Impact of multimorbidity on healthcare professional task-shifting potential in patients with type 2 diabetes in primary care: a French cross-sectional study.

Irene Supper, Yann Bourgueil, René Ecochard, Laurent Letrilliart

Keywords: Interprofessionnal collaboration diabetes multimorbidity cross-sectional study

Increasing patient complexity and shortage of doctors lead to consider more interprofessional collaboration.

Research questions:
To estimate the transferability of processes of care from general practitioners (GPs) to allied healthcare professionals, and the determinants of such transferability.

A French national cross-sectional multicentre study in 128 family practices.
Participants: All patients consulting with their GP over a total number of 20 days. Secondarily, encounters where type 2 diabetes was one of the managed health problems were selected for analysis.
Outcome measures: Processes of care that were associated with specific health problems were collected by 54 residents, who consulted under senior GPs’ supervision. Potential process transferability was the main outcome assessed; including the professionals involved in the collaboration and the conditions associated with any transfer.

From 8574 processes of care that concerned 1088 encounters of patients with diabetes, 21.9% (95%CI 21.1-22.8) were considered eligible for transfer from GPs to allied healthcare professionals (78.1% to nurses and 36.7% to pharmacists). 70.6% processes were transferable with condition(s), i.e. a predefined protocol, a shared medical record or supervision. The most transferable processes concerned health maintenance/prevention (32.1%), followed by management of cardiovascular risk factors (hypertension (28.7%), dyslipidaemia (25.3%) and diabetes (24.3%)). Multivariate analysis showed that educational processes or a long term condition status were associated with an increased transferability (OR= 3.26 and 1.47, respectively), whereas patients that held higher intellectual professions or that had two or more associated health problems managed during the encounter were associated with a lower transferability (OR =0.33 and 0.81, respectively).

A significant part of GP activity relating to patients with at least a diabetes could be transferred to allied healthcare professionals, mainly on prevention and global education to cardiovascular risk factors. Organisational and finance conditions of team work as views of patients and healthcare professionals must be explored before implementation in primary care

Points for discussion:
Healthcare organization to face patients' complexity and multimorbidity rather than a disease centered approach

Fostering teamwork at a proximity level

Prevention in a person centered team care rather than strictly curative care