10B: Primary Care
Tracks
Track 2
| Wednesday, November 13, 2019 |
| 9:00 AM - 10:30 AM |
| Room 109 - 110 |
Details
Chaired by Alison Verhoeven, CEO, Australian Healthcare and Hospitals Association (AHHA)
Speaker
Mr Clory Carrello
Chief Executive Officer
Cockburn Integrated Health
102 GP Super Clinics - The Cockburn Experience in the Development of an Integrated Service Model
Abstract
GP Super Clinics – The Cockburn Experience in the Development of an Integrated Service Model
Cockburn Integrated Health (CIH) was established in 2014 as part of the previous Commonwealth Labor Government’s GP Super Clinic Program and is one of 5 Super Clinics in Western Australia.
As with all the Super Clinics, CIH’s operations are guided by the Commonwealth Program objectives, with the aim being to establish integrated services which are responsive to community and consumer needs and maximise linkages with other health services both on site and within the region.
CIH was established in line with the vision created in the WA Health Department Health 2020: A Discussion Paper (1998) report, specifically relating to the development of service hubs in the community which provide a range of services and have linkages with other part of the Health System, thereby breaking down some of the silos that exist in the delivery of healthcare to the community.
The establishment of CIH is also in line with the strategies outlined in the Report of the Health Reform Committee, A Healthy Future for Western Australians (2004) which also outlined the need for community service hubs and the integration of services.
While there is a significant amount of literature on the efficacy of integrated service hubs, the experience in Western Australia is limited for a range of reasons, mostly around the cost and challenges that integration creates. CIH has now been operational for 5 years and we continue to remain ambitious in what we are trying to achieve for our community. CIH has over 20 co-located services ranging from general practice, allied health, family support, employment and financial counselling services. It has also established close linkages with the University sector through Curtin University, who provide a range of student led services for the local community.
CIH is also co-located as part of a larger integrated hub, the Cockburn Health and Community facility, which also includes NDIS, pharmacy, radiology, dental, specialist medical, Centrelink and library services. In total, there are over 30 complimentary services in the building, with the cost of service establishment exceeding $50m.
The service mix established at CIH and at the Cockburn Health and Community facility is unique and reflects local community needs. It includes Government, Not for Profit and Private Services which ensures that we can maximise access and linkages to low/no cost services for the financially disadvantaged in the community.
Co-location does not however necessarily mean that integration of services will occur. Our experience has been that although service providers have the right intent in terms of participating in the establishment of integrated service models, there are multiple barriers to this occurring that need to be addressed, ranging from financial, privacy, service quality and expertise, consumer choice, governance and coordination issues. While we have made progress to achieving our organisational objectives and have learnt a significant amount about the realities of integration in a practice, the challenge remains to ensure we maximise the potential of what we have established in Cockburn.
Cockburn Integrated Health (CIH) was established in 2014 as part of the previous Commonwealth Labor Government’s GP Super Clinic Program and is one of 5 Super Clinics in Western Australia.
As with all the Super Clinics, CIH’s operations are guided by the Commonwealth Program objectives, with the aim being to establish integrated services which are responsive to community and consumer needs and maximise linkages with other health services both on site and within the region.
CIH was established in line with the vision created in the WA Health Department Health 2020: A Discussion Paper (1998) report, specifically relating to the development of service hubs in the community which provide a range of services and have linkages with other part of the Health System, thereby breaking down some of the silos that exist in the delivery of healthcare to the community.
The establishment of CIH is also in line with the strategies outlined in the Report of the Health Reform Committee, A Healthy Future for Western Australians (2004) which also outlined the need for community service hubs and the integration of services.
While there is a significant amount of literature on the efficacy of integrated service hubs, the experience in Western Australia is limited for a range of reasons, mostly around the cost and challenges that integration creates. CIH has now been operational for 5 years and we continue to remain ambitious in what we are trying to achieve for our community. CIH has over 20 co-located services ranging from general practice, allied health, family support, employment and financial counselling services. It has also established close linkages with the University sector through Curtin University, who provide a range of student led services for the local community.
CIH is also co-located as part of a larger integrated hub, the Cockburn Health and Community facility, which also includes NDIS, pharmacy, radiology, dental, specialist medical, Centrelink and library services. In total, there are over 30 complimentary services in the building, with the cost of service establishment exceeding $50m.
The service mix established at CIH and at the Cockburn Health and Community facility is unique and reflects local community needs. It includes Government, Not for Profit and Private Services which ensures that we can maximise access and linkages to low/no cost services for the financially disadvantaged in the community.
Co-location does not however necessarily mean that integration of services will occur. Our experience has been that although service providers have the right intent in terms of participating in the establishment of integrated service models, there are multiple barriers to this occurring that need to be addressed, ranging from financial, privacy, service quality and expertise, consumer choice, governance and coordination issues. While we have made progress to achieving our organisational objectives and have learnt a significant amount about the realities of integration in a practice, the challenge remains to ensure we maximise the potential of what we have established in Cockburn.
Biography
Clory Carrello is Chief Executive of Cockburn Integrated Health and has over 30 years’ experience in the health care industry. He has undergraduate qualifications in Medical Laboratory Science and postgraduate qualifications in Business Administration. While he spent the first 12 years of his working life in various clinical roles, he subsequently moved into health administration and has worked across the continuum of care from primary prevention to end of life palliative care. In November 2011, he took up the position of Chief Executive Officer of Cockburn GP Super Clinic Ltd (trading as Cockburn Integrated Health), which was being developed as part of the establishment of the Cockburn Health and Community facility by the City of Cockburn, Western Australia.
Mrs Rebecca Tretheway
Senior Research and Evaluation Officer
The Science of Knowing Pty Ltd
78 Investigation of the impact of HealthPathways in reducing variations in care in general practice
Abstract
Introduction
Despite the availability of Australian clinical practice guidelines, evidence suggests there are substantial variations in care within primary care settings. Use of web-based guidelines and tools has the potential to assist healthcare providers in meeting clinical guidelines, thereby reducing unwarranted variations in care. HealthPathways is a web-based clinical guide to assist primary care clinicians with assessment, management, and localised referral pathways for various health conditions. HealthPathways has been implemented in many areas across Australia to facilitate the achievement of better integration of care for patients. This study aimed to evaluate the effectiveness of HealthPathways in assisting GPs to provide appropriate care for five paediatric conditions.
Theory/methods
A quasi-experimental design was used to test the hypothesis that HealthPathways improves the quality of patient care. GPs documented their assessment of hypothetical patient scenarios with or without the use of HealthPathways. A marking rubric was used to assess adherence to clinical indicators, and percent agreement and inter-rater reliability tests were calculated. Clinical indicators were aligned to those from the CareTrack Kids project.
Results
Overall, 50 GPs and GP registrars participated in the study. Across all conditions, the proportion of indicators met were higher for those who used HealthPathways compared to those participants who didn’t use HealthPathways, but only one of these differences was statistically significant (GOR, p=0.03). On average, participants met only 57% of all clinical indicators used in the study.
Discussion
This study showed that participants who used HealthPathways scored higher than participants who did not, across all five conditions. However, these differences were generally not statistically significant, especially once demographic differences were accounted for. Nonetheless, statistical significance may not reflect clinical significance. For instance, adherence to an additional one or two clinical indicators may make an important clinical difference to the quality of treatment and care provided by a healthcare professional. Poor adherence to clinical indicators has been demonstrated in other similar studies in Australia and overseas, highlighting that these results are widespread and unlikely to be unique to western Sydney.
Conclusions
The study demonstrated that HealthPathways may have some impact on GPs’ ability to provide quality care, through better adherence to clinical guidelines. The results also suggest there may be a need for additional assistance for primary care practitioners to ensure their care meets clinical guidelines and results in positive outcomes for patients.
Lessons learned
Considerable time was allocated to clinical reviews of the patient scenarios, development of the rubric, and pilot testing the study procedure. This contributed substantially to the overall robustness and quality of the study protocol, allowing for replication in other regions, with very minimal changes required.
Limitations
The laboratory setting did not allow GPs to interact with a patient by asking follow-up questions, or to utilise visual, behavioural, and verbal cues in assessing the patient. The use of convenience sampling and the relatively small sample size limits the generalisability of the findings.
Suggestions for future research
Further research in other geographic regions would be beneficial to determine the impact of HealthPathways on a broader scale.
Despite the availability of Australian clinical practice guidelines, evidence suggests there are substantial variations in care within primary care settings. Use of web-based guidelines and tools has the potential to assist healthcare providers in meeting clinical guidelines, thereby reducing unwarranted variations in care. HealthPathways is a web-based clinical guide to assist primary care clinicians with assessment, management, and localised referral pathways for various health conditions. HealthPathways has been implemented in many areas across Australia to facilitate the achievement of better integration of care for patients. This study aimed to evaluate the effectiveness of HealthPathways in assisting GPs to provide appropriate care for five paediatric conditions.
Theory/methods
A quasi-experimental design was used to test the hypothesis that HealthPathways improves the quality of patient care. GPs documented their assessment of hypothetical patient scenarios with or without the use of HealthPathways. A marking rubric was used to assess adherence to clinical indicators, and percent agreement and inter-rater reliability tests were calculated. Clinical indicators were aligned to those from the CareTrack Kids project.
Results
Overall, 50 GPs and GP registrars participated in the study. Across all conditions, the proportion of indicators met were higher for those who used HealthPathways compared to those participants who didn’t use HealthPathways, but only one of these differences was statistically significant (GOR, p=0.03). On average, participants met only 57% of all clinical indicators used in the study.
Discussion
This study showed that participants who used HealthPathways scored higher than participants who did not, across all five conditions. However, these differences were generally not statistically significant, especially once demographic differences were accounted for. Nonetheless, statistical significance may not reflect clinical significance. For instance, adherence to an additional one or two clinical indicators may make an important clinical difference to the quality of treatment and care provided by a healthcare professional. Poor adherence to clinical indicators has been demonstrated in other similar studies in Australia and overseas, highlighting that these results are widespread and unlikely to be unique to western Sydney.
Conclusions
The study demonstrated that HealthPathways may have some impact on GPs’ ability to provide quality care, through better adherence to clinical guidelines. The results also suggest there may be a need for additional assistance for primary care practitioners to ensure their care meets clinical guidelines and results in positive outcomes for patients.
Lessons learned
Considerable time was allocated to clinical reviews of the patient scenarios, development of the rubric, and pilot testing the study procedure. This contributed substantially to the overall robustness and quality of the study protocol, allowing for replication in other regions, with very minimal changes required.
Limitations
The laboratory setting did not allow GPs to interact with a patient by asking follow-up questions, or to utilise visual, behavioural, and verbal cues in assessing the patient. The use of convenience sampling and the relatively small sample size limits the generalisability of the findings.
Suggestions for future research
Further research in other geographic regions would be beneficial to determine the impact of HealthPathways on a broader scale.
Biography
Ms Penny Jones
Director Integration & Partnerships, Primary & Community Health
South Western Sydney LHD
20 The Oran Park Story: creating & evaluating an Integrated Primary Care Centre
Abstract
Introduction:
The suburb of Oran Park in south west Sydney is undergoing rapid housing development, population increase and demographic change which in turn, drives major changes in the area’s population characteristics, their health service needs, and provides an opportunity to strategically evaluate and address those needs.
Practice Change:
The establishment of the Oran Park Family Health (OPFH) Integrated Primary Care Centre (IPCC) seeks to provide multidisciplinary, evidence-based and patient centred healthcare at primary care level. It is a unique partnership between the Local Health District , Primary Health Network, University and private practice stakeholders.
Aim and theory of change:
The primary aim of OPFH is to provide relevant and effective primary and integrated care services to the locality as an alternative to and prevention of the use of hospital services. Its evaluation adopts an in-depth case study approach, collecting quantitative and qualitative data to determine whether the establishment of OPFH is associated with change in the use of hospital services and what may be the underlying causative factors.
Population and Stakeholders:
The service needs of the catchment will be driven by resident population growth with its associated socio-economic and epidemiological characteristics, and will be monitored via the evaluation arm of the project.
Timeline:
Started in 2017 – prospective long-term
Highlights:
The OPFH baseline evaluation has been completed:
• Semi-structured interviews – clients (Group 1) and stakeholders & clinicians (Group 2)
• Practice records – define patient population, service use patterns and health needs.
Group 1 Perspectives (n=20)
Age range of 24-70 years (median = 38). Patient awareness of service integration was low, although they reported that clinicians and support staff work well as a team. Key themes identified: 1) ability of OPFH to meet patient demand; 2) need for additional services; and 3) desire for continuity of care with their preferred GP.
Group 2 Perspectives (n=13)
The group’s shortlist of priority service needs at OPFH has some overlap with patients’ service requests such as imaging, paediatrics/child health, physiotherapy, and mental health.
Sustainability:
Outcomes from the evaluation are fed-back to the OPFH and IPCC governance to address any program development changes so as to tailor the delivery of services to the population needs.
Transferability:
The learning of this initiative can be easily transfer to other Local Health District.
Discussion:
This initial stage of evaluation indicates that while patients are not highly aware of the integrated model that underpins delivery of care at OPFH, they see the need for a greater volume and variety of services at the centre to serve the rapidly growing, predominantly young population. Stakeholder feedback also highlighted the need for a variety of services at OPFH, although the specific services prioritised by each group differed substantially.
Lessons:
In future stages interview data will be obtained from external providers referring clients to OPFH (Group 3) and practice data linkage with Hospital/District records will allow patients’ use of primary care and hospital services.
The suburb of Oran Park in south west Sydney is undergoing rapid housing development, population increase and demographic change which in turn, drives major changes in the area’s population characteristics, their health service needs, and provides an opportunity to strategically evaluate and address those needs.
Practice Change:
The establishment of the Oran Park Family Health (OPFH) Integrated Primary Care Centre (IPCC) seeks to provide multidisciplinary, evidence-based and patient centred healthcare at primary care level. It is a unique partnership between the Local Health District , Primary Health Network, University and private practice stakeholders.
Aim and theory of change:
The primary aim of OPFH is to provide relevant and effective primary and integrated care services to the locality as an alternative to and prevention of the use of hospital services. Its evaluation adopts an in-depth case study approach, collecting quantitative and qualitative data to determine whether the establishment of OPFH is associated with change in the use of hospital services and what may be the underlying causative factors.
Population and Stakeholders:
The service needs of the catchment will be driven by resident population growth with its associated socio-economic and epidemiological characteristics, and will be monitored via the evaluation arm of the project.
Timeline:
Started in 2017 – prospective long-term
Highlights:
The OPFH baseline evaluation has been completed:
• Semi-structured interviews – clients (Group 1) and stakeholders & clinicians (Group 2)
• Practice records – define patient population, service use patterns and health needs.
Group 1 Perspectives (n=20)
Age range of 24-70 years (median = 38). Patient awareness of service integration was low, although they reported that clinicians and support staff work well as a team. Key themes identified: 1) ability of OPFH to meet patient demand; 2) need for additional services; and 3) desire for continuity of care with their preferred GP.
Group 2 Perspectives (n=13)
The group’s shortlist of priority service needs at OPFH has some overlap with patients’ service requests such as imaging, paediatrics/child health, physiotherapy, and mental health.
Sustainability:
Outcomes from the evaluation are fed-back to the OPFH and IPCC governance to address any program development changes so as to tailor the delivery of services to the population needs.
Transferability:
The learning of this initiative can be easily transfer to other Local Health District.
Discussion:
This initial stage of evaluation indicates that while patients are not highly aware of the integrated model that underpins delivery of care at OPFH, they see the need for a greater volume and variety of services at the centre to serve the rapidly growing, predominantly young population. Stakeholder feedback also highlighted the need for a variety of services at OPFH, although the specific services prioritised by each group differed substantially.
Lessons:
In future stages interview data will be obtained from external providers referring clients to OPFH (Group 3) and practice data linkage with Hospital/District records will allow patients’ use of primary care and hospital services.
Biography
Penelope (Penny) Jones
MHM, MPH, MN-NP MH, GC C&A MHN, BN, RN
Director of Integration and Partnerships
Primary and Community Health South West Sydney Local Health District
Penny is a registered nurse of over 25 years with expert knowledge of the public, private and NGO sectors, with a particular interest in the mental health and wellbeing of children and youth. Her clinical, managerial and strategic knowledge and application in health has been enhanced with significant self-directed post graduate study. Penny is known to challenge the status quo and help find efficiencies on practice development and work to build the strengths in the people that surround her. She has a keen interest in research and evaluation, health planning and developing and testing new models of care. In her current role she is working to further integrate the primary and acute sectors of health, both personally and through the use of technology.
Hanne Birke
Project Leader
Center for Clinical Research and Prevention
135 A multimorbidity care model in primary care: a feasibility study
Abstract
Introduction
The prevalence of multimorbidity is high in Denmark. Care provision in multimorbid patients is often fragmented, the quality of care is considered unsatisfactory, and patients experience a high disease and treatment burden. Organizational models for providing integrated care in multimorbidity exist, but with limited evidence of the effectiveness of specific interventions. The objective of this study was to assess the feasibility of an organizational model before evaluation in a cluster RCT-design.
Methods
The basic elements of the model are: prolonged consultations in general practice (a care manager; improved inter-sectorial communication through care plans; increased rates of referrals to rehabilitation in the community; medication review; and transfer of outpatient clinic controls to general practice. The model was implemented in a large general practice clinic in Copenhagen. Patients completed the ’The Patient Assessment of Chronic Illness Care (PACIC) and EuroQol 5-Dimension Questionnaire (EDQ5) questionnaires. Further, observation of consultations and focus group interviews with patients and professionals were performed to obtain information on important subjects such as patient-centeredness, level of integration of care, information flow, and medication satisfaction and safety.
Results
Forty-eight patients with at least two of three selected chronic conditions (diabetes, heart disease, and COPD) were included. The mean age of the included patients was 72 years (48% men). At baseline, the mean total PACIC score was 2.7, with the highest subscale scoring for problem solving (3.3) and the lowest for coordination/follow-up (2.1). The EQ-5D-3L TTO index score and the EQ-5D-3L health status scale were 0.6 and 5.9, respectively.
From focus groups with patients, we identified a lack of treatment coordination; that prolonged consultations provided better coordination; and that patients wanted to be involved in treatment planning. Consultation observations and focus group interviews with health professionals pointed out communication barriers between general practice and outpatient clinics; emphasized the importance of patient-centered approaches to comprehend patients’ daily life problems; and elucidated prolonged consultations necessary for provision of high-quality care. Also, using the questionnaires in the consultation helped the GP to structure the dialog and improved the patient’s awareness and motivation for lifestyle changes.
Discussion/Limitations
Our study reveals that organizational innovations in general practice, such as prolonged consultations, patient involvement in decision making, and using a care manager to help with the planning of an individualized care plan seem to improve the multimorbid patient’s satisfaction with their treatment and care plan. Because of our small sample, the strength of our statistics is weak. As general practices in Denmark are heterogeneous, precautions should be taken regarding generalization of the conclusions.
Conclusions/Lessons learned
The multimorbidity care model showed promising results. However, the model should undergo a focused revision before a larger RCT study. The development of feasible organizational innovations in existing health and social care systems is a task that requires improved collaboration and patient information-sharing between sectors in the healthcare system.
Suggestions for future research
RCTs investigating organizational collaboration between the healthcare sectors and patient involvement in order to improve the quality and the continuity of the treatment and care for multimorbid patients.
The prevalence of multimorbidity is high in Denmark. Care provision in multimorbid patients is often fragmented, the quality of care is considered unsatisfactory, and patients experience a high disease and treatment burden. Organizational models for providing integrated care in multimorbidity exist, but with limited evidence of the effectiveness of specific interventions. The objective of this study was to assess the feasibility of an organizational model before evaluation in a cluster RCT-design.
Methods
The basic elements of the model are: prolonged consultations in general practice (a care manager; improved inter-sectorial communication through care plans; increased rates of referrals to rehabilitation in the community; medication review; and transfer of outpatient clinic controls to general practice. The model was implemented in a large general practice clinic in Copenhagen. Patients completed the ’The Patient Assessment of Chronic Illness Care (PACIC) and EuroQol 5-Dimension Questionnaire (EDQ5) questionnaires. Further, observation of consultations and focus group interviews with patients and professionals were performed to obtain information on important subjects such as patient-centeredness, level of integration of care, information flow, and medication satisfaction and safety.
Results
Forty-eight patients with at least two of three selected chronic conditions (diabetes, heart disease, and COPD) were included. The mean age of the included patients was 72 years (48% men). At baseline, the mean total PACIC score was 2.7, with the highest subscale scoring for problem solving (3.3) and the lowest for coordination/follow-up (2.1). The EQ-5D-3L TTO index score and the EQ-5D-3L health status scale were 0.6 and 5.9, respectively.
From focus groups with patients, we identified a lack of treatment coordination; that prolonged consultations provided better coordination; and that patients wanted to be involved in treatment planning. Consultation observations and focus group interviews with health professionals pointed out communication barriers between general practice and outpatient clinics; emphasized the importance of patient-centered approaches to comprehend patients’ daily life problems; and elucidated prolonged consultations necessary for provision of high-quality care. Also, using the questionnaires in the consultation helped the GP to structure the dialog and improved the patient’s awareness and motivation for lifestyle changes.
Discussion/Limitations
Our study reveals that organizational innovations in general practice, such as prolonged consultations, patient involvement in decision making, and using a care manager to help with the planning of an individualized care plan seem to improve the multimorbid patient’s satisfaction with their treatment and care plan. Because of our small sample, the strength of our statistics is weak. As general practices in Denmark are heterogeneous, precautions should be taken regarding generalization of the conclusions.
Conclusions/Lessons learned
The multimorbidity care model showed promising results. However, the model should undergo a focused revision before a larger RCT study. The development of feasible organizational innovations in existing health and social care systems is a task that requires improved collaboration and patient information-sharing between sectors in the healthcare system.
Suggestions for future research
RCTs investigating organizational collaboration between the healthcare sectors and patient involvement in order to improve the quality and the continuity of the treatment and care for multimorbid patients.
Biography
Hanne Birke’s research field is in the organization of better treatment and collaboration in the Danish health care system for patients suffering from multimorbidity. She is the project leader on a pilot project testing a model of multimorbidity in the Danish primary healthcare system, using mixed methods. She has previously done research in the use of opioids for chronic pain in Denmark and in Norway and got a Ph.D. degree in January 2019. She has several years of experiences in doing epidemiological studies using register-based data.
Dr. Nelly Oelke
Associate Professor
University of British Columbia
160 Facilitating integrated care through primary healthcare teams: A policy analysis of four Canadian provinces
Abstract
Background: Improving health services integration for patients with complex needs is a challenge given the rising complexity of patients and the services they require. Team-based primary healthcare (PHC) models have been developed to address the needs of this population. These models have been implemented in diverse ways across Canada in an effort to improve patient experience and better coordinate care to improve population health and reduce costs. Mixed evidence exists on the impact of PHC teams on outcomes, including integrated services delivery. Policy-makers have little evidence on what policies and structures facilitate, incentivize, or promote integrated service delivery, especially for patients with complex needs.
Theory/Methods: A comparative policy analysis was conducted to examine the policies and structures that support health and social services integration for complex patients through PHC teams in British Columbia, Alberta, Ontario, and Quebec, Canada. We also explored patient engagement in policy development and implementation related to PHC teams and integration.
The Patient Medical Home goals, (1) the 10 key principles of integration, (2) and the policy triangle framework (3) guided data collection and analysis. Case study methodology was used for the study. We compiled provincial and regional level policies on PHC teams and integrated service delivery. Individual provincial case studies were completed followed by a cross-case analysis.
Results: This study is currently in process. We will share key themes from each of the case studies and compare themes across cases. Results will include an in-depth analysis of current policies for PHC teams and how these policies support or do not support integrated health services delivery. Indicators and outcomes for PHC teams and integration will also be reported. The involvement of patients/caregivers in policy development, implementation and evaluation will be included.
Discussion: PHC teams are essential for improving outcomes for complex patients. Policies provide the framework for action in how teams are implemented and their contribution to integration. Unintended consequences may also arise and are important to recognize.
Conclusions: This research is timely, given the changes implemented in PHC care within Canada and internationally. The results provide a foundation for policy change in participating provinces with relevance nationally and internationally.
Lessons learned: 1) A good understanding of current policies will provide a foundation for improving these policies and practice; 2) Identified outcome indicators for integration will assist in measuring impact for patients, providers, and the health system; 3) An understanding of patient engagement in policy-making and implementation will facilitate the engagement of patients/caregivers; and 4) Identification of unintended consequences will enable policy-makers to address these issues in current and new policies.
Limitations: All relevant policy documents may not be readily available for analysis. The complexity of the project may impact the depth of analysis. Finally, government changes can result in significant changes in policy; this analysis focuses on a snapshot in time. Despite limitations, important information for policy and decision-makers to improve integration through PHC teams will be provided.
Suggestions for future research: Recommendations for future research in the areas of policy and practice will be presented.
Theory/Methods: A comparative policy analysis was conducted to examine the policies and structures that support health and social services integration for complex patients through PHC teams in British Columbia, Alberta, Ontario, and Quebec, Canada. We also explored patient engagement in policy development and implementation related to PHC teams and integration.
The Patient Medical Home goals, (1) the 10 key principles of integration, (2) and the policy triangle framework (3) guided data collection and analysis. Case study methodology was used for the study. We compiled provincial and regional level policies on PHC teams and integrated service delivery. Individual provincial case studies were completed followed by a cross-case analysis.
Results: This study is currently in process. We will share key themes from each of the case studies and compare themes across cases. Results will include an in-depth analysis of current policies for PHC teams and how these policies support or do not support integrated health services delivery. Indicators and outcomes for PHC teams and integration will also be reported. The involvement of patients/caregivers in policy development, implementation and evaluation will be included.
Discussion: PHC teams are essential for improving outcomes for complex patients. Policies provide the framework for action in how teams are implemented and their contribution to integration. Unintended consequences may also arise and are important to recognize.
Conclusions: This research is timely, given the changes implemented in PHC care within Canada and internationally. The results provide a foundation for policy change in participating provinces with relevance nationally and internationally.
Lessons learned: 1) A good understanding of current policies will provide a foundation for improving these policies and practice; 2) Identified outcome indicators for integration will assist in measuring impact for patients, providers, and the health system; 3) An understanding of patient engagement in policy-making and implementation will facilitate the engagement of patients/caregivers; and 4) Identification of unintended consequences will enable policy-makers to address these issues in current and new policies.
Limitations: All relevant policy documents may not be readily available for analysis. The complexity of the project may impact the depth of analysis. Finally, government changes can result in significant changes in policy; this analysis focuses on a snapshot in time. Despite limitations, important information for policy and decision-makers to improve integration through PHC teams will be provided.
Suggestions for future research: Recommendations for future research in the areas of policy and practice will be presented.
Biography
Dr. Nelly Oelke is an Associate Professor with the School of Nursing, University of British Columbia, Okanagan. She is a registered nurse and graduated with her PhD in Interdisciplinary Studies from the University of Calgary. Dr. Oelke is a health services researcher with expertise in integrated health systems, primary health care, patient engagement, mental health, Indigenous health, and health policy. Her research skills include qualitative methodology, mixed methods, case study methodology, knowledge translation, and deliberative dialogue.
Dr. Oelke has been working at the University of British Columbia, Okanagan Campus since 2011. Prior to coming to UBC, she worked for 10 years in an applied research unit with Alberta Health Services working in the Health Systems and Workforce Research Unit. Prior to that time, she worked in prevention and promotion for the Alberta Cancer Board, focusing on breast and cervical cancer screening and reaching vulnerable populations. Dr. Oelke has also worked in public health, pediatrics, medicine and nursing education.
Currently, Dr. Oelke has several funded projects including a comparative policy analysis on primary health care teams that support integration and a knowledge translation methods project focusing on consensus building through integrated knowledge translation. She also has several studies that focus on integrated services and supports for individuals with mental health concerns in rural communities. She also is involved in research on care transitions as a key component of integrated health systems. Furthermore, she has completed a knowledge synthesis on measuring integration in health systems. Finally, Dr. Oelke also has a partnership with researchers in Brazil focusing on integration and care transitions.
Dr Yik Voon Lee
Lee and Tan Family Clinic & Surgery
87 An Innovative Collaborative Platform to Augment the Care Delivery Model in Primary Practice to enable Improved Clinical Outcomes Among Patients with Chronic Disease.
Abstract
Chronic diseases such as hypertension, diabetes mellitus and hypercholesterolaemia have been the dominant area of practice in primary care in Singapore. The Ministry of Health in Singapore has developed several clinical practice guidelines to aid the medical practitioners in providing the best possible evidence-based care to this group of patients. However, the majority of this is based on episodic model of care with vital parameters being taken only during the particular visit to the doctor. This care model may be the most convenient in the past and is not reflective of the patient’s current condition in their daily life.
There needs to be a shift from the current episodic care model to a more longitudinal type of care to better assess the patient’s daily well-being outside of the doctor’s consult room. With the advent of faster, cheaper and more accurate medical devices and data processing algorithms, our company aims to revise and improve the current model of care of patients with chronic disease or those at risk of chronic disease from an episodic to a near longitudinal care model.
Through intensive scoping of the needs of the primary care physicians, specialists and patients, we have developed a collaborative mobile platform for continuous monitoring of medical parameters which can be shared with their respective primary care physicians outside of the clinic consult. We will be presenting the collaborative results with one of our partner clinics in Singapore. To the best of our knowledge, this is the first time such a collaborative platform has been deployed in Singapore.
Hypertension was the first chronic disease selected for this study, for ease of monitoring and faster enrolment. Suitable patients were identified by the physician and were subsequently contacted for the enrolment. Patients were informed of the purpose of the programme and assured that data shared would be secured and stored based on the HIPAA guidelines. Patients were asked to monitor their blood pressure with a Bluetooth-enabled monitoring device which syncs with our cloud platform that would be shared on the physician mobile application. Alerts would be sent based on pre-determined thresholds.
During the monitoring period of 30 patients, there were a couple of situations where the physicians were able to detect and act upon abnormal blood pressure readings which would have otherwise gone undetected until the next visit and prevent potentially adverse outcomes. Through the availability of our specialist medical board, our primary care physician was able to perform an ad hoc consultation for one patient to improve better blood pressure control.
We have expanded to monitoring of diabetic patients and believe that through this collaborative and longitudinal care model, patient care will be improved, leading to better clinical outcomes.
There needs to be a shift from the current episodic care model to a more longitudinal type of care to better assess the patient’s daily well-being outside of the doctor’s consult room. With the advent of faster, cheaper and more accurate medical devices and data processing algorithms, our company aims to revise and improve the current model of care of patients with chronic disease or those at risk of chronic disease from an episodic to a near longitudinal care model.
Through intensive scoping of the needs of the primary care physicians, specialists and patients, we have developed a collaborative mobile platform for continuous monitoring of medical parameters which can be shared with their respective primary care physicians outside of the clinic consult. We will be presenting the collaborative results with one of our partner clinics in Singapore. To the best of our knowledge, this is the first time such a collaborative platform has been deployed in Singapore.
Hypertension was the first chronic disease selected for this study, for ease of monitoring and faster enrolment. Suitable patients were identified by the physician and were subsequently contacted for the enrolment. Patients were informed of the purpose of the programme and assured that data shared would be secured and stored based on the HIPAA guidelines. Patients were asked to monitor their blood pressure with a Bluetooth-enabled monitoring device which syncs with our cloud platform that would be shared on the physician mobile application. Alerts would be sent based on pre-determined thresholds.
During the monitoring period of 30 patients, there were a couple of situations where the physicians were able to detect and act upon abnormal blood pressure readings which would have otherwise gone undetected until the next visit and prevent potentially adverse outcomes. Through the availability of our specialist medical board, our primary care physician was able to perform an ad hoc consultation for one patient to improve better blood pressure control.
We have expanded to monitoring of diabetic patients and believe that through this collaborative and longitudinal care model, patient care will be improved, leading to better clinical outcomes.
Biography
Dr. Lee Yik Voon is a Singapore-based general practitioner with over 30 years of experience in looking after patients within the primary care setting. He is involved in a number of initiatives by the Ministry of Health in Singapore set to improve the delivery of care in the outpatient setting, including the primary care masterplan and the national general practitioner’s advisory panel. Dr Lee is also the current president of the Singapore Medical Association, a national medical organisation representing the majority of medical practitioners in both the public and private sectors with over 8200 registered doctors in the association.
Dr. Lee also has a keen interest in the use of innovative technology to improve the provision of healthcare to his patients. He has been serving as a member of the MOHH IT steering committee member, such as the National Electronic Health Record (NEHR) and Clinic Electronic Medical Record and Operations (CLEO) since 2011 to provide on advise of the clinical impact of implementing these national initiatives by the Ministry of Health in Singapore.
