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Abstract
Objectives To estimate the transferability of processes of care from general practitioners (GPs) to allied healthcare professionals and the determinants of such transferability.
Design French national cross-sectional multicentre study
Setting 128 family practices providing supervised training for residents in general practice.
Participants All patients consulting with their GP over a total number of 20 days (ie, 1 day a week from December 2011 to April 2012). Encounters where type 2 diabetes was one of the managed health problems were selected for analysis.
Primary and secondary outcome measures Processes that were associated with specific health problems were collected by 54 residents. Potential process transferability was the main outcome assessed, as well as the professionals involved in the collaboration and the eventual conditions associated with transfer.
Results From 8572 processes of care that concerned 1088 encounters of patients with diabetes, 21.9% (95% CI 21.1% to 22.8%) were considered eligible for transfer from GPs to allied healthcare professionals (78.1% to nurses, 36.7% to pharmacists). Processes were transferable with condition(s) for 70.6% (ie, a protocol, shared record or supervision). The most transferable processes concerned health maintenance (32.1%) and cardiovascular risk factors (hypertension (28.7%), dyslipidaemia (25.3%) and diabetes (24.3%)). Multivariate analysis showed that educational processes or a long-term condition status were associated with increased transferability (OR 3.26 and 1.47, respectively), whereas patients with higher intellectual occupations or those with two or more associated health problems were associated with lower transferability (OR 0.33 and 0.81, respectively).
Conclusions A significant part of GP activity relating to patients with multimorbidity including type 2 diabetes could be transferred to allied healthcare professionals, mainly on prevention and global education to cardiovascular risk factors. The organisational and finance conditions of team work as views of patients and healthcare professionals must be explored before implementation in primary care.
- general diabetes
- primary care
- organisation of health services
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Footnotes
Original reference: None
Contributors LL conceived the cross-sectional study. LL and IS designed the cross-sectional study. Interns of the ECOGEN study group collected the data. YB revised the protocol for data analysis. IS, LL and RE analysed the data. IS wrote the first draft, which was revised by RE, YB and LL. IS, RE, YB and LL approved the final draft.
Funding This work was supported by the French National College of teachers in general practice and Pfizer.
Competing interests None declared.
Patient consent Detail has been removed from the case description(s) to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval National committee for informatics and freedom, CNIL n°1549782 and the committee for the protection of the persons, CPP n°L11-149.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Technical appendix, statistical code, and dataset are not available from the Dryad repository. The dataset is available upon request from laurent.letrilliart@univ-lyon1.fr. The corresponding author is available for further information.
Collaborators The ECOGEN study group