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

慢性病对个人和卫生保健系统构成重大负担，在初级卫生保健从业人员的工作和卫生支出中所占比例越来越大。许多干预措施已被证明能够持续改善慢性病患者的健康状况，包括：更有效地利用非医生提供的护理和护士病例管理；将自我管理支持方案与基于指南的治疗计划相结合；更密集的跟踪和提供提醒和反馈的登记。虽然其中一些方法已经在澳大利亚的协调护理试验和增强型初级保健(EPC)计划中进行了探索，但非医务人员在全科医疗中在慢性病护理中的作用尚未得到系统的调查。2001年，英联邦提出了一些倡议，以支持在全科医生中提高糖尿病和哮喘的护理质量，并在四年内提供1.042亿美元，用于劳动力压力大、需要雇用更多护士的普通医生服务。业务经理和接待员的角色受到的关注要少得多。这些措施包括将获得护理的机会分解，通过向执业医生提供专家管理服务(主要是信息技术、工作人员、财务和设施管理)，支持医生提供高质量的临床护理。随着政府最近的举措扩大了全科医生在澳大利亚的作用，在全科医生队伍中建立有效的管理结构和流程至关重要。在劳动力压力增加的情况下，非全科医生可能是实现更有效的慢性病管理的手段。该项目旨在评估培训和促进非全科医生工作人员参与慢性病患者管理的计划的影响。

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.