Shared-Care Schemes for Chronic Diseases in the UK and Their Applicability to Spain

Soler-Lopez, Mar (1993) Shared-Care Schemes for Chronic Diseases in the UK and Their Applicability to Spain. MSc(R) thesis, University of Glasgow.

Full text available as:
Download (8MB) | Preview


Failures in the organisation of traditional care for patients with chronic disease have led to the development of new strategies of care. Despite evaluation studies showing the benefits of shared-care schemes its uptake has been slow. This study aimed to identify new schemes of care for four chronic diseases (diabetes, hypertension, thyroid disease and rheumatoid arthritis) and to investigate doctors' attitudes to shared-care schemes. The methodology for the study consisted of a literature review, snowball sampling and a postal survey with both descriptive and analytical components. The setting of the study was Health Authorities and Health Boards in Great Britain. The population surveyed consisted of 147 consultants responsible for the care of patients with diabetes, hypertension, thyroid disease and rheumatoid arthritis and 208 general practitioners (GPs) from 16 Family Practitioner Committees (Primary Care Divisions in Scotland). Twenty nine schemes were identified of which 18 were shared-care schemes. The survey's response rate was 70% for consultants and 64% for GPs, in both cases after one reminder. Forty three (42%) consultants and 45 (43%) GPs claimed to have participated in shared-care schemes. However, and despite our efforts to define 'shared-care' schemes in the questionnaire, there were obvious different understandings. Only 25 (58%) of 43 consultants who were 'claimed' participants met our classification for 'classified' participants in shared-care schemes. Diabetes was the specialty most likely to have shared- care schemes, 20 (47%) consultants with responsibility for diabetes were participants compared to only five other consultants. In general practice, nearly a third of GPs were participating in shared-care schemes for diabetes and another third had set up mini-clinics for diabetes and hypertension. However, more than a half and nearly two thirds did not have special arrangements for the follow- up of patients with thyroid disease and rheumatoid arthritis respectively. Consultant participants in shared-care were more likely than non-participants (29% vs 7%) (chi2 = 16.2/ df = 4/ p<0.005) to think that responsibility for ensuring that all patients in the area are screened for complications at regular intervals should be the consultant's alone. Participating consultants were more likely (82% vs 42%) to take the view that not all GPs provide good follow-up and consultants need to take a more active approach, and were more likely (80% vs 51%) to take responsibility for making contact after a patient non-attendance . Only 21% of the GPs thought that setting up a shared-care scheme should be their responsibility. Although shared-care has been shown to be cost-effective, the number of identified schemes was few, just 18 in Britain. Different factors seem to influence the individual decision to take up a new idea. For example compatibility of shared-care with professional roles and attitudes seems to have a large influence. This study has shown that shared-care schemes have been set up by hospital consultants who have more of a "population approach" to care and enough enthusiasm for this to overcome the difficulties of initiating a scheme. Even so, few of the schemes identified in this study have had the explicit aim or mechanisms for ensuring that all patients in a given area are being followed-up. There is now a clear responsibility for purchasers to buy equitable, efficient and effective health care for people with chronic disease. Evaluation studies suggest that formal shared-care schemes are more likely to achieve these aims. The indications are that most doctors are willing to co-operate in shared-care but need the extra impetus which can come from purchasing teams requiring consultants to establish such schemes. However, purchasers and providers will have to ensure that they are very clear about what exactly they mean by shared- care.

Item Type: Thesis (MSc(R))
Qualification Level: Masters
Additional Information: Adviser: R Jones
Keywords: Medicine, Health care management
Date of Award: 1993
Depositing User: Enlighten Team
Unique ID: glathesis:1993-75614
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 19 Nov 2019 19:17
Last Modified: 19 Nov 2019 19:17

Actions (login required)

View Item View Item


Downloads per month over past year