Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

Models of care and relational coordination between health professionals involved in insulin initiation for people with type 2 diabetes: An exploratory survey (#262)

Jo-Anne Manski-Nankervis 1 , John Furler 1 , Irene Blackberry 1 , Doris Young 1
  1. General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Vic, Australia

Background: Insulin initiation in general practice for people with type 2 diabetes (T2D) is generally not occurring in a timely manner1-3 and the majority of patients are referred to specialist care4. Changing practice to support insulin initiation in general practice may require better inter-professional collaboration. Relational coordination (RC) theory identifies key concepts that underpin effective interprofessional work: communication which is problem solving, timely, accurate and frequent which is in turn dependent on professional roles, characterized by shared goals, shared knowledge and mutual respect5.

Aims: To explore the acceptability of insulin initiation in Australian general practice, existing levels of RC between health professionals involved in this task and factors which may affect this.

Method: Paper and electronic surveys were distributed to GPs, practice nurses (PNs), physicians and CDE-RNs. Descriptive statistics and regression analysis were used to describe RC scores and whether this was impacted by the current and preferred models of care for insulin initiation for people with T2D.

Results: 179 surveys were returned. 57.1% of physicians reported working within a specialist routine model. 67.7% of CDE-RNs reported managing insulin in conjunction with a GP. 50% of GPs and 65% of PNs reported that the majority of insulin initiation occurred in general practice without specialist involvement. There was a significant difference across the professional groups (p=0.034) in whether this was seen to be appropriate, with lower level of support from CDE-RNs (71%). RC was strongest along specialist and generalist lines. All groups reported strongest RC with CDE-RNs except PNs. CDE-RNs reported the lowest RC with PNs. Lower RC with CDE-RNs and physicians was reported by those working within a GP model of care. 

Conclusion: This exploratory study has indicated that there is support for insulin initiation in general practice, but that if practice nurses are to be involved in this increased RC with other health professionals may be important. Current practice, funding and models of care may impact on the ability to achieve this. 

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  2. Harris SB, Kapor J, Lank CN, Willan AR, Houston T. Clinical inertia in patients with T2DM requiring insulin in family practice. Canadian Family Physician Médecin De Famille Canadien. 2010;56(12):e418-24.
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  4. Britt H, Miller GC, Charles J, Henderson J, Bayram C, Valenti L, et al. General Practice Activity in Australia 2008-09. Canberra:AIHW; 2009.
  5. Gittell JH. Relational coordination: Guidelines for theory, measurement and analysis. Brandeis University, Waltham, MA 2011.