Dunt D, Southern D, Elsworth G, Harris C, Potiriadis M, Young D; AcademyHealth. Meeting (2003 : Nashville, Tenn.).
Abstr AcademyHealth Meet. 2003; 20: abstract no. 329.
The University of Melbourne, Centre for Helath Program Evaluation, PO Box 477 West Heidelberg, Melbourne, 3081 Tel. +61 3 94964433 Fax +61 3 94964424
RESEARCH OBJECTIVE: to describe and explain variation in levels of GP (family physician) integration with the wider health care system across Australia. Health service delivery in Australia is fragmented largely due to its mixed public/private system of payment for health care and the overlapping responsibilities and activities of Federal and State governments. Initiatives to promote GP integration have been the most common strategy adopted by governments to redress this. STUDY DESIGN: national mail surveyusing the GP integration index as well as reported levels of professional activities relevant to GP integration. Its psychometric development and validation have been reported. (1) The overall response rate was 51.7% though the average response rate by Divisions was 65.9%. Fourteen different factors of integrated general practice are identified and measured. These are Integration Factors - Holistic Patient Care, GP Flexibility, Patient Information, Attitude to teamwork, Care Coordination (non-hospital), Hospital role, Health Planning subsumed by two Higher Order Factors - Patient care management (PCM), Community health role (CHR) and Enabling Factors - Knowledge of local resources, Information technology, Practice organization, Time & funding and Personal domain. A setwise multilevel multivariate analysis involving both higher order factors was undertaken using characteristics of the GPs as well as the characteristics of the organization and service delivery characteristics of their practices, as well as the GP integration enabling factors as the independent variables.1 Batterham R, Southern D, Appleby N et al (2002) Construction of a GP integration model. Soc Sci & Med; 54:1225-1241. POPULATION STUDIED: GP members drawn from a sample of 27 of 122 Divisions of General Practice (local area groupings of family physicians) PRINCIPAL FINDINGS: Levels of GP integration were generally higher in activities relating to GPs' patient care roles than their community health roles. Rural GPs had higher levels for a number of factors of integration than urban GPs, principally but not only in their community health roles. Within both rural and urban Divisions, some Divisions showed consistent higher or lower levels for particular GP integration factors compared with their relevant Divisional grouping than others. More than one quarter of total CHR variance (27.7%) and almost no (1.2%) PCM variance was partitioned to area level. Urban-rural location and to a lesser extent, Enabling Factors made the greatest contribution to explaining area level CHR variance. Enabling Factors made the greatest contribution in explaining individual level variance, for both PCM and CHR. Knowledge of local resources constituted the variable with the highest standardized regression coefficients for areawide CHR as well as individual level CHR and PCM. CONCLUSIONS: GP integration varies greatly across Australia. Most of this variation can be explained in terms of the practice and other characteristics of individual GPs though an important contribution to their community health roles is explained at area level, coterminous with the GPs' Division of General Practice. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: A strategy of further promoting GPs' Knowledge of local resources (by their Division of General Practice or in other ways) amongst all competing strategies has most potential to increase GP integration.
Publication Types:
Keywords:
- Australia
- Delivery of Health Care
- Family Practice
- Humans
- Physicians, Family
- Population Groups
- United States
- hsrmtgs
Other ID:
UI: 102275309
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