Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice: an exploratory survey

BMC Health Services Research

John Furler¹  Elizabeth Patterson²  David O’Neal⁴  Doris Young¹  Irene Blackberry³  Jo-Anne Manski-Nankervis¹ 

[1] General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia;Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Carlton, Victoria, Australia;Faculty of Health Sciences, La Trobe University, Wodonga, Victoria, Australia;Department of Medicine, St Vincent’s Hospital, Fitzroy, Victoria, Australia

关键词: General practice;    Type 2 diabetes;    Insulin initiation;    Relational coordination;   

Others  :  1092438
DOI  :  10.1186/s12913-014-0515-3

 received in 2013-11-04, accepted in 2014-10-13,  发布年份 2014

【 摘 要 】

Background

The majority of people with type 2 diabetes (T2D) receive their care in general practice and will eventually require initiation of insulin as part of their management. However, this is often delayed and frequently involves referral to specialists. If insulin initiation is to become more frequent and routine within general practice, coordination of care with specialist services may be required. Relational coordination (RC) provides a framework to explore this. The aim of this study was to explore RC between specialist physicians, specialist diabetes nurses (DNEs), generalist physicians in primary care (GPs) and generalist nurses (practice nurses (PNs)) and to explore the association between RC and the initiation of insulin in general practice, and the belief that it is appropriate for this task to be carried out in general practice.

Methods

A survey was distributed to a convenience sample of specialist physicians, DNEs, GPs and practice nurses. We collected data on demographics, models of care and RC in relation to insulin initiation. We expected that RC would be higher between specialists than between specialists and generalists. We expected higher RC between specialists and generalists to be associated with insulin initiation in general practice and with the belief that it is appropriate for insulin initiation to be carried out in general practice. We used descriptive statistics and non-parametric tests to explore these hypotheses.

Results

179 health professionals returned completed surveys. Specialists reported higher RC with each other and lower RC with PNs. All groups except PNs reported their highest RC with DNEs, suggesting the potential for DNEs to serve as boundary spanners. Lower RC with specialists was reported by those working within a general practice model of care. Health professionals who felt that a general practice model was appropriate reported lower communication with specialist physicians and higher shared knowledge with GPs.

Conclusion

Given the need for coordination between specialist and generalist care for the task of insulin initiation, this study’s results suggest the need to build relationships and communication between specialist and generalist health professional groups and the potential for DNE’s to play a boundary spanner role in this process.

【 授权许可】

   
2014 Manski-Nankervis et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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