Initiatives to integrate primary health care services

1. 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

2. 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

3. Understanding integrated care

4. Levels of integration YOU ARE HERE

5. 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

6. 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

7. Methods Literature review Electronic databases, websites, grey literature (documents and reports) Search Terms Integration, integrated care (synonyms) Relevant articles Peer-reviewed and grey literature

8. Australian models of integrated care • Medicare Locals (61) • GP Super Clinics (60) • Primary Care Partnerships • Integrated Primary Health Care Services • Comprehensive Primary Health Care

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Summary & conclusions Change processes Communicate Collaborate Commit Understand local needs Share information Evaluate

17. 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