title: Cross-sectional survey of older patients' views regarding multidisciplinary care for chronic conditions in general practice.
abstract: The ageing population and increasing prevalence of chronic illness have contributed to the need for significant primary care reform, including increased use of multidisciplinary care and task substitution. This cross-sectional study explores conditions under which older patients would accept having health professionals other than their general practitioner (GP) involved in their care for chronic disease management (CDM). Ten practices were randomly sampled from a contiguous major city and inner regional area. Questionnaires were distributed to consecutive patients aged 60 years and over in each practice. Agency theory was used to inform analyses. Statistical analysis was undertaken using Wald's test, growth modelling and linear regression, controlling for the clustered design. The response rate was 53% (n=272). Most respondents (79%) had at least one chronic health condition. Respondents were more comfortable with GP than with practice nurse management in the CDM scenario (Wald's test=105.49, P<0.001). Comfort with practice nurse CDM was positively associated with increased contact with their GP at the time of the visit (β=0.41, P<0.001), negatively associated with the number of the respondent's chronic conditions (β=-0.13, P=0.030) and not associated with the frequency of other health professional visits. Agency theory suggests that patients employ continuity of care to optimise factors important in CDM: information symmetry and goal alignment. Our findings are consistent with the theory and lend support to ensuring that interpersonal continuity of care is not lost in health care reform. Further research exploring patients' acceptance of differing systems of care is required.
authors.affiliation: Graduate School of Medicine, Building 28, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bonney
authors.affiliation: Centre for Health Initiatives, Building 233 (ITAMS), Innovation Campus, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Magee
authors.affiliation: Shell Cove Family Health, Shallows Drive, Shell Cove, NSW 2529, Australia.
authors.forename: Russell
authors.initials: R
authors.lastname: Pearson
mesh_terms: D057179:Advanced Practice Nursing / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001315:Australia; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data