How should the primary care system respond to people with chronic disease and complex conditions?
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Transcript of How should the primary care system respond to people with chronic disease and complex conditions?
How should the primary care system respond to people with chronic
disease and complex conditions?
Leanne Wells CEO, Consumers Health Forum of Australia
Chronic Disease & Mental Health Symposium
The Australian College of Mental Health Nurses in partnership
with the Australian Primary Health Care Nurses Association and Australian Diabetes Educators Association
Overview
• Why primary health care matters?
• What is the patient experience?
• Current issues in primary health care?
• A better system?
Why primary health care matters?
• Growing chronic condition burden
• The setting where we prevent/treat most
• It’s efficient and accessible
• We can get good outcomes
• It’s the backbone of a strong health systems
Major chronic conditions of Australians 2014-15
3.5 million
1.6 million
203,400
2.6 million
1.2 million
1.2 million
370,100 2.5 million
National Health Survey 2014-15
4 million Australians
(17.5%) reported having
a mental or behavioural
condition
3.6 million Australians
(15.8%) reported co-existing long-term mental and behavioural and physical health
conditions.
What is the impact?
Improving the way we respond to co-morbid physical and mental
health problems would have a high impact in
terms of patient experience and clinical
outcomes
WHY?
Because both of these are
substantially poorer relative to those for people
with a single condition
2015 Commonwealth Fund survey
Primary care doctors from 10 countries: is practice well prepared to manage patients with
complex needs?
COUNTRY Patients with…
Patients needing…
Multiple
chronic
condit-
ions
Dem-
entia
Severe
mental
health
issues
Substance
use-related
issues
Long-
term
home
care
services
Social
services
Palliat-
ive care
AUS (n=747) 85% 46% 34% 19% 47% 41% 48%
CAN (n=2,284) 70 42 24 15 40 28 42
GER (n=559) 88 67 32 14 68 71 58
NET (n=618) 88 65 44 16 80 25 92
NZ (n=503) 81 41 24 20 54 48 62
NOR (n=864) 86 69 56 36 78 41 54
SWE (n=2,905) 66 57 14 6 51 45 25
SWIZ (n=1,065) 80 49 26 25 64 55 48
UK (n=1,001) 79 64 43 41 60 44 81
US (n=1,001) 76 47 16 16 46 32 41 Source: 2015 Commonwealth Fund international Health Policy Survey of primary Care Physicians
Primary care doctors from 10 countries: practice capacity to provide enhanced access and care
management
C
o
u
n
t
r
y
Practice uses nurses/case
managers to monitor/ manage
care for chronic patients
Practice
staff…
Patients can….
Within
practice
Outside
practice
Make
frequent
home visits
Access
after
hours care
Email re
medical
concerns
View
records
online
AUS 75% 6% 25% 78% 30% 11%
CAN 43 23 19 48 15 7
GER 20 7 57 85 50 8
NET 78 14 88 94 57 13
NZ 83 7 20 92 53 24
NOR 32 37 20 80 32 3
SWE 75 13 24 75 61 20
SWIZ 8 52 43 69 80 11
UK 87 8 84 89 38 28
US 43 24 6 39 57 60 Source: 2015 Commonwealth Fund international Health Policy Survey of primary Care Physicians
21% reported
WAITING LONGER THAN ACCEPTABLE
23% from RURAL and REMOTE areas
28% of patients felt their
GP DID NOT SPEND ENOUGH TIME with them
1 in 8 reported issues caused by
LACK OF COMMUNICATION
between professionals
28% of patients felt their
GP DID NOT LISTEN
carefully to them
WOMEN reported longer
wait times than men
23% v 18%
ABS Patient Experiences : General Practice 2014-15
Survey
Chronic disease costs
1 in 3 have at least 1 chronic condition
Medicare spending
INCREASING
Potentially
preventable
Primary Health Care Advisory Group Discussion Paper
Primary Health Care Advisory Group consultations
• A fragmented system and providers working in isolation not as a team
• Uncoordinated care • Difficulty finding services • Service duplication, absent or delayed services • Low uptake of eHealth and other health
technology • Access problems due to cost, transport, language,
mobility and remoteness • Feelings of disempowerment
Experience of the system
“I don’t have a huge support structure outside of hospital. I’ve got my regular GP, because I have to have the same form filled every two to three months saying I can’t return to work. There’s a lot in the community if you can source it, but it’s hard because most people don’t know what’s available ….. I think what I’d tell people with a chronic condition is ….ask questions and be proactive. They aren’t going to cure you, but you they can help you get the most out of life”
“Michael”, type 2 diabetes
14
Impact of low health literacy
“As a patient with a lot of insight into my condition, the nurses will listen to me”
“Katy”, dysautonomia, chronic fatigue,
asthma, chronic pain
“I can understand that living in the country that I’m not going to have everything in one place. I’m not expecting the world. But I think at least having visiting specialists would help – or being told when they do have one – or central registries that doctors could access. That would be helpful. There is so much information out there, but nobody can get it”
“Eleanor”, intracranial hypertension
15
Multiple reviews and new ‘meso’ structures
• Make life easier, more
convenient for ME
• Let ME take ownership
• Empower ME
• Include and respect ME
in the relationship
• Keep ME informed
• Enable transparent
access to MY information
• Give ME the best care you can
• Reduce MY costs
Accessible and Affordable
Care
Timely access to care based
on need
Well organised, without
organisational or systemic
barriers
Affordable for consumers
Equitable access
Coordinated and
Comprehensive Care
Linked care with good referral
and feedback
Integrated with supported
transitions across the system
Availability of a range of services
to multidisciplinary care
Complete personally controlled
health record
Appropriate Care
Meet the needs and preferences of
individuals
Evidence based with consumers
engaged in research
Treatment options, risks and
benefits identified
Safe and technically proficient with
risks minimised
Practitioner engages with
consumers, families and carers
to ensure understanding
Whole of person care
Take account of consumers
lives and personal values
Emotional
Physical
Cultural, spiritual and social
factors
Consider carers and support
Address risk factors and all
health problems
Principles of
Consumer –
Centred
Health care
Trust and Respect
Provider asks about and
understands concerns
Transparent
Accountable
Timely and effective
complaint resolution process
Shared responsibility and
decision making
Informed Decision Making
Access to right information at
right time
Information is clear and
understandable
Costs are clear
Personal choice and right to
refuse respected
Informed and timely consent
Consider carers and supporters Planning and Governance
Partnership with consumers to
ensure sustainability
Consumers involved at all
levels of planning, system
design and service
development
Consumers involved in key
governance structures
Putting people in control of their own health and care
• Engaging people in keeping healthy
• Shared decision making
• Supported self management
• Having a personal health or social care budget
• Involving families and carers
• Choosing a provider
• Taking part in research as part of your care and treatment
• Evaluating services through feedback
Building a Better Primary Care System
Changing role of consumers
Makers and Shapers
NOT Users and Choosers
(Cornwall and Gaventa 2000)