An evidence-based health workforce model for primary and community care

Abstract

Background: The delivery of best practice care can markedly improve clinical outcomes in patients with chronic disease. While the provision of a skilled, multidisciplinary team is pivotal to the delivery of best practice care, the occupational or skill mix required to deliver this care is unclear; it is also uncertain whether such a team would have the capacity to adequately address the complex needs of the clinic population. This is the role of needs-based health workforce planning. The objective of this article is to describe the development of an evidence-informed, needs-based health workforce model to support the delivery of best-practice interdisciplinary chronic disease management in the primary and community care setting using diabetes as a case exemplar.

Discussion: Development of the workforce model was informed by a strategic review of the literature, critical appraisal of clinical practice guidelines, and a consensus elicitation technique using expert multidisciplinary clinical panels. Twenty-four distinct patient attributes that require unique clinical competencies for the management of diabetes in the primary care setting were identified. Patient attributes were grouped into four major themes and developed into a conceptual model: the Workforce Evidence-Based (WEB) planning model. The four levels of the WEB model are (1) promotion, prevention, and screening of the general or high-risk population; (2) type or stage of disease; (3) complications; and (4) threats to self-care capacity. Given the number of potential combinations of attributes, the model can account for literally millions of individual patient types, each with a distinct clinical team need, which can be used to estimate the total health workforce requirement.

Summary: The WEB model was developed in a way that is not only reflective of the diversity in the community and clinic populations but also parsimonious and clear to present and operationalize. A key feature of the model is the classification of subpopulations, which gives attention to the particular care needs of disadvantaged groups by incorporating threats to self-care capacity. The model can be used for clinical, health services, and health workforce planning.

Figure 1

Needs-based workforce planning framework. FTE - Full-time equivalent.

Figure 2

Workforce Evidence-Based (WEB) model for diabetes, with prevalence data*#. *Data represent the number of cases per 10,000 persons with diabetes, which, based on an estimated prevalence rate of known diabetes of 4% [19], equates to a total population of 250,000 persons. #Prevalence data are derived from the Australian Bureau of Statistics National Health Survey (2007-2008) [19], unless specified otherwise. ^aAustralian diabetes, obesity, and lifestyle study (1999/00) [21,22]; ^bFrench, Canadian, German, and U.S. surveys of persons aged 16 years and older with any type of diabetes [24-28]; ^cAmsterdam survey of adults aged 40-94 years with any type of diabetes [29]; ^dAustralian hospital admission data [23]; ^eU.S. surveys of persons aged 18 years and older with any type of diabetes [30-32]; ^fGerman survey of persons aged 18 years and older with any type of diabetes [33]; ^gAustralian Bureau of Statistics birth data (2007) [34].

Figure 3

Example of a clinical care protocol--the "impaired physical ability" module of the WEB model.