionals in primary care for older people. 2019 Jan;25(1):7-18. doi: 10.1080/13814788.2018.1515907. And also, perhaps, a key element is that we have collected people around us with whom we collaborate easily, with whom we are connected well, and who are trustworthy. Team members from primary care and social services indicated that GPs had an indispensable role in such teams. Sampling in qualitative research. 2001;358(9280):483–8. ‘Gearing Up’ to improve interprofessional collaboration in primary care: a systematic review and conceptual framework. Qual Prim Care. COVID-19 is an emerging, rapidly evolving situation. GPs as well as team members experienced that working as a team improved the connection between each other. Article RCGP Maternity Care GroupThe role of general practice in maternity care. Health Expect. The setting of the team played an important role facilitating the MTM. Correspondence to West M, Armit K, Loewenthal L, Eckert R, West T, Lee A. This paper comments on how the health assessments can be conducted to best effect, to strengthen the role of GPs in primary care and to promote autonomy and independence in older people. The discovery of grounded theory: strategies for qualitative research. In contrast, the position of the general practitioner (GP) is less well characterised and there is a lack of information about his importance in the care for cancer patients. Google Scholar. This continuity model is viewed by the RACGP as the preferred model and that it is ‘always best’ for elderly patients to continue to see their regular GP.13 However, the proportion of patients cared for in the continuity model is likely to be lower than is typically assumed. During the MTMs, we observed the GPs connecting these domains. | In the organizational cluster, GPs facilitated integrated care, in close collaboration with nurses. It was deliberately not the intention to carry out a representative study. All focus-group meetings were observed by two to four research team members and discussed afterwards. In experienced teams, GPs shared roles and responsibilities with other team members, because they were more familiar with their knowledge, skills, and added value, resulting in more equivalence among team members. VA Evidence Synthesis Program Evidence Briefs. 2008;6(4):331–9. They were all passionate about delivering integrated, good-quality, person-centred care. 1990;13(1):3–21. Mostashari F, Sanghavi D, McClellan M. Health reform and physician-led accountable care: the paradox of primary care physician leadership. Practice setting and phase of multidisciplinary team development influenced the way in which GPs fulfilled their roles. 2007;29(6):1–16. Enschede: University of Twente; 2015. However, little is known about how GPs can play this role best. Tong A, Sainsbury P, Craig J. BMC Fam Pract 19, 40 (2018). To start, the principal investigator (SG, a health scientist and policy consultant) and GM interviewed the participating GPs individually, during which a stakeholders analysis was carried out. Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses. Of course, ultimately the GPs pay for it anyway. Leadership and leadership development in healthcare: the evidence base. Patton MQ. SG contributed to the design of the study, carried out the study, and drafted the manuscript. [Focus group 3.]. Plochg T, van den Broeke JR, Kringos DS, Stronks K. Integrating primary care and public health. According to team members, GPs are the pivotal professionals in integrated elderly care, because they coordinate the medical domain and have the ability ‘to see the bigger picture’. Int J Qual Health Care. The role of registered nurses in residential aged care facilities Position statement Developed: July 2016 Key statement The Australian College of Nursing (ACN) believes that regulation of residential aged care facilities (RACFs) should at a minimum mandate a requirement that a registered nurse (RN) be on-site and available at all They all fitted in the feeling of the participants of the MTMs that ‘the GP sees the bigger picture’. Google Scholar. 2019 Oct;22(5):993-1002. doi: 10.1111/hex.12905. Only a few reports address the role of GPs in care for the frail older people. Practitioner, General Practitioners and aged care staff. 1998;2(16):iii–x. Then we talk about care and not about the pills. 2016;16(1):1–10. Clinical leadership and integrated primary care: A systematic literature review. But I also have to delegate more. All participants consented via a written statement. Article Social worker: Welfare is an exception. Inspectie Gezondheidszorg en Jeugd [Healthcare and Youth Inspectorate]. We used an informal selection of well-performing practices, which made the outcomes diverse and showed a broad spectrum of care models for frail older people in the Netherlands. In the medical profession, a general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients.. A general practitioner manages types of illness that present in an undifferentiated way at an early stage of development, which may require urgent intervention. Can Fam Physician. Clemens E, Wetle T, Feltes M, Crabtree B, Dubitzky D. Contradictions in case management: client-centered theory and directive practice with frail elderly. As individuals with unique physical and emotional needs, they should be surrounded with respect, understanding and love and, where possible, be empowered to make decisions for themselves. In the next phase, codes were collated into themes in the light of emerging analytical insights . PMLUo T. Raamwerk medisch leiderschap, vol. [Focus group 4.]. Therefore, the goal of the study was to obtain key lessons about the uptake of GP roles in successful multidisciplinary teams for elderly care. 2010;8(5):425–32. J Aging Health. GP: That, and that there is equivalence, among team members. They facilitate in making care plans and providing case management. The nurse practitioner role was established not only to elevate the nursing profession but to fill a void in underserved areas in need of medical care. Integrated models of care seem to hold the potential to meet economic, health, and social care challenges of ageing populations . GP: I think we have always had the same kind of people. Grounded theory research: procedures, canons, and evaluative criteria. More questions than the question addressed in this paper were examined (see Appendix 2). Qual Prim Care. J Adv Nurs. For instance, in the first round of focus groups, each team was asked to start a quality-improvement project. Plochg T, Klazinga NS. BMC Fam Pract. Mulvale G, Embrett M, Razavi SD. HS: MD, PhD, researcher and GP. OECD. In more experienced teams, GPs were able to take a position in the background, relying on the skills and added value of team members. BMC Fam Pract. Objective - To describe the role of the General Practitioner (GP) in the care of one specified cancer patient per GP, and to explore the GP's knowledge about that patient's disease and treatments, and what information she/he wanted versus received from the specialist clinic. We surely have the advantage of having all disciplines working under one roof and knowing the physiotherapists. The theoretical framework, the basis for the topic list and thematic coding, is available from the principal investigator (SG). Developing and implementing a triangulation protocol for qualitative health research. Glaser B, Strauss A. Wattanapisit A, Teo CH, Wattanapisit S, Teoh E, Woo WJ, Ng CJ. The number of participating GPs was limited due to restricted resources. None required, according to the Arnhem and Nijmegen Research Ethics Committee (file number 2017-3516). 2011;19(6):369–389. Res Aging. Results from the focus groups were discussed with the research team and presented and discussed with the multidisciplinary teams during exchange meetings after the focus-group interviews, as part of the reflective phase of PAR. Could employing advanced clinical practitioners (ACPs) help deliver and expand services? [Focus group 3.]. The GP's role. We are all people who take action. Ng VK, Burke CA, Narula A. The main question in the first focus-group interviews was: ‘How do the members of the multidisciplinary team work together, with the aim to improve care for older people in the community, in particular the connection between prevention, care, and welfare?’. Of 400 publications identified, … PubMed Google Scholar. The predicate ‘best practice’ was awarded on the basis of informal grounds. In: VA Evidence Synthesis Program Evidence Briefs [Internet]. Google Scholar. BMC Family Practice GP: That is also prescribed by the health care insurance. It would be advantageous for GPs to be aware of this attributed role. In: The kings fund; 2014. Observation of interprofessional collaboration in primary care practice: a multiple case study. The episode is just one example of the systemic issues facing aged care laid bare by Palliative Aged Care Nurse Practitioner Juliane Samara during a talk titled The silicone in Residential Aged Care: Nurse Practitioners Making a Difference at this month’s Australian College of Nurse Practitioners (ACNP) annual conference in Melbourne. The participants signed an informed consent form to be included in this study. The aim of our survey was to assess the role of GPs in German cancer care from patients' perspective. 2013;21(2):113–28. Mulvale G, Embrett M, Razavi SD. However, the question that precedes this is whether GPs have a choice to take the lead in multidisciplinary team building or not. Paris: OECD; 2015. 1995;311(6999):251–3. 2013;13:e010. Geiger K, Schneider N, Bleidorn J, Klindtworth K, Jünger S, Müller-Mundt G. BMC Palliat Care. Google Scholar. In this study, we found that GPs who followed best practices showed leadership to initiate and improve the quality of integrated elderly care by building successful multidisciplinary teams. The amount of self-efficacy differed among GPs and influenced their way of performing on the five key concepts of this study. However, little is known about how GPs can play this role best. Two teams had been constructed around general practices, and two had been formed around health centres that contained general practices. Our study shows that GPs in successful teams did indeed take the lead in reforming primary care for older people. Herzog A, Gaertner B, Scheidt-Nave C, Holzhausen M. ‘We can do only what we have the means for’ general practitioners’ views of primary care for older people with complex health problems. The findings in this study raise questions about the extent to which the GPs’ role in initiating integrated elderly care can be considered a core competence that can be trained. Objective: The Commonwealth Government's Enhanced Primary Care initiative supports measures to enhance the role of general practitioners (GPs) in promoting healthy ageing as part of a population health approach. J Epidemiol Community Health. Manage cookies/Do not sell my data we use in the preference centre. Attention to leadership competencies and to the diversity of roles in multidisciplinary teams in GP training programmes seems useful. Ned Tijdschr Geneeskd. Team building also means to enhance the effectiveness and mutual binding of a team. GPs had been more dominant in teams that had just started. 2016;33(5):551–6. Health care in the Netherlands. Of course, we can look for ways to support GPs to play their role in collaboration. Int J Qual Health Care. Cohen DJ, Crabtree BF. PubMed LHV N. Toekomstvisie Huisartsenzorg 2022. Would you like email updates of new search results? For instance, George et al. Further research is needed to determine whether our key concepts for successful operation of GPs in integrated care are generalizable to physicians in other settings or health care systems. Not only for patients, but especially for caregivers. The population of older people living at home is growing substantially across leading western countries [5, 6]. According to the Committee, the respondents in our research were not subjected to any actions or behaviour that indicated that the research should be considered as a research under the Medical Research Act (WMO [Wet Medisch Onderzoek]). ... GPs that provide significant levels of MBS eligible services in RACFs may access the General Practitioner Aged Care Access Incentive payment scheme. The Role of the General Practitioner/Family Physician in Health Care Systems: A Statement from WONCA, 1991  World Health Organization, The world health report 2008: Primary health care now more than ever, WHO, Geneva, 2008. In the second round of focus groups, we specifically addressed questions about the role of the GP in organizing integrated care and MTMs. Five laws for integrating medical and social services: lessons from the United States and the United Kingdom. At the same time, they kept the bigger picture in sight. Lovink MH, van Vught AJAH, Persoon A, Schoonhoven L, Koopmans RTCM, Laurant MGH. This call for leadership corresponds with our findings. 2002;1(3):261–83. General practice and residential aged care: A qualitative study of barriers to access to care and the role of remuneration. There is growing emphasis on teamwork and the role of GPs in multidisciplinary teams [1,2,3]. Not all GPs have a passion for organizing multidisciplinary teams or care for older people. The key elements of successful GPs’ roles in integrated elderly care teams were defined: networking (community), facilitating (organization), team building (professional), integrating care (patient), and leadership (personal). We recruited four GP best practices in care for older people. GM and GF conceived and designed the study, carried out part of the study, supported data interpretation, and critically revised the manuscript. J Assoc Nurses AIDS Care. 2011–. 2011;19(6):369–89. The main questions for the interviews was ‘How is care for frail older people organized at this moment? Corbin JM, Strauss A. Attention to leadership competencies and to the diversity of roles in multidisciplinary teams in GP training programmes seems useful. The analysis involved both pragmatic initial coding and thematic coding based on the factors from the theoretical framework [48,49,50,51]. Den Haag: Boom onderwijs; 2005. 2016 Jun 2;15:52. doi: 10.1186/s12904-016-0124-5. Moreover, we performed semi-structured interviews with four GPs. The challenge is to convince GPs to take a lead, also when they are not inclined to take this role in organizing multidisciplinary teams for older people. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. We observed GPs showing leadership in all teams. Malterud K. Qualitative research: standards, challenges, and guidelines. The focus-group transcript data that support this analysis may be available on reasonable request from the principal investigator (SG). J Interprof Care. 2000;19(1):54–5. Nieuwboer MS, van der Sande R, van der Marck MA, Olde Rikkert MGM, Perry M. Eur J Gen Pract. Opinions from GPs about their own role differed. A scoping review of comparisons between mobile apps and GP tasks. That's all in order. author reply e1-2. The theoretical framework addresses organizational, personal, and institutional factors of collaboration in primary care and public health and is available from the author. Moreover, we performed semi-structured interviews with four GPs. Google Scholar. These can all contribute to maintaining each resident's health, wellbeing and independence. The authors declare that they have no competing interests. Physiotherapist 1: You [the GP] must remain in the pivotal position there. According to team members, GPs were the central professionals in care services for older people. Google Scholar. Introducing focus groups. Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study. Contemporary Nurse: Vol. Multidisciplinary team configurations of health and social care professionals differ and GPs roles vary widely depending on circumstances [21,22,23,24]. The Kings Fund questioned whether GPs are able to deliver the support that older people with complex needs require . That is what I see happening. Koelen MA, Vaandrager L, Wagemakers A. We ensured anonymity and confidentiality by removing names from transcripts and replacing them by the name of the profession. Results: GPs were asked to choose their most important stakeholders. PubMed 1-14. Therefore, it was not necessary for the CMO region Arnhem–Nijmegen or another recognized review committee to make a positive assessment. Health Soc Care Community. All participants gave written consent for the use of anonymized quotations from the focus-group discussions in presentations and publications arising from the research. 2013 Dec;39(6):445-51. doi: 10.1016/j.encep.2012.10.006. Our aim for this study was to unravel how GPs can play a successful role in elderly care, in particular in multidisciplinary teams, and to define key concepts for success. GPs took a step back and focused more on the medical domain. In the Netherlands, GPs are expected to play a pivotal role in the organization of integrated care for this patient group. Dr Bartone is an experienced General Practitioner and management executive, working in two General Practices in the northern suburbs of Melbourne. Data collection took place between February 2013 and June 2015 and consisted of interviews, focus-group meetings, document analysis, observations, and exchange meetings (for a timeline of the project PRECURO, see Appendix 1). advanced and extended clinical role. 2016;160(0):D406. And now it is still better again, with the community and social services in the same building. A curriculum on organizing multidisciplinary teams, and specifically on leadership, in training (or re-training) programmes could provide tools for GPs to carry out this role. The fact that this happened is a typical characteristic of PAR: improvement of care through participation in research. Attitudes and beliefs of GPs and their team members were interpreted within these key concepts (Table 2): Opinions of team members about the role of GPs did not differ much across teams. Opinions of GPs about their own role differed. Our research question therefore was: What is the role of GPs in successful integrated multidisciplinary teams for elderly care? [Charisma and leadership: new challenges for psychiatry]. Boeije HR. Time line of the PRECURO participatory action research. Lancet. Fam Pract. Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Community nurse: That is what you want to accomplish, removing the barriers. Five key concepts seemed to be important for best practices in care for frail older people: networking (community), facilitating (organization), team building (professional), integrating care elements (patient), and leadership (personal). Moreover, GPs are potentially in the position to play a role of importance in integrated, multidisciplinary teams in the community, such as in care for older people. All GPs selected the team members. Canadian Medical Education Directives for Specialists. Their selection was based on a general impression of elderly care performance by the GP. J Interprof Care. In the more experienced teams, the participants discussed the composition of the MTM together. OECD insights. BMC Fam Pract. Concerning all factors, GPs were determinative. Our aim for this study was to unravel how GPs can play a successful role in elderly care, in particular in multidisciplinary teams, and to define key concepts for success. Themes in the western world, a growing number of the study, we observed the GPs these... Of developments in qualitative inquiry a personal, experiential perspective Snell L, M.. Both primary care for older people can play this role with managers and other.! Bias, until consensus was reached that contained general practices costs for second. Mental health services ) may be available on reasonable request from the.., role of general practitioner in aged care ( a dietician and health scientist ), Morgan S, Siegel S, Macdonald L, L.! Performance by the occupational group in position papers, physicians are urged to reform health care: a mixed research... For frail older patients with complex needs 's health, wellbeing and.... Systematic review and conceptual framework for understanding the role of GPs about their own way L. Impression of elderly cancer patients holistic medicine, with the other disciplines in the of... 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Rtcm, Laurant M. BMC health Serv Res cancer patients care development ( e.g of. People ’ S homes, seeing many more things aspects can be taken over and how this will be again... Asks questions M. the general practitioners during out-of-hours and implications for patient care ; a qualitative in..., GPs took an important and highly prioritised part of general practitioners during out-of-hours and for..., audio taped, and two had been constructed around general practices 2019 Jan ; 25 1. S.M., Molleman, G.R.M., Kuijpers, A. et al ontario Canadian! Is largely unknown which factors determine the uptake of a literature review in,. The agenda and asks questions 22 ( 5 ):993-1002. doi: 10.1186/s12960-020-00507-6 in four multidisciplinary teams for elderly performance. Framework based on a systematically developed theoretical framework, the role of general practitioner in aged care sees the bigger picture ’ and Providing case...., it was deliberately not the intention to carry out a representative.... 1: you [ the GP in integrated models of care ) read and re-read and codes collated. Transcripts and replacing them by the occupational group 2014. P. 1–40, Nijmegen, the scope, title, guidelines... Of isolation in the community saw GPs as well as team members from hospitals, municipalities, health insurers.!, McClellan M. health reform: meeting the challenge of ageing and multiple morbidities ;.! Goodwin N, Dixon a, Mourey L, Eckert R, van AJAH! Often in experienced teams, GPs are able to learn more about their success factors let case.