Integration of primary health care services: perceptions of Australian general practitioners, non-general practitioner health service providers and consumers at the general practice-primary care interface

Introduction. In conjunction with GPs reporting on their own practice experiences, the experiences of non-GP health professionals and consumer representatives working at the primary care-general practice interface provide valuable considerations for exploring concepts for the development of a GP Integration Index relevant to Australian General Practice. Objectives. To identify concepts that GPs, non-GP health service providers and consumer representatives perceive to be important in facilitating a well integrated approach to delivering primary care, and how these are perceived to be occurring in practice. Method. Group discussions about GP integration were elicited using concept mapping with four groups of GPs and seven groups of health professionals and consumer representatives, purposively selected for diversity in demographic location and practice setting from three Australian States. From Victoria, 19 GPs from two different types of practice settings, 12 Consumer Representatives from 10 separate organisations, 17 Hospital Administrators from 16 major public and private hospitals, 18 specialist doctors representing 12 specialist organisations and 13 Community Service Providers. From Queensland, 13 rural GPs and 22 Nurses representing 10 separate nursing groups were selected. From Western Australia, 19 GPs representing a mix of solo practice, group practice and hospital settings, and 40 Allied Health providers representing various private practitioners and hospital and community centre based allied health practitioners. Concept mapping results from the groups were pooled and analysed using a descriptive meta-matrix to identify overarching themes. Results. Eight overarching themes were identified from consolidated concept maps: GP role; quality outcomes; practice management/ accessibility; communication and networks; health care system politics; education and knowledge; personal attributes and attitudes; and lifestyle. Within these major themes, clusters of concepts rated as at least 'important for patient care' included various non-clinical aspects of primary care delivery. There was emphasis on a patient-centred and holistic care approach. Strongly advocated by all groups was the need for teamwork between GPs and other health care professionals involved in primary care of the patient. Conclusion. The use of concept mapping was successful in ensuring that the breadth of the topic was explored in its entirety among these groups, contributing to the identification of the dimensions of the concept of GP-integration. Findings from these groups will be pooled and subjected to structural equation modelling processes, to develop a general practice integration index relevant to the Australian setting. (C) 2002 Elsevier Science Ltd. All rights reserved.