Exploring Social Network Characteristics at the Primary and Secondary Care Interface and Association with Patient Care Processes and Outcomes

Abstract

Social network theory, organizational theory and systems theory all point to individual performance being strongly influenced by the interpersonal systems and networks within which they work. These insights have been little studied in primary healthcare where doctors and nurses, as a group, have a history of relatively autonomous roles, together with underperformance against ideal process and patient outcome measures. Secondary care practitioner s are considered to embody some of the expertise considered relevant to improving primary care performance. This study explores how inter-professional networks and the frequency, quality and perceived value of the interactions between doctors and nurses in primary and secondary care are associated with improved primary care processes and outcomes for patients with diabetes. The setting was South Auckland, New Zealand, with 18 general practitioners, 4 practice nurses, and 18 secondary care doctors and nurses involved in the care of 314 diabetic patients. A multi-strategy method was employed. An online survey collected data for a Social Network Analysis. Anonymous patient data extracted from primary care records was used to measure appropriate intensification of therapy (assessed by prescription changes in response to raised glucose, blood pressure or cholesterol). Interviews with 17 participants explored factors that might strengthen or weaken interpersonal interactions between primary and secondary care. The results confirmed a positive association between frequency of interactions and appropriate prescription response. The interviews identified that better collaboration, communication, knowledge transfer, successful adaptation to new changes, coordination, diffusion and uptake of information, and innovation adoptions were the mechanisms that may explain this association. Additionally, respondents have identified that proximity, similarity, power, trust, leadership and social cohesion were the factors associated with network development. This study is the first to combine these strategies of enquiry to investigate social networks between primary and secondary care. The main limitation is the small numbers investigated within the resources available. The finding that variability in primary care performance is associated with social network characteristics advances explanatory models of primary care performance, and supports development of network strategies as one option to improve primary care processes and outcomes for patients with diabetes and other long term conditions.