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

慢性病给个人和卫生保健系统带来了重大负担，导致初级卫生保健从业人员的工作比例不断增加，并增加了卫生支出。一些干预措施已被证明能够持续改善慢性病患者的健康状况，其中包括：更有效地利用非医生护理提供者和护士病例管理；自我管理支持方案与基于指南的治疗计划的整合；更密集的跟进和提供提醒和反馈的注册。虽然在澳大利亚的协调护理试验和加强初级保健（EPC）计划中已经采用了其中一些方法，但在慢性病护理的一般实践中，非医务人员的作用尚未得到系统的调查。2001年，联邦提出了一些倡议，支持提高糖尿病和哮喘全科护理的质量，并在四年时间里为劳动力压力大的地区的全科护理提供了1.042亿美元，以雇用更多的护士。实践经理和接待员的角色受到的关注要少得多。它们包括通过提供专家管理服务（主要是信息技术、人员、财务和设施管理）来促进获得护理，支持从业人员提供高质量的临床护理。随着最近政府举措扩大全科实践在澳大利亚的作用，在全科实践中有效的管理结构和过程是至关重要的。非全科医生全科医生的工作人员可能是手段，更有效的慢性疾病管理可以在增加劳动力压力的时候实现。该项目旨在评估一个方案的影响，该方案对非全科医生的工作人员进行培训，并促进他们参与慢性病患者的管理。

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.