RESERCH ABSTRACT
Social network theory,
organizational theory and systems theory all point to individual performance
being strongly influenced by the interpersonal systems and networks within
which they work. These insights have been little studied in primary healthcare
where doctors and nurses, as a group, have a history of relatively autonomous
roles, together with under-performance against ideal process and patient
outcome measures. Secondary care practitioners are considered to embody some of
the expertise considered relevant to improving primary care performance.
This study explores how
inter-professional networks and the frequency, quality and perceived value of
the interactions between doctors and nurses in primary and secondary care are
associated with improved primary care processes and outcomes for patients with
diabetes. The setting was South Auckland, New Zealand, with 18 general practitioners,
4 practice nurses, and 18 secondary care doctors and nurses involved in the
care of 314 diabetic patients. A multi-strategy method was employed. An online
survey collected data for a Social Network Analysis. Anonymous patient data
extracted from primary care records was used to measure appropriate
intensification of therapy (assessed by prescription changes in response to
raised glucose, blood pressure or cholesterol). Interviews with 17 participants
explored factors that might strengthen or weaken interpersonal interactions
between primary and secondary care.
The results confirmed a positive association between
frequency of interactions and appropriate prescription response. The interviews
identified that better collaboration, communication, knowledge transfer,
successful adaptation to new changes, coordination, diffusion and uptake of information,
and innovation adoptions were the mechanisms that may explain this association.
Additionally, respondents have identified that proximity, similarity, power,
trust, leadership and social cohesion were the factors associated with network
development.
This study is the first to combine these strategies of
enquiry to investigate social networks between primary and secondary care. The
main limitation is the small numbers investigated within the resources
available. The finding that variability in primary care performance is
associated with social network characteristics advances explanatory models of
primary care performance, and supports development of network strategies as one
option to improve primary care processes and outcomes for patients with
diabetes and other long term conditions.
