A comparative case study of how different models of integrated primary health care centres optimise access and integration
Dr Julie McDonald, Prof Grant Russell (Monash University), Dr Sarah Dennis (Sydney University), Prof Jeff Fuller (Flinders University), Other team members
Increasing rates of chronic illness within an ageing population will require increasingly accessible and well integrated PHC. International evidence shows countries with well-functioning primary health care (PHC) systems achieve improved health outcomes; better integration and coordination, and thus more effective management of chronic disease and improved health outcomes. However, challenges remain for achieving improved coordination and integration. PHC providers and consumers still experience poorly coordinated care.
PHC services are often not well set up to provide well integrated primary healthcare, and IPHCCs have been set up in part to achieve this. However although there is some evidence that IPHCCs can improve access and integration , there is little information about how Australian IPHCCs are organised and operate, which types of IPHCSs are best able to do this in the Australian context and their impact on access and integration of care.
The overall aim of the study was to identify and evaluate the different approaches that Integrated Primary Health Care Centres (IPHCCs) used to optimise access and integrate care for people with chronic conditions, and to demonstrate how this can be supported through policy. The study had several aims:
- To describe the approaches (systems, arrangements and organisational routines) that Integrated Primary Health Care Centres use to optimise access; and integration of care for people with chronic conditions.
- To identify the factors that act as enablers and barriers to the use of these approaches.
- To describe the impact of these approaches on access and integration of care.
Qualitative case study comparing different models of integrated primary health care centres. Six sites were selected from two states (NSW and Victoria) representing different models of co-located services (GP Superclinics; HealthOne NSW; NGO community health centres; and other developments). Data collection includes a 3 day site visit to conduct semi structured interviews (with a range of medical, nursing and allied health and administrative staff and senior management), non-participant observation of routines and the environment in which the centres are operating and administration of a survey on team climate and team functioning. Additional data collection is undertaken via a mix of face to face and telephone interviews. Data collection and analysis is proceeding iteratively with early analysis informing later data collection. An analytic framework based on the literature is guiding the thematic analysis. This framework includes themes relating to context, access and integration. Cross case analysis is being undertaken to identify similarities and differences between centres and interactions between the themes. A 2-day data retreat is being held where the team considers the emerging findings and interpretations and identifies questions of interest for further analysis
Initial findings are feedback to each site as a form of validating the data and as an opportunity to gather more in-depth data on emerging findings.