GP Perspectives on Enhancing Integrated Care at the GP-Hospital Interface: A Pilot Delphi Consensus Study

Problem

Providing a joined up person centred coordinated healthcare system is a constant challenge and integrated care is thought to be a potential solution. Ireland’s healthcare system is currently focused on delivering an integrated care system where emphasis is placed on universal healthcare which is primary care focused and patient-centred. The GP-Hospital interface has been identified as a key problem area and a need to account for the various professional perspectives when guiding reform is required. The aim of this study was to identify structures, processes and outcomes from GPs which may be important to enhance integrated care at the GP-Hospital interface using a Delphi consensus method.

Approach

An e-Delphi consensus study was conducted over two rounds. In Round 1, 15 participants were asked to score 32 statements, by how much they agree with their importance in enhancing integrated care at the GP-Hospital interface on a 4-point Likert scale. Options included strongly agree, agree, disagree, and strongly disagree. The statements were grouped under three headings, (Structures, Processes & Outcomes) using the Donabedian model to analyse the quality of care at the GP-Hospital interface. Participants were also allowed to suggest their own statements. In Round 2, the 13 participants who completed Round 1 were shown the distribution of scores from Round 1 and were asked to rescore if they wished. Eleven participants completed Round 2.

Findings

Based on the Round 1 ranking, 15 of the 32 statements met the 70% threshold for consensus. Five additional statements suggested by participants in Round 1 were added, and two of these statements reached the consensus threshold in round 2. The largest consensus was observed in areas such as rapid access diagnostics, direct access to specific hospital departments and improved communication between GPs and Hospitals.

Consequences

This study has identified the key structures, processes, and outcomes that GPs believe would be important for enhancing integrated care at the GP-Hospital interface. The 17 statements that met the ≥70% and <15% threshold criteria will help guide future research when identifying important enhancements in integrated care. The identified elements for enhancing integrated care are also essential for the creation, development, and improvement of integrated healthcare policy in Ireland and elsewhere.