Presenters:
Mark Harris et al

Aim
To present the research findings from Australian studies of teamwork in the management of chronic disease in general practice

Content of presentation/s
A key element of the chronic illness model is redesign of the care delivery system through the use of patient care teams. This has been recognized in various initiatives to encourage teamwork and team roles both within general practice and between in and other services. It is also a key activity of Divisions of General Practice in working to improve the quality of care for patients with chronic conditions in general practice. There has been previous oversease research to demonstrate the value of teamworking in patient care. However the optimal strategies to achieve this in the Australian context are not clear.
CPHCE has just completed two large studies on teamwork within general practice and another two will be completed this year. These have involved facilitation of teamwork within the practice enhancing the roles of practice nurses and administrative staff in the detection and management of diabetes, cardiovascular disease and chronic respiratory disease. Other studies have evaluated the impact of facilitating teamwork between general practice staff and other providers especially allied health providers outside the practice.
These studies have demonstated a variety impacts on the process and organisation within general practice, between it and other service and service providers. and on the quality of care for patients. For example facilitating non GP staff roles in chronic disease management was associated with improvements in care planning and patient assessment of the quality of care for chronic illness. This was independent of change in the quality of care provided by GPs.

Relevance to the conference theme
These studies provide insight into what are effectve strategies to facilitate teamwork and what the place of team based care has in better manage chronic illness within primary health care. They have implications for current policy initiatives designed to improve team care and to integrate service delivery including the Enhanced Primary Care program and superclinics as well as for the role of Divisions of General Practice in facilitating change.

Presenters:
Bridget Bassilios et al

Aim
The Access to Allied Psychological Services (ATAPS) component of the Better Outcomes in Mental Health Care program, introduced in 2001, is testament to Australian reform to improving consumer access to primary mental health care. This program was a precursor to the Better Access to Psychologists, Psychiatrists and GPs under the Medicare Benefits Schedule (MBS) program (Better Access). Although operationalised in different ways, both programs enable GPs to refer consumers to allied health professionals for up to 12 (or 18 in exceptional circumstances) individual and/or group sessions of evidence-based care per calendar year. This symposium will present the latest ATAPS evaluation findings.

Content of presentation/s
Data from a range of sources, such as a minimum dataset, purpose-designed interviews and surveys, and MBS data supplied by the Medicare Benefits Branch of the Department of Health and Ageing, will be synthesised to showcase achievements of the ATAPS projects in improving consumer access and mental health outcomes. In addition, uptake changes in urban and rural areas since the introduction of Better Access; consumer and session profiles; differences between projects in service delivery models; and new pilots funded under ATAPS (telephone CBT, suicide prevention, and perinatal depression) will be used as a platform to generate discussion.

Relevance to the conference theme
In addition to the symposium being clearly linked to the theme of driving change in (primary care of) mental health, it is also relevant to multiple other conference themes, such as: policy (there is a reciprocal relationship between ATAPS and policy); workforce (ATAPS and Better Access may have increased the number of privately practicing providers); equity and access (improving access for consumers who might not otherwise be able to afford psychological services), rural and remote health (improving access for rural and remote consumers); partnerships and collaboration (collaboration among GPs, allied health providers, General Practice Networks and other organisations); building research capacity (of General Practice Networks).

Presenters:
Helena Britt et al

Aim
This symposium will explore relationship between National Health Priorities, Government policy and the service delivery of general practice in Australia

Content of presentation
Method: These studies used BEACH and SAND data collected between April 1998 and March 2008 consisting of one million encounters. BEACH (Bettering the Evaluation And Care of Health) is a continuous national cross-sectional study of general practice activity in Australia. About 1000 randomly selected GPs per year each record information about encounters with 100 consecutive consenting patients. Throughout the year, a series of substudies (SAND) are conducted in conjunction with the ongoing data collection. Findings: The symposium will allow discussion of the interplay of of policy driven health systems changes and general practitioner behaviour. A series of brief papers will explore the interrelationship of seven national health priority areas (NHPAs) with policy and regulatory change and its effect on the service delivery of general practice in Australia over the decade 1998 to 2008. The NHPAs covered in this symposium are respiratory disorders, cardiovascular disease, Type 2 diabetes, musculoskelital disorders, mental health,injury and cancer. Significant changes include the effect of the 3+ Asthma plans, the effect of guidelines and regulation on lipid management, the profound changes in diabetes management in response to multiple policy initatives, the rapid increase in referrals to psychologists following MBS changes, and the place of ADEs in the NHPA of injury.

Relevance to the conference theme
This symposium picks up the conference themes of policy, chronic disease management and clinical practice to explore how and if policy and related regulatory processes drives change in clinical general practice.

Presenter:
Dale Ford

Aim
To inform the audience about collaborative programs in England, Scotland, Canada and Australia, the improvements made, the differences in results between countries, and the lessons learned.

Content of presentation/s
Primary Care Collaborative Programs have achieved significant improvements in the delivery of Primary Care to patients in England, Scotland, Canada and Australia.
The presenter will introduce the Collaboratives Methodology and demonstrate how the Improvement Foundation (UK) Collaboratives Program has been responsible for impressive improvements in the management of Diabetes and CHD in the UK, Scotland, Australia and Canada.
The Collaboratives Methodology is a specific method of quality improvement that can be applied to achieve incremental, rapid and locally relevant improvements across a broad range of clinical and practice business issues.
Change Principles and Change Ideas are a key component of the methodology and the presenter will discuss how readily they can be transferred to achieve rapid quality improvement in primary care and chronic disease management. In addition the presenter will also share the improvements that have been achieved in improving patient access to primary care in each health system - the successes and lessons learned.
Participants will be given the opportunity to discuss and compare the improvements in each country, the reasons for differences in results between countries, and how the lessons may apply to their respective organisations.
This session will be of interest to those who advocate sharing expertise, continuous quality improvement, and capacity building in the primary care environment.

Relevance to the conference theme
Chronic disease management, workforce, clinical practice, systems in health care

Presenter:
Ross Bailie

Aim
To improve measurement, understanding and relevance of variation in quality of care for primary health care quality improvement purposes

Content of presentation/s
We will present data on variation of quality of care in relation to diabetes care, preventive care, maternal health care and child health care. This body of studies is based on a national quality improvement project conducted in 56 Indigenous community health centres across four States/Territories (NT, Far West NSW, WA and North QLD). Data were collected between 2005 and 2008 through audits of clinical medical records. Main outcome measures include assessment of adherence to best practice guidelines and patient outcomes as appropriate.
Wide variation was observed across health centres regarding delivery of these four types of primary care. For example, overall adherence to diabetes care guidelines was 53%, with a range of 5%-81% across health centres. Twenty-seven percent of patients with diabetes had HbA1c<7%, with a range of 0%-54% across centres. Health centre level characteristics accounted for 40% of total variation in adherence to care and about 10% of variation in patient intermediate outcomes; the remaining substantial variations were attributable to patient level variables. Similar wide variations were found in relation to preventive care, maternal care and child health care. We will aim to engage the audience in a discussion of the factors underlying variation in quality of care, how to advance this understanding and how to use this understanding to improve quality of care.

Relevance to the conference theme
The symposium will address the conference theme of 'driving change' through promoting understanding of the potential for application of systematic methods to explore variation in quality of care, and of drivers in variation, to improve the quality of primary health care.

Presenters:
Frank Sullivan et al

Aim
To share experiences with Record Linkage (RL) using clinical and research datasets in the UK and Australia

Content of presentation/s
In Scotland a simple and far-sighted decision in the 1970’s means that every person registered with a general practitioner (GP) in Scotland as part of the National Health Service is allocated a unique identifying number from a centrally maintained register called the Community Health Index (CHI). The CHI number is the unique patient identifier in all primary health care activities, and is now used in hospital based clinical information systems achieving 93% compliance. The CHI register contains data on address, postcode, GP, date and region of registration and, where relevant, date of death, allowing the demographic profile of Scotland, death and patient migration to be analysed. Where the CHI number is unavailable (e.g. historical data) probability matching is used, and the record linkage unit within Information Services Division (ISD) of NHS National Services Scotland has an international reputation for using probability matching to link research databases to routine admissions and death data.

Findings
This symposium will use examples of current and completed clinical trials, epidemiology and pharmacovigilance to demonstrate the utility of record linkage in Scotland. Planned research in the Wellcome Trust/MRC funded AU$ 7.1M Scottish Health Informatics Programme (SHIP) and links to the Health Research Support Service (HRSS) being developed by the Connecting for Health (CfH) programme in the NHS in England will be discussed.

Relevance to the conference theme
A ‘step-change’ in the quality, quantity and governance of clinical care and research using EPRs can now be achieved with a more joined-up eHealth records strategy. The SHIP programme will provide a platform for Scottish record linkage that will provide lessons for EPR research throughout the UK and abroad.