Andrew D Bonney

An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice

AIM To identify facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general (family) practice. BACKGROUND Internationally, a shortage of doctors entering and remaining in general practice and an increasing burden of chronic disease has diversified the nurses role in this setting. Despite a well-established general practice nursing workforce, little attention has been paid to the ways doctors and nurses collaborate in this setting. DESIGN Integrative literature review. DATA SOURCES CINAHL, Scopus, Web of Life, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews and Trove (dissertation and theses) were searched for papers published between 2000 and May 2014. REVIEW METHODS This review was informed by the approach of Whittemore and Knafl (2005). All included papers were assessed for methodological quality. Findings were extracted, critically examined and grouped into themes. RESULTS Eleven papers met the inclusion criteria. Thematic analysis revealed three themes common to the facilitators of and barriers to collaboration and teamwork between GPs in general practice: (1) roles and responsibilities; (2) respect, trust and communication; and (3) hierarchy, education and liability. CONCLUSION This integrative review has provided insight into issues around role definition, communication and organizational constraints which influence the way nurses and general practitioners collaborate in a team environment. Future research should investigate in more detail the ways doctors and nurses work together in general practice and the impact of collaboration on nursing leadership and staff retention.

General practice training and virtual communities of practice - a review of the literature

BackgroundGood General Practice is essential for an effective health system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs) in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence relevant to virtual communities of practice in General Practice training, identify evidence-based principles that might guide their construction and suggest further avenues for research.MethodsMajor online databases Scopus, Psychlit and Pubmed were searched for the terms “Community of Practice” (CoP) AND (Online OR Virtual OR Electronic) AND (health OR healthcare OR medicine OR “Allied Health”). Only peer-reviewed journal articles in English were selected. A total of 76 articles were identified, with 23 meeting the inclusion criteria. There were no studies on CoP or VCoP in General Practice training. The review was structured using a framework of six themes for establishing communities of practice, derived from a key study from the business literature. This framework has been used to analyse the literature to determine whether similar themes are present in the health literature and to identify evidence in support of virtual communities of practice for General Practice training.ResultsThe framework developed by Probst is mirrored in the health literature, albeit with some variations. In particular the roles of facilitator or moderator and leader whilst overlapping, are different. VCoPs are usually collaborations between stakeholders rather than single company VCoPs. Specific goals are important, but in specialised health fields sometimes less important than in business. Boundary spanning can involve the interactions of different professional groups, as well as using external experts seen in business VCoPs. There was less use of measurement in health VCoPs. Environments must be supportive as well as risk free. Additional findings were that ease of use of technology is paramount and it is desirable for VCoPs to blend online and face-to-face involvement.ConclusionsThe business themes of leadership, sponsorship, objectives and goals, boundary spanning, risk-free environment and measurements become, in the health literature, facilitation, champion and support, objectives and goals, a broad church, supportive environment, measurement benchmarking and feedback, and technology and community.General Practice training is under pressure from isolation and virtual communities of practice may be a way of overcoming isolation. The health literature supports, with some variation, the business CoP framework developed by Probst. Further research is needed to clarify whether this framework is an effective method of health VCoP development and if these VCoPs overcome isolation and thus improve rural retention of General Practice registrars.

Perceptions of family physician trainees and trainers regarding the usefulness of a virtual community of practice

Background Training for Australian general practice, or family medicine, can be isolating, with registrars (residents or trainees) moving between rural and urban environments, and between hospital and community clinic posts. Virtual communities of practice (VCoPs), groups of people sharing knowledge about their domain of practice online and face-to-face, may have a role in overcoming the isolation associated with general practice training. Objective This study explored whether Australian general practice registrars and their supervisors (trainers) would be able to use, and would be interested in using, a VCoP in the form of a private online network for work and training purposes. It also sought to understand the facilitators and barriers to intention to use such a community, and considers whether any of these factors may be modifiable. Methods A survey was developed assessing computer, Internet, and social media access and usage, confidence, perceived usefulness, and barriers, facilitators, and intentions to use a private online network for training purposes. The survey was sent by email link to all 139 registrars and 224 supervisors in one of Australia’s 17 general practice training regions. Complete and usable responses were received from 131 participants (response rate=0.4). Results Most respondents had access to broadband at home (125/131, 95.4%) and at work (130/131, 99.2%). Registrars were more likely to spend more than 2 hours on the Internet (P=.03), and to use social media sites for nonwork purposes (P=.01). On a 5-point Likert scale, confidence was high (mean 3.93, SD 0.63) and was negatively associated with higher age (P=.04), but not associated with training stage. Social media confidence was lower, with registrars more confident than supervisors for almost all social media activities. On a 5-point Likert scale, overall usefulness was scored positively (n=123, mean 3.63, SD 0.74), and was not significantly associated with age or training level. The main concerns of respondents were worries about privacy (registrar: 61/81, 75.3%; supervisor: 30/50, 60.0%) and insufficient time (registrar: 41/81, 50.6%; supervisor: 36/50, 72.0%). Using a multivariate generalized linear regression model, training stage and perceived usefulness were positively predictive, and concerns about privacy and time were negatively predictive of intention to use a private online network. Conclusions General practice registrars and supervisors are interested in using a private online network, or VCoP, for work and training purposes. Important considerations are the extent to which concerns such as privacy and usefulness may be overcome by training and support to offset some other concerns, such as time barriers. Participants at an early stage in their training are more receptive to using an online network. More senior registrars and supervisors may benefit from more training and promotion of the online network to improve their receptiveness.

Usefulness of a virtual community of practice and Web 2.0 tools for general practice training: experiences and expectations of general practitioner registrars and supervisors

General practice training is a community of practice in which novices and experts share knowledge. However, there are barriers to knowledge sharing for general practioner (GP) registrars, including geographic and workplace isolation. Virtual communities of practice (VCoP) can be effective in overcoming these barriers using social media tools. The present study examined the perceived usefulness, features and barriers to implementing a VCoP for GP training. Following a survey study of GP registrars and supervisors on VCoP feasibility, a qualitative telephone interview study was undertaken within a regional training provider. Participants with the highest Internet usage in the survey study were selected. Two researchers worked independently conducting thematic analysis using manual coding of transcriptions, later discussing themes until agreement was reached. Seven GP registrars and three GP supervisors participated in the study (average age 38.2 years). Themes emerged regarding professional isolation, potential of social media tools to provide peer support and improve knowledge sharing, and barriers to usage, including time, access and skills. Frequent Internet-using GP registrars and supervisors perceive a VCoP for GP training as a useful tool to overcome professional isolation through improved knowledge sharing. Given that professional isolation can lead to decreased rural work and reduced hours, a successful VCoP may have a positive outcome on the rural medical workforce.

Benefits of Online Health Education: Perception from Consumers and Health Professionals

With the advancement in technology and availability of the Internet, online health education could become one of the media for health education. As health education is to persuade patients on health behavioural change, understanding perceived benefits of online health education is an important aspect to explore. The aim of this study is to explore consumers and health professionals opinion on online health education. Literature review was conducted and identified the benefits of online health education (OHE). Survey was conducted to health consumers and health professionals. Descriptive analyses were performed using SPSS Version 19.0. The analysis of the literature has identified a set of 12 potential benefits of OHE which had been used to understand the perceptions of the effectiveness of OPE sites and these have been validated in the study. This study has the practical implication as the study identified OHE effectiveness, which definitely can assist health practitioners on health education, which can lead to better health outcome.

Trends in uptake of the 75+ health assessment in Australia: a decade of evaluation

In Australia, older adults aged 75+ years are encouraged to avail themselves of the comprehensive 75+ health assessment (75+ HA) to identify medical conditions and highlight potential risk factors for poor health. However, uptake of this item has been reported to be low. This study aimed to identify the uptake of the 75+ HA within regional areas of New South Wales and compare this against state and national trends over an 11-year period. Data on uptake of the 75+ HA for item numbers 700 and 702, from 1999 until 2010, were obtained from the Medicare Australia portal and Department of Health and Ageing databases. Trends over time were collated and compared at the regional, state and national level. The study found that an increasing number of the 75+ HAs were performed from 1999 to 2009. Overall, the uptake of the 75+ HA is generally low across Australia, at -20% of the eligible population, but varied across states and even regions within states. The study also revealed that despite low uptake encouraging trends were evident over a decade of 75+ HA implementation. It is argued that strategies in improving the uptake should be targeted for early identification of health risk and overall improved quality of health in older adults.

Feasibility of implementing routine nutritional screening for older adults in Australian general practices: a mixed-methods study

BackgroundNutrition screening in older adults is not routinely performed in Australian primary care settings. Low awareness of the extent of malnutrition in this patient group, lack of training and time constraints are major barriers that practice staff face. This study aimed to demonstrate the feasibility of including a validated nutrition screening tool and accompanying nutrition resource kit for use with older patients attending general practice. Secondary aims were to assess nutrition-related knowledge of staff and to identify the extent of malnutrition in this patient group.MethodsNine general practitioners, two general practice registrars and 11 practice nurses from three participating general practices in a rural, regional and metropolitan area within a local health district of New South Wales, Australia were recruited by convenience sampling.Individual in-depth interviews, open-ended questionnaires and an 11-item knowledge questionnaire were completed three months following in-practice group workshops on the Mini Nutritional Assessment Short Form (MNA-SF). Staff were encouraged to complete the MNA-SF within the Medicare-funded 75+ Health Assessment within this time period. Staff interviews were digitally recorded, transcribed verbatim and analysed thematically using qualitative analysis software QSR NVivo 10.ResultsFour key themes were determined regarding the feasibility of performing MNA –SF: ease of use; incorporation into existing practice; benefit to patients’ health; and patients’ perception of MNA-SF. Two key themes related to the nutrition resource kit: applicability and improvement. These findings were supported by open ended questionnaire responses. Knowledge scores of staff significantly improved from baseline (52% to 66%; P < 0.05). Of the 143 patients that had been screened, 4.2% (n = 6) were classified as malnourished, 26.6% (n = 38) `at risk’ of malnutrition and 69.2% (n = 99) as well-nourished.ConclusionIt is feasible to include the MNA-SF and a nutrition resource kit within routine general practice, but further refinement of patients’ electronic clinical records in general practice software would streamline this process.

Area-level socioeconomic gradients in overweight and obesity in a community-derived cohort of health service users - a cross-sectional study

Background Overweight and obesity lead to higher probability of individuals accessing primary care but adiposity estimates are rarely available at regional levels to inform health service planning. This paper analyses a large, community-derived clinical database of objectively measured body mass index (BMI) to explore relationships with area-level socioeconomic disadvantage for informing regional level planning activities. Materials and Methods The study included 91776 adults who had BMI objectively measured between 1 July 2009 and 30 June 2011 by a single pathology provider. Demographic data and BMI were extracted and matched to 2006 national census socioeconomic data using geocoding. Adjusted odds-ratios for overweight and obesity were calculated using sex-stratified logistic regression models with socioeconomic disadvantage of census collection district of residence as the independent variable. Results The prevalence of overweight or obesity was 79.2% (males) and 65.8% (females); increased with age to 74 years; and was higher in rural (74%) versus urban areas (71.4%) (p<0.001). Increasing socioeconomic disadvantage was associated with increasing prevalence of overweight (p<0.0001), obesity (p<0.0001) and overweight or obesity (p<0.0001) in women and obesity (p<0.0001) in men. Socioeconomic disadvantage was unrelated to overweight (p = 0.2024) and overweight or obesity (p = 0.4896) in males. Conclusion It is feasible to link routinely-collected clinical data, representative of a discrete population, with geographic distribution of disadvantage, and to obtain meaningful area-level information useful for targeting interventions to improve population health. Our results demonstrate novel area-level socioeconomic gradients in overweight and obesity relevant to regional health service planning.

Teaching telehealth consultation skills

Although teleconsultations have been used for many years in Australia, there has been a recent increase following new government incentives. There is a paucity of literature on enabling medical students to acquire the relevant skills. With a focus on equipping students for practice in rural and remote areas, our medical school has developed an innovative clinical skills lesson to prepare our students for their rural practice placements.

Heroic struggles, criminals and scientific breakthroughs: ADHD and the medicalization of child behaviour in Australian newsprint media 1999–2009

ABSTRACT There is a dearth of scholarly analysis and critique of the Australian newsprint media’s role in the medicalization of child behaviour. To begin to redress this lack this paper analyses newsprint media’s use of metaphors that re/describe and construct realities of ADHD with a medicalizing effect. The interdisciplinary team used the FactivaTM database to locate and review 453 articles published in Australian national and metropolitan newspapers during the decade 1999–2009. Data analysis involved generating statistical descriptions of the dataset according to attributes such as: date, state, newspaper titles and author names. This was followed by inductive analysis of article content. Content analysis revealed pervasive and striking use of metaphor in newsprint media reporting of ADHD content, especially when describing health professionals, educators, parents and children. This collection of metaphors was striking, and while the metaphors deployed were varied, this diversity seemed underscored by a common functionality that increased the risk that child behaviour was explained using medicalized knowledge. We contend that these metaphors collectively and coherently functioned to simplify and delimit meanings of children’s health and behaviour to favour depictions that medicalize problems of children and childhood.