The Research Process
The PCSIP aimed to investigate community based health care and the management of chronic disease. Specifically, the project looked at the impact of different levels of practice nurse involvement in clinical based activities on the health of patients with type II diabetes, obesity and/or depression.
The project occurred in five phases.
Phase 1: Practice recruitment
This phase involved the recruitment of 15 general practices (10 with practice nurses and 5 without practice nurses) in the Adelaide Northern Division of General Practice (ANDGP). Each practice was categorised into one of three types, based on the presence of a practice nurse and the level of clinical based activities undertaken by the practice nurse. Examples of clinical based activities include providing education or self management advice, and monitoring a patients clinical progress or treatment adherence.
Phase 2: Patient identification and recruitment
Within each practice, we recruited patients diagnosed with one or more of the three study conditions.
Phase 3: Data collection
The project requested patient consent to access the following data sources: electronic medical records held at the practice, Medicare (MBS) and Pharmaceutical Benefits (PBS) records and hospitalisation data from SA Health. Data was collected for the period between 1 October 2007 to 1 October 2010. The information collected for each patient included socio-demographic characteristics (such as age and gender), use of health services, and clinical measures (such as HbA1C in patients with diabetes, and BMI in patients with obesity).
Phase 4: Data analysis
From the information collected, we identified differences between patients in the treatment, management and progression of their condition. After taking into account variations in the characteristics of patients, we isolated the effect of the type of practice on the management of the condition. This enabled us to determine the effects of the practice type on the patients' health outcomes. Combined with information on the cost of the health care provided to the patients, we could determine whether different types of practice, i.e. whether different levels of practice nurse involvement in the care of patients with the chronic conditions studied, were more or less cost-effective.
Using this information and data from other sources, we were then able to estimate the long term benefits and costs associated with each type of practice.
Phase 5: Sharing the findings
The findings of the study were then prepared for publication in peer reviewed journals and for reporting back to general practices within the northern areas of Adelaide.
The research process has been summarised in figure 1.