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Construction of a GP integration model

Author

Listed:
  • Batterham, R.
  • Southern, D.
  • Appleby, N.
  • Elsworth, G.
  • Fabris, S.
  • Dunt, D.
  • Young, D.

Abstract

There are frequent calls to improve integration of health services, within and between primary and secondary care sectors. In Australia, general medical practitioners (GPs) are central to these endeavours. This paper aims to better conceptualise GP integration and to develop a model and index based on this. A conceptualisation of integration is proposed based on integration fundamentally as an activity or process not structure. Integration process is the frequency and quality of episodes of information exchange involving the GP and another practitioner or patient and aimed at fulfilling the objectives of the health care system with regard to patient care. These are both direct responses to structural forces and emergent GP capacities and dispositions. The content of this typology was studied using Concept Mapping in 11 groups of GPs, consumers and other practitioners. Clusters of related statements within thematic domains were used as the basis for a provisional model. This was tested using confirmatory factor analysis in a data set derived from a national probability sample of 501 GPs. Some re-specification of the model was necessary, with three integration process factors needing to be subdivided. One factor congeneric model assumptions were used to identify the constituent items for these factors. The result was a model in which 50 items measured nine integration process factors and 20 items measured five enabling factors. Two distinct but correlated higher order factors, relating to individual patient care and public (or community) health--in contrast to a single higher order factor for integration--were identified. The re-specified model was tested with a new sample of 151 GPs and exhibited strong psychometric properties. Reliability and validity were acceptable to this stage of the indices' development. Further testing of the index is necessary to demonstrate factor invariance of the indices in other contexts as well as their utility in cross-structural analysis. That said, the indices have immediate uses.

Suggested Citation

  • Batterham, R. & Southern, D. & Appleby, N. & Elsworth, G. & Fabris, S. & Dunt, D. & Young, D., 2002. "Construction of a GP integration model," Social Science & Medicine, Elsevier, vol. 54(8), pages 1225-1241, April.
    • Handle: RePEc:eee:socmed:v:54:y:2002:i:8:p:1225-1241
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    Citations

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    Cited by:

    1. Reavley, Nicola & Livingston, Jenni & Buchbinder, Rachelle & Bennell, Kim & Stecki, Chris & Osborne, Richard Harry, 2010. "A systematic grounded approach to the development of complex interventions: The Australian WorkHealth Program - Arthritis as a case study," Social Science & Medicine, Elsevier, vol. 70(3), pages 342-350, February.
    2. Rosas, Scott R. & Ridings, John W., 2017. "The use of concept mapping in measurement development and evaluation: Application and future directions," Evaluation and Program Planning, Elsevier, vol. 60(C), pages 265-276.
    3. Gask, Linda, 2005. "Overt and covert barriers to the integration of primary and specialist mental health care," Social Science & Medicine, Elsevier, vol. 61(8), pages 1785-1794, October.
    4. Scott R. Rosas, 2017. "Group concept mapping methodology: toward an epistemology of group conceptualization, complexity, and emergence," Quality & Quantity: International Journal of Methodology, Springer, vol. 51(3), pages 1403-1416, May.
    5. Theobald, Hildegard, 2004. "Entwicklung des Qualifikationsbedarfs im Gesundheitssektor: Professionalisierungsprozesse in der Physiotherapie und Dentalhygiene im europäischen Vergleich," Discussion Papers, Research Unit: Labor Market Policy and Employment SP I 2004-104, WZB Berlin Social Science Center.
    6. Dunt, D. & Elsworth, G. & Southern, D. & Harris, C. & Potiriadis, M. & Young, D., 2006. "Individual and area factors associated with general practitioner integration in Australia: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 63(3), pages 680-690, August.

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