New Workforce-based Models of Primary Care and an evaluation of the quality of evidence underpinning them

Professor Deborah SchofieldChair of Health Economics, NHMRC Clinical Trials Centre and School of Public Health, Sydney Medical School, University of Sydney

Dr Lucio Naccarella NHMRC Postdoctoral Training Fellow, The Australian Health Workforce Institute, The University of Melbourne and General Practice

Victoria

13th International Health Workforce Collaborative Conference October 24-26, 2011, Brisbane, Australia

Remembering Our Elders

“Imagination is more important than

knowledge. Knowledge is limited. Imagination

encircles the world”

Albert Einstein

(18-12-1932 to 10–06-2011)

Context

Strengthening primary care by extending workforce roles and skills within health

systems is one way to meet the increasing demands upon the health system

• Essential to assess the available evidence for each new or revised workforce-based models of primary care, and to conduct well designed rigorous evaluations

Paper Objectives

1. Models of primary care using different workforce arrangements

2. Framework for assessing evidence about models of primary care

3. Evaluate the quality of evidence in relation to models of diabetes care in the primary care setting

Primary Care Workforce Model Typology

• Innovation

• Supplementation/ enhancement

• Substitution/delegation

Framework for assessing the quality of evidence

• Relevant and replicable

• Theoretical framework• Strength of the

evidence • Size of the effect • Transferability and

representative • Duration • Value for money

Evidence of Workforce Models Models of Diabetes Care Workforce Models– roles, skills mix…

• Point of care testing Shephard et al(2005) • local GP, diabetes educator, podiatrist

•Diabetes model of care – WA (2008) •GP-coordinated multidisciplinary approach ?

• Pharmacy diabetes care Krass et al (2007)

• Pharmacists

• POCT Shephard (2006) • Clinical staff, aboriginal health care workers, allied health professionals

• Greater green triangle diabetes prevention project Laatikainen et al (2007) and Kilkkinen et al (2007)

• Nurses, dietician, physiotherapist

• Enhanced primary care Foster et al (2008) • GPs, allied health professional

• Chronic disease management in primary care Dennis et al (2008)

• Multidisciplinary team care?

Discussion

• Policy directions are:– Supporting & strengthening a well-trained multidisciplinary team-

based primary care workforce– Piloting new approaches for the delivery of PHC services

• Coordinated Care for Diabetes Pilot in the primary care setting

BUT….• Review revealed need for higher standard of evidence about

the merits of models of primary care. – Limited representativeness & replicability– No study included assessment of cost effectiveness

And… – Limited evidence about workforce models - roles & skills mix

In Conclusion

• Proliferation of new models of primary care in Australia + new workforce roles & skills mix

• Need for more robust studies to assess whether:– interventions are effective in producing improved

health outcomes– effective interventions represent value for money

• Need for more evidence about workforce models of primary care -> sustainability

Thank You

“The intuitive mind is a sacred gift and the rational mind is the faithful servant. We have created a

society that honours the servant and has forgotten the gift”

Albert Einstein

Source• Wade Davis (2009) The Wayfinders: why ancient wisdom matters in the

modern world. Chapter 4: Sacred Geography