title: Role of the GP liaison nurse in a community health program to improve integration and coordination of services for the chronically ill.
abstract: This paper explores the role of the General Practitioner Liaison Nurse (GPLN) in improving integration and coordination of services within Primary Health Care. This position can play a major role in care coordination and cultural change. The GPLN within HealthOne Mt Druitt (HOMD) identifies patients' needs and facilitates communication, case conferencing and care coordination between health and other providers. The priority areas of children and their families at risk or with significant unmet needs, and chronic aged and complex care, were identified as target areas. This paper focuses on the GPLN within the chronic aged and complex care service model. The GPLN within HOMD was able to improve coordination and integration of services for patients of the facility. Activities included organising multidisciplinary services and addressing psychosocial issues. Patients and community health staff identified the importance of the role for improving coordination and integration of services. Decision and policy makers saw the position as vital to the implementation, operation and sustainability of HOMD.
authors.affiliation: Menzies Centre for Health Policy, D02 Victor Coppleson Building, University of Sydney, NSW 2006, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: McNab
authors.affiliation: HealthOne, Mount Druitt Community Health Centre, Buran Close, Mount Druitt, NSW 2770, Australia.
authors.forename: Janis
authors.initials: J
authors.lastname: Paterson
authors.affiliation: WentWest, Level 1, 85 Flushcombe Road, Blacktown, NSW 2148, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Fernyhough
authors.affiliation: Primary Care and Community Health Services, 288-292 Macquarie Road (PO Box 593), Springwood, NSW 2777, Australia.
authors.forename: Rod
authors.initials: R
authors.lastname: Hughes
mesh_terms: D002908:Chronic Disease / Q000451:nursing*; D003152:Community Health Nursing; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D024802:Nurse's Role; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research