title: Factors associated with relational coordination between health professionals involved in insulin initiation in the general practice setting for people with type 2 diabetes.
abstract: OBJECTIVE
  To examine associations between characteristics of general practice settings and primary healthcare providers (general practitioners and practice nurses) and the degree of relational coordination for the task of insulin initiation for type 2 diabetes between primary healthcare providers and diabetes specialists.
  
  
  BACKGROUND
  Relational coordination is a component of effective chronic disease management and can be used to measure collaboration and communication between health professionals. High levels of relational coordination may be important to support insulin initiation in general practice.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Surveys were completed by general practitioners and practice nurses participating in the Stepping Up trial. Data on demographics, practice characteristics and relational coordination were collected between October 2012-June 2014. Univariate and multivariate analyses examined factors associated with relational coordination.
  
  
  RESULTS
  General practitioners (n = 174) and 115 practice nurses from 78 general practices were included in the analysis. General practice characteristics associated with relational coordination were geographical location and number of administrative staff. Female general practitioners and older practice nurses reported lower relational coordination. Practice nurses with diabetes educator qualifications and experience in insulin initiation reported higher relational coordination.
  
  
  CONCLUSIONS
  An expanded role and experience of practice nurses in diabetes care increased relational coordination and has the potential to deliver more effective chronic disease management in general practice. Practice and health professional characteristics should be taken into account when designing models of care to increase insulin initiation.
authors.affiliation: Department of General Practice, University of Melbourne, Carlton, Victoria, Australia.
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: Manski-Nankervis
authors.affiliation: Department of General Practice, University of Melbourne, Carlton, Victoria, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Furler
authors.affiliation: Department of General Practice, University of Melbourne, Carlton, Victoria, Australia.
authors.forename: Doris
authors.initials: D
authors.lastname: Young
authors.affiliation: Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Carlton, Victoria, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Patterson
authors.affiliation: Department of General Practice, University of Melbourne, Carlton, Victoria, Australia.|Faculty of Health Sciences, La Trobe University, Wodonga, Victoria, Australia.
authors.forename: Irene
authors.initials: I
authors.lastname: Blackberry
mesh_terms: D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D036262:Empirical Research; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008503:Medical Staff; D009740:Nursing Staff
chemical_list: D007328:Insulin
keywords: Relational coordination; chronic disease management; coordination; general practice; general practitioners; insulin; practice nurses; type 2 diabetes