Table 1 Practice details and contextual levers
Outer contexta | Inner context | ||||||||
|---|---|---|---|---|---|---|---|---|---|
Practice core | Adaptive reserve | Attitude to intervention | |||||||
Relevant historical factors or recent events | Particulars of patient populations | Other external contextual issues i.e. rural setting | Links with the external environment | (i.e. Staffing IT maturity, staff roles and space) | Facilitative leadership | Aligned management model | Healthy relationship infrastructure | ||
A | Worked with AUSDRISK diabetes tool: mixed success. | High socio-economic status (SES), some migrants but “high health literacy” | Lack financial support for longer consults | Accreditation context for prevention. Medicare Local training on PEN-CAT software | Good 3 GPs. Inconsistent data entry | Strong PM | Aligned, whole of practice systems prevention focus prior | Good strong team | Very engaged – all clinicians participated. No prior facilitation experience |
B | Stable practice | Mixed SES | Semi-rural practice. Few local specialists bulk bill | Good connections to allied health providers (AHPs), long distance to medical specialists | Good 1–2 GPs. | Strong | Partially aligned, through risk assessment and recall system | Strong | Organised and committed. All clinicians participated |
C | Acted as a diabetes collaborative. | Medium/mixed SES | Suburban practice | Some visiting AHPs; can be cost barriers | Fair. Few systems. 13 GPs Very busy | PM felt let down by GPs | Partially aligned, variation for weight, height, alcohol, smoking | Fair – many meetings | Poor: 3/13 GPs participated |
D | Long interest in HIV care | Medium-Low SES. Many of a non-English-speaking background, overseas students. | Suburban practice | AHP referrals for more difficult patients | Staff turnover during intervention, 4 GPs Inconsistent data entry | Hierarchic – leaders positive | Aligned roles post intervention Systems for PNs to see clients before GP | Dysfunctional staff tensions. PN resignation led to redeveloping a prevention team. | Lead GP and PM support. All GPs participated, but at varying levels Key PN opposition |
E | A university teaching practice | Medium | Rural - People have to drive for services. | Good AHP connections at low cost | Good 2–3 GPs Good recall system | Strong | Whole of practice approach | Vibrant culture well organised and enthusiastic | Engaged – all clinicians participated |
F | Utilise health check MBS items | High SES, mostly Caucasian employed families. | Suburban practice | Free gym passes | 12 GPs Inconsistent data entry Cramped | Fair | Fragmented Nurse hired as prevention coordinator | Teamwork mostly informal. PNs overworked | Weakly engaged while PN champion on leave. Then good 5/8 GPs fully participated, 2 partly |
G | New building new IT system | Low SES | Most clinical staff related to each other. Specialists’ cost an issue | AHP links | 5+ GPs Poor – major IT change Cramped | PM led, but away for much of intervention | Disorganised PNs not at meetings | Fair Poor communications | Unresponsive 4/5 GPs weakly participated |
H | Recently opened practice | Low-mid SES. Many patients of Greek background | Suburban practice Yet to go through accreditation | Community Health for AHPs | Fair IT deficiencies in new start clinic | Solo GP supportive | Aligned following GP / PN discussions | Fair – some GP/ PN communication difficulties | Positive Slow start until GP / PN discussions |