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Transmural cooperation between general practioners and nursing staff in residential care facilities
Prof dr Bart Van Rompaey, department of nursing and midwifery Jolien De Cock MS department of nursing and midwifery Prof dr Johan Wens, department of general practice Prof dr Tinne Dilles, Nurse and Pharmaceutical Care Research Group 1
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Outline of the presentation
Background Methodology Results Conclusions Take home message
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Transmural cooperation?
Background Transmural cooperation? Transmural care (Aeyels et al. 2011, Directory General Organisation of Healthcare Facilities, Belgium) All kinds of care, patient tailored, based on agreements… between specialised and general care givers, given a shared responsibility superordinating different profession-related responsibilities Cooperation (Knowles et al. 2015, BMC Family Practice 16-2) A multidisciplinary approach to patient care including structured care plans, follow-up and improvement of interprofessional communication
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Background Patients are free to choose their general practioner (GP) in Free choice remains in a residential care facility (RCF) 2/3 (of n=176) facilities deal with 11 to 30 GP’s GP’s: The visit and care for older people is not a priority A patient visit in a RCF lasts 5 minutes (Theile et al 2011, BMC Family Practice 12-12) Indicate a need for easy and accessible communication with the staff 56% patient contact, 26% indirect patient activities, 18% non patient activities (van Hassel et al 2014, Huisarts en wetenschap 4) Double patient data file GP’s patient file RCF’s patient care file
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Aim and research questions
To obtain insight in the transmural cooperation between GP’s and the staff in RCF Strenghts Limitations Challenges Recommendations How do nurses and GP’s experience transmural cooperation? Which factors seem to influence this transmural cooperation? What are opportunities to improve this transmural cooperation?
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Methodology Qualitative design: phenomenology using a descriptive approach Semi structured interview - topic list based on literature review /discussion Convenience sample Interviewees Informed consent RCF older than 2010 6 Head nurses of RCF (2 yrs) 8 GP’s (no CRA) Recored, transcribed whitin 24 hrs Coding Thematic clustering
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Population Head nurse GP Gender Male Female 2 4 5 3 Age in yrs 31 – 40
41 – 50 51 – 60 >60 1 Yrs in job 3 – 5 6-10 11-15 16-20 >20 7 # Wards 1 – 3 >3 # GP’s in RCF 1-10 11-20
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Results - topics Perception of the cooperation Expectations
Continuity of care Relation GP – nurse Factors influencing the cooperation Opportunities for improvement
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Results - Perception of the cooperation
Head Nurse GP Need for structured visits Crucial position: timing and number of visits GP has very limited time for discussion and briefing Less time available for visits in RCF Contact via telephone when needed Medication (errors!) Written confirmation Responsibility Contact via telephone for changes in treatment Need for structured information Fast, easy and in time No free access for GP tot nurses station – GP has to sign in Visit is no priority since patient is under supervision of nurses
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Results - Expectations
Head Nurse GP Need for improved medication management GP does not thoroughly check medication chart Adverse drug reactions Drug interference Medication not needed anymore Follow-up on chronic medication is no priority GP is responsabele for medication management, has to give clear written orders Expects from the nurse Understanding of medication management and ADR Knowledge of medication Indication when to stop medication
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Results - Continuity of care
Head Nurse GP Contact with other caregivers besides head nurse Contact with caregiver close to patient Head nurse not necessary More trust in somebody acquainted Flexibility in staff is not good Poor information or history (medical and social) at admittance Too much paperwork at admittance Introduction of an EPD?
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Results - Relation GP – nurse
Head Nurse GP Better when acquainted for years Clear expectations Clear routines Obvious trustworthiness Hierarchical relationship is counterproductive Need for appreciation of nurses’ work Need for respect Need to be taken seriously
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Results - Factors influencing the cooperation
Head Nurse GP Attitude and personality of GP Accept recommendation Attitude and personality of nurse Experience Holistic approach Clinical decision-making Age of GP Younger GP’s are easier to cope with Younger GP’s are therapeutically less flexible Access to all information Need to be well informed Nurse has to master the local language (foreign workers!)
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Results - Opportunities for improvement
Head Nurse GP Structured and planned visits of GP Staff remains on same ward Feedback after visit EPD! (Advance) Care planning
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Conclusions Good cooperation often related to attitude and personality of GP Hierarchic relation leads to poor appreciation and denial of recommendations Nurses has to collect all information and provide it in a structured way EPD solves most problems when all caregivers have complete access to the data
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Take home message This presentation aims at rising the awareness and the respect for the aspects of each profession in transmural care. A well designed and easy to use electronic patient file with respect to all caregivers is needed for a fast and continuous information in interdisciplinary residential care.
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Transmural cooperation between general practioners and nursing staff in residential care facilities
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