Communication and collaboration between general practitioners and acupuncturists in New Zealand: A case study of integrated mental health care
General practitioners (GPs) play an important role in integrated care management of primary mental health, and in most cases act as the primary provider and access point for further services. In recent years more service users are utilising complementary and alternative medicine (CAM), including acupuncture, for the management of mental health. The workforce within the acupuncture profession could potentially support healthcare management of common primary mental health problems, particularly in light of current workforce challenges, and address bodily stress and physical symptomatology of mental health presentations. However, the interaction and collaboration between these two groups (GPs and acupuncturists) in relation to shared mental health care has not been investigated. This thesis explores interprofessional communication between GPs and acupuncturists in New Zealand utilising a case study of mental health care. The aim of this thesis was to understand the barriers to communication, and to facilitate collaboration between the two participant groups. The project utilized a mixed methods multiphase design: with both qualitative and quantitative inquiry and involving the convergence of data and analyses. A nationwide survey of 400 GPs and 250 acupuncturists was conducted. Univariate data was analysed using descriptive statistics, which included frequencies and percentages for categorical data. This was followed by individual semi-structured interviews of 13 purposively sampled acupuncturists, and 14 GPs which was analysed using thematic analysis. This design consisted of four distinct phases: quantitative, qualitative, implementation and reflection. Following the integration of the data within the literature, the project continued to tool kit development and piloting to further address the project’s aims. The convergent analysis of the quantitative and qualitative data identified both facilitators and barriers to integrative mental health care between the two provider groups. Facilitators included a willingness by both groups to engage, and the desire to support patient choice. Interview data indicated increased patient preference for CAM, including acupuncture, and the expectation of integration of CAM with mainstream by patients. A further facilitator was the concern of participants about low levels of patient disclosure about CAM use and the lack of routine asking about CAM by GPs. Both provider groups acknowledged the complexities of working within mental health care, and supported the development of specific mental health competencies in light of the recognition of the limitations surrounding current mental health care. Barriers included the limited opportunities for sharing of information and the lack of current established pathways for communication or direct referrals. This included the technical limitation of an absence of shared electronic health records. A further barrier was acupuncture not having an established position within clinical guidelines and clinical pathways. The role evidence played in clinical decision-making was complex. The unfamiliarity of acupuncture's evidence-base to both provider groups was an identified barrier, yet both groups acknowledged that while practice is informed by the evidence, there are many other factors that also inform clinical practice. The analysis of data supported the development, testing and piloting of a communication and collaboration toolkit. The tools contained within this kit were aimed at enabling both participant group’s opportunities and pathways to communicate and collaborate. The initial piloting and evaluation of these tools by a subset of both provider groups found them to be practical and accessible. This thesis contributes to the body of knowledge concerning communication and collaboration between GPs and acupuncturists, and suggests that by facilitating communication and enhancing training, acupuncture can provide a significant component of integrated care in primary mental health. This thesis provides context within a New Zealand health care setting, and also provides insight through the disaggregation of specific provider groups for analysis, rather than a grouping together of CAM as a whole. The data driven design and development of a toolkit has direct clinical utility and transferability to other groups within health care. These tools have the potential to facilitate communication between acupuncturists and GPs working with shared mental health patients, and to inform future research and tool development through their piloting in practice.
Advisor: Dowell, Tony; Nie, Jing-Bao
Degree Name: Doctor of Philosophy
Degree Discipline: Primary Health Care and General Practice, UOW
Publisher: University of Otago
Keywords: CAM, acupuncture, integrative care, toolkits, primary care
Research Type: Thesis