Patient Centred Care Insights from 5 Countries Tracey Johnson CEO, Inala Primary Care Brisbane, Australia
On an average day in Australia 342,000 people visit a GP 742,000 medicines are dispensed in community pharmacies 6,800 people are transported by ambulance (+900 treated) 71,000km are flown by the RFDS and 107 evacuations performed 23,000 people are admitted to hospital (5,000 for elective surgery) 820 babies are born (inc 260 by caesarean section) 17,000 people visit an ED at the larger public hospitals 400 treatment episodes with ATODS 1 million Medicare claims are made (1 in 4 tax dollars = health) In a system ranked 4 th in the World (Commonwealth Fund 2015)
Crossing the GP divide Those 342,000 GP consults are delivered: By 7000 practices (& falling) Using just 6% of government health expenditure (8% overall) Through 32,000 GPs (23,000 work full-time, 46% >55yrs) With 83.6% of care bulk billed (30.5% of patient visits > 65) Costing government an average of $299 per person in 2013/14 21% of GPs report their job is very or extremely stressful 64.2% of patients receive an urgent appointment within 4 hours
Sites of Interest New Zealand Canada America United Kingdom Hong Kong
Primary Care First Centre of gravity moving to primary care More patient perspectives and inclusions acknowledging that what GPs set up as care expectations or patient planning has implications for hospital delivery More responsibility being given to GPs to coordinate care & specialise
Right Care, Right Time, Right Place Incentives for GPs, hospitals & other players to work together Ratings on whole system performance not just hospitals Funding shifts behaviour from volume to value Overall, less focus on seeing patients, more on supporting patients
Who Cares? Moving from caring for to caring with patients and their families Principles: Dignity & Respect Information Sharing Partnership & Participation Collaboration
New Players = Outcomes Health Coaches & Community Health Workers Care Coordinators (often nurses) Nurses Managing Patients Non-Dispensing Pharmacists Social Workers & Psychologists Volunteers Social Care Sector bigger teams, revised clinical protocols, leadership demands, new types of infrastructure
Patient Centred Care Person Centred Persons inc Family Central & Engaged Medical Home as Support Partner Wellness & Prevention Focus Care Coordination In & With the Community
Healthcare Home
Health Neighbourhood
Governance in Canada New Accreditation Standards Patients & Carers on Practice Advisory Committees Patients on Planning Committees Patients on Accreditation Audit Teams Patients part of Adverse Event Committees Board meetings beginning with patient correspondence
Patient Involvement Co-Design Co-Delivery Integrated Health and Social Care Budgets
Sharing Care Re-enablement programs self care Shared decision making tools + staffing + timeframes Self-management tools shared care Need large changes to funding & incentives! Canadian Public Health Approach: What are my options? What are the risks? When do I need to make this decision? Where else can I get information?
New Data Patient Satisfaction Data Patients Reviewing Dashboards Patient Access to their Health Information Patient experience as well as clinical efficiency and outcomes as important criteria for measuring health system delivery
Waiting Do we need f2f? Who do we need?
Matching Support to Needs 5% of Australians create 28% of costs! 1 in 8 Australians sees a GP at least 12 times a year and see on average 5 or more GPs = 41% of non-hospital Medicare costs
A Day in the Life Patient phones call centre Daily huddle in GP practice Doctor triage 30% no visit req d Visit When? Who with? Nurses 75% patient contact Doctors 2/3 patients then non-contact Recalls & reminders in PM
New Design at Kirkland No waiting rooms, no treatment rooms, no stock rooms
New Age of Care Environment Mind Body
Nursing Levels NP Clinical Nurse Training & Responsibility Advanced Practice Nurse Registered Nurse Enrolled Nurse Medical Assistant/Assistant Nurse Community Health Worker, Link Workers, Volunteers
Complex Care Services Small panels of patients Doctor, Nurse Practitioners & other carers Strong behavioural & addictions support Regular access to multi-disciplinary team review Stratification of 4-5% or 20% of top 4%...? Predictive risk care interventions & frailty guidelines Shared patient records Reinvestment of savings from falling hospital admissions
Behavioural Drivers In-house Psychology, Mental Health Nurses & Visiting Psychiatry Social Workers, Link Workers/Community Health Workers Specialty Streaming for those with Behavioural Deficits Youth/Young Adult Engagement Programs Re-attachment Programs
Personal Care Health Coaches? Coffee machines? Cooking, Dancing, Pilates & Art Class
Technology Patient Portals Email & Phone consults (Skype?) Apps Big screens
The future is already here it is just not equally distributed yet! Blog: www.inalaprimarycare/news/churchill2015 @Januarygirlie Tracey Johnson Report: https://www.churchilltrust.com.au/media/fellows/johnson_t_2014_bringing_ care_out_of_hospitals_and_into_the_community.pdf