Trial of structured support to enhance the role of non-GP staff in chronic disease management in general practice

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Chronic disease presents a significant burden to individuals and the health care system , contributing to both an increasing proportion of the work of primary health care practitioners and to health expenditure. A number of interventions have been shown to result in sustained improvement of health outcomes for people with chronic diseases, including: more effective use of non-physician providers of care and nurse case management; integration of self-management support programs with guideline based treatment plans; more intensive follow up and registries that provide reminders and feedback. While some of these approaches have been pursued within the Coordinated Care Trials and the Enhanced Primary Care (EPC) program in Australia, the role of non medical staff within general practice in chronic disease care has not been systematically investigated. In 2001 the Commonwealth introduced a number of initiatives to support better quality of care for diabetes and asthma in general practice and $104.2 million over four years was provided for general practices in areas of high workforce pressure to employ more Nurses. The roles of the Practice Manager and Receptionist have received much less attention. They include faclitating access to care, supporting the delivery of quality clinical care by the practitioners through the provision of expert management services (primarily information technology, staff, financial and facilities management) to the practice. With recent government initiatives expanding the role of general practice in Australia, effective management structures and processes within general practices are vital. Non-GP general practice staff may be the means by which more effective chronic disease management can be achieved at a time of increasing workforce pressure. This project aims to evaluate the impact of a program in which non-GP staff are trained and facilitated to be involved in the management of patients with chronic disease.