Shared medical roles and subsequent task-shifting between General Practitioners and Haematologists: A mixed method study

<p dir="ltr"><b>Background</b> Limited access to specialist medical care means that care in other settings such as primary care needs to be considered. This thesis aims to assess shared tasks in the scope of practice of general practitioners (GPs) and haematology specialists that may be amenable to possible task-shifting to primary care settings. The thesis will also explore the potential for shared models of care, involving care integrated between GPs and haematology teams.</p><p dir="ltr"><b>Methods</b> This Master’s thesis was designed to comprise a systematic review, compilation of haematological guidelines, interview and focus group as the first phase of a Delphi study, followed by two rounds of surveys as the second phase of the Delphi study. <i>Chapter 3</i> consisted of a systematic review of 22 studies which investigated the shared tasks between GPs and haematologists for haematological conditions. <i>Chapter 4</i> consisted of compilation of health guidelines for haematological conditions for GPs. A grey literature search was used to identify guidelines from across Australia. <i>Chapter 5</i> adopted a qualitative approach, where interviews and a focus group with GPs (n=4), public haematologist (n=8), clinical nurse consultant (CNC) (n=4), and private haematologist (n=1) from the Illawarra Shoalhaven Region. <i>Chapter 6</i> consists of the second phase of the Delphi method approach and involved two round of surveys (Round 1 and Round 2) that were curated on Qualtrics, with the link being sent to the interview and focus group participants.</p><p dir="ltr"><b>Results</b> <i>Chapter 3</i> found limited literature on shared care and task shifting between GPs and haematologists. <i>Chapter 4</i> found that local management and referral guidelines prompted GPs to manage many haematological conditions before referring on to haematology specialists. It however lacked clear shared care pathways for GPs. <i>Chapter 5</i> found GPs were already performing many medical tasks but many barriers such as role clarity, communication gaps limited the use of their confidence. <i>Chapter 6</i> found complete stakeholder agreement on GP roles, haematologists roles, shared care roles and barriers to share. There was unanimous consensus that GPs are well-suited to manage conditions such as iron deficiency, warfarin therapy, and the initial evaluation of lymphadenopathy. Likewise, there was complete agreement that follow-up care for leukemia, lymphoma, and myeloma could be effectively handled using a shared care model.</p><p dir="ltr"><b>Conclusion</b> This thesis highlights substantial opportunities for adopting shared care in haematology, underscoring the pivotal role of haematologists in endorsing the model and providing a safety net through robust oversight mechanisms. The successful implementation of this approach necessitates a multifaceted strategy, including a reassessment of funding structures and continuous investment in health technology interfaces. Furthermore, both GPs and haematologists require initial and ongoing support, coordinated by a dedicated shared care facilitator. Efforts to integrate this model into standard practice for all stakeholders are also essential for its long-term success.</p>