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Initiatives to integrate primary health care services. Petra Bywood Jodie Oliver-Baxter Lynsey Brown John O’Connor Belinda Lunnay 13 th International Conference on Integrated Care Berlin, 11-12 April 2013. High expectations. Improve individual’s experience (continuity of care)

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initiatives to integrate primary health care services

Initiatives to integrate primary health care services

Petra Bywood

Jodie Oliver-Baxter

Lynsey Brown

John O’Connor

Belinda Lunnay

13th International Conference on Integrated Care

Berlin, 11-12 April 2013

high expectations
High expectations
  • Improve individual’s experience (continuity of care)
  • Improve population health outcomes
  • Improve access to services
  • Address local needs
  • Create efficiencies – sharing resources & services
integration means different things to different people
Integration…means different things to different people…
  • User (patient):
    • “health care that is seamless, smooth and easy to navigate”
  • Provider (health professional):
    • “separate technical services (and their management support systems) are provided, managed, financed and evaluated either together, or in a closely co-ordinated way”

WHO. (2008). Integrated health services - what and why? Geneva: World Health Organization

slide6
Aims
  • To identify the initiatives and mechanisms that facilitate integrated care at the level of service delivery (micro level integration)
    • Patient experience
    • Health provider experience
    • Challenges and enablers
methods
Methods

Literature review

Electronic databases, websites, grey literature (documents and reports)

Search Terms

Integration, integrated care (synonyms)

Relevant articles

Peer-reviewed and grey literature

australian models of integrated care
Australian models of integrated care
  • Medicare Locals (61)
  • GP Super Clinics (60)
  • Primary Care Partnerships
  • Integrated Primary Health Care Services
  • Comprehensive Primary Health Care
case study of comprehensive phc
Case study of Comprehensive PHC
  • Brisbane South Comprehensive Care Network (Qld)
    • Not-for-profit model established 2007
    • Multidisciplinary PHC team
    • Network of PHC services, linked to outreach specialist services
    • “3Cs” model: communication & access; cultural change & teamwork; commitment & incentives

Jackson et al. (2007). Creating an integrated vision by collocating health organisations: Herding cats or a meeting of minds? Australian Health Review, 31(2), 256-266

case study
Case study …
  • Common information transfer systems
  • Shared clinical initiatives, strategic objectives, client base, physical space
  • Improved knowledge of other groups
  • Enhanced communication
  • Increased opportunities for collaboration

Jackson et al. (2007). Creating an integrated vision by collocating health organisations: Herding cats or a meeting of minds? Australian Health Review, 31(2), 256-266

case study1
Case study …
  • Inala Primary Care
  • Co-location, coordinated care
  • Multidisciplinary team (endocrinologist, diabetes educator, clinical fellows, podiatrist etc.)
  • Treatment: comprehensive assessment, care plan, case management, GP updates
  • Diabetes educator 2xweekly phone contact
  • Discharge to GP; direct advice for GP

Jackson et al. (2010). GPs with special interests impacting on complex diabetes care. Australian Family Physician, 39(12), 972-974

case study2
Case study …
  • Other strategies:
    • Employed more Indigenous staff
    • Culturally appropriate waiting room
    • Cultural awareness training
    • Indigenous-specific information about service
    • Inter-sectoral collaboration
    • Increased Indigenous attendance (from <20 in 1994 to >3000 in 2008)

Hayman et al. (2009). Improving Indigenous patients' access to mainstream health services: The Inala experience. Med J Aust, 190(10), 604-606

case study3
Case study …
  • Results after 12 months:
    • Glycaemic control increased to 45.6% from baseline (14%)
    • Costs were 38% less (despite having 3x more visits) for better outcomes

Jackson et al. (2010). GPs with special interests impacting on complex diabetes care. Australian Family Physician, 39(12), 972-974

reality check there are always challenges
Reality check – there are always challenges

Difficult for multiple service providers to coordinate discharge, transfer, and ongoing care:

Multi-morbidities - chronic mental illness, disabilities and degenerative conditions

Lack of capacity/resources to work effectively with other services (e.g. some solo general practices)

Some populations not well connected to the health system (refugees, Indigenous people, limited resources, physical/intellectual disabilities, language/cultural barriers, remote/rural locations)

Sustainability – initial gains lost over time; planning at outset

what are the mechanisms
What are the mechanisms?

Two key mechanisms for successful integration

Communication & Support

case conferences, patient health literacy, reminders & prompts, patient-held records

Infrastructureto support coordination

Strong provider networks with multiple services, strong multidisciplinary teams, co-location, investment in systems to support coordination of care (IT, administration, information systems)

Powell Davies et al. (2008). Coordinating primary health care: An analysis of the outcomes of a systematic review. Med J Aust, 188(8 Suppl), S65-68

summary conclusions
Summary & conclusions

Change processes

Communicate

Collaborate

Commit

Understand local needs

Share information

Evaluate

phc ris our location
PHC RIS – our location
  • PHC RIS website: http://www.phcris.org.au/index.php
  • Contact details: petra.bywood@flinders.edu.au

Flinders University, Adelaide

Adelaide, South Australia