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Researchers to explore primary care delivery

Professor Nicolette Sheridan.

Professor Nicolette Sheridan, from Massey University’s School of Nursing, will lead a collaborative research project, investigating the effectiveness of primary care delivery.

“Most people see a GP each year,” Professor Sheridan says. “We want to find out the best ways to organise general practice so that everyone gets the best care and the best outcomes.

“Evidence is unclear on which models of primary care are most effective in New Zealand. We will study three models of primary care – traditional general practice; corporate general practice; and the health care home. We will consider effectiveness in terms of quality, equity, and cost effectiveness. The aim is to learn practical lessons for the most effective future primary care system for New Zealanders, in particular for Māori, Pacific and other groups not currently well served,” she says.

The traditional model of primary care has seen GPs and nurses working from shared premises, operated as small businesses, to deliver health care to patients. Professor Sheridan says increasing pressures on the traditional model has come from a number of factors, including an ageing and multi-ethnic population with increasing medical complexity, an ageing workforce, changing expectations of new graduate doctors and nurses and greater demands for accountability of health professionals.

“These pressures have led to the development of corporate models of care delivery, with an emphasis on business management and processes that lower patient fees and increase access to care;  and health care homes, with an emphasis on better use of doctor and nurse time, team-based care - mainly with nurses, pharmacists and doctors, and alternatives to face-to- face consultations, such as email and video.”

Professor Sheridan says the team of researchers have real concerns about groups of people who often do not get the best service and outcomes from primary care. This includes Māori, Pacific peoples, those experiencing financial hardship and people with mental health issues.

“A model of general practice that improves access and quality of occasional visits for most, and intensive well-managed care for people with complex health needs, can improve the value of the health system. An increasing GP shortage and escalating levels of long term conditions means nurses and community health workers have an even greater part to play, including in the delivery of outreach services and culturally-specific care,” she says.

“Many people say they don’t get the care they want when they go to a general practice, and too many people go to the hospital emergency department for things that could be managed in general practice. Often, people who work find it difficult to get appointments, especially after hours and in the weekend, and many people find the cost of going to the general practice and getting medicines from the pharmacy just too expensive. Most people prefer to see the same doctor or nurse when they visit general practice but this seems to happen less often than it used to. Home visits are hugely valued by patients but are available less often than they used to be,” Professor Sheridan says.

Currently, the Government spends more than $900 million each year subsidising primary health services but Professor Sheridan says it has little information regarding quality, utilisation and outcomes of different types of primary care services, making it impossible to manage and continually improve primary care across the country.

“One outcome of this study will be the largest coherent reporting, to our knowledge, from already-collected data about primary care in New Zealand,” she says. “Our research will identify indicators that can be used to monitor health needs and health outcomes, and responses from primary care and social support systems. We are committed to identifying the characteristics of a primary care model that is equitable and can substantially improve health outcomes for everyone, and in particular for Māori, Pacific peoples, and other underserved groups.”

The research will investigate which general practice characteristics are associated with the best patient and health system outcomes. There are close to 1000 general practices in New Zealand. Practice characteristics will be collected from 24 practices (in case studies), from PHOs (primary health organisations consisting of about 500 practices), and from national data (about 1000 practices). Practice outcomes will be calculated from national data sets and from PHO data.

“The 24 case studies will describe their models of care, their activities and impacts. Data collection will include individual or group interviews with doctors, nurses, managers and patients. Quantitative analysis of national and regional datasets will augment case studies, and assist to assess how generalisable case study findings are across New Zealand. Analysis of costs of different models, to individuals and to government, will provide a context in which to interpret outcomes as cost effective,” Professor Sheridan says.

The project involves a multi-disciplinary team of primary care clinicians and academics from five universities – Massey University, University of Auckland, University of Otago, Cambridge University (United Kingdom), and the Karolinska Institute (Sweden) and organisations with specialist knowledge who will work together.

“This is a unique team and an incredible opportunity to combine academic and health sector knowledge to support the interpretation of new data and practical application in the health sector,” Professor Sheridan says.

The study begins this month and will run for two years. It is jointly funded by a partnership grant of $1.33 million from the Health Research Council of New Zealand and the Ministry of Health.

Research Team

Professor Nicolette Sheridan, (Lead Researcher) Massey University

Associate Professor Tim Kenealy, (co-Lead) University of Auckland

Dr Tom Love, (co-Lead) Sapere Research Group

Dr Rawiri Jansen, National Hauora Coalition

Dr Matire Harwood, University of Auckland, National Hauora Coalition

Dr Debbie Ryan, Pacific Perspectives Limited

Ms Debra Lampshire, University of Auckland

Professor Jane Mills, Massey University

Professor Jenny Carryer, Massey University

Associate Professor Karen Hoare, Massey University

Associate Professor Leonie Walker, Massey University

Professor Bruce Arroll, University of Auckland

Professor Ngaire Kerse, University of Auckland

Dr Tana Fishman, Greenstone Family Clinic, South Auckland

Professor Peter Crampton, University of Otago

Professor Robyn Gauld, University of Otago

Professor Tim Stokes, University of Otago

Professor Tony Dowell, University of Otago

Associate Professor Lynne McBain, University of Otago

Dr Maria Stubbe, University of Otago

Dr Carol Atmore, Mornington Health Centre, Dunedin

Mr Jayden MacRae, Datacraft Analytics

Dr Gary Jackson, Ernst & Young

Professor John Øvretveit, Karolinska Institute, Sweden

Professor Martin Roland, University of Cambridge, United Kingdom

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